Benefits of Chronic Care Management for Providers and Patients 

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Benefits of Chronic Care Management for Providers and Patients 
by Lucy Lamboley

There are numerous benefits of chronic care management (CCM) that help patients, providers, and payers alike. Since chronic disease is a runaway freight train here in the United States the chronic care management model is functioning somewhat as a proverbial emergency break, slowing down the speed in which chronic disease is impacting our economy and our patients' health and longevity.

Noteworthy Benefits Of Chronic Care Management

The following are seven of the most noteworthy chronic care management benefits.

1. Chronic care management improves access to care and can increase satisfaction rates.

Simply put, accessing quality healthcare isn't an easy task for most patients. Between the shortages in primary care providers, lack of practitioners willing to work in rural healthcare settings, restrictive practice hours, transportation barriers, and limited rates of health literacy, receiving regular, routine healthcare can often be an uphill battle at best.

Patients who participate in a chronic care management model will find they receive the individualized support they need to better navigate their chronic diseases and the world of healthcare in general. CCM connects patients swiftly and directly with the care they need from specialists and other outside resources, making them both healthier and more satisfied with their care overall.

Chronic care management providers who effectively and sometimes creatively coordinate care and eliminate patient access barriers will find their patients are happier with the care they receive, are more engaged, and are loyal to the providing organization and their provider.

2. Chronic care management leverages technology that can make care more effective and efficient.

Since the chronic care management model allows for non-face-to-face patient care activities, these virtual services are convenient for patients and providers. Technology-based tools, like cellular phones, secure email, web portals, and electronic health records (EHRs), make connecting patient and provider simple no matter where or when that connection must occur.

Furthermore, the use of EHRs can make access to medical records for patients and outside providers immensely more practical and efficient. Easy-to-read, easy-to-access, and often downloadable, EHRs can offer chronic care management patients' greater control and add a level of personal responsibility, thus allowing them to better follow their individualized care instructions.

From a provider perspective, the right chronic care management technology can help CCM activities to run smoother, be more effective, and better ensure providers identify all eligible patients and get paid for CCM services. Historically, the only options for getting patient information to the entities that needed it were slow, unreliable, and even expensive. Mailing patient records took time and money, and before electronic health records, it was a toss-up whether handwritten records would be understood. Email, secure portals, cellular technology, connected healthcare devices, EHRs, and CCM-specific software all make the job of coordinating patient care easier, faster, affordable, and more effective and efficient for all.

3. Chronic care management can be a key component of value-based care and risk sharing.

As you will see, many of the benefits of chronic care management discussed here support the idea of CCM as a value-based and risk-sharing program. Through chronic care management, patients receive ongoing services and support that helps improve chronic disease management and address potential concerns quicker. For most patients, CCM reduces their overall usage of healthcare services; better ensures the healthcare services they need are timely, appropriate, and not duplicated; and decreases the need for emergent and urgent care. This all lowers the costs of chronic disease management.

How much? The Medical Group Management Association notes that one report from the Center for Medicare & Medicaid Innovation indicated that a CCM program reduced costs by $74 per beneficiary per month over an 18-month period studied; patients in the program had lower hospital, emergency department, and nursing home costs; and chronic care management was also linked with a reduced likelihood of hospital admission for those with a variety of conditions, including diabetes, COPD, and congestive heart failure.

Such impressive clinical and financial outcomes make it clear that organizations pursuing value-based care and financial risk-sharing opportunities would be wise to make chronic care management a crucial, if not the central, component of their care management programs.

4. Chronic care management is cost-effective for patients and generates new, recurring revenue for providers.

While patients can expect some out-of-pocket costs, the patient benefits of chronic care management far outweigh those costs and should help patients keep more of their money over time. When it comes to chronic disease management, making an investment in one's health pays dividends both in dollars and wellness.

Patients who participate in chronic care management have better control over their chronic disease with fewer exacerbations. Patients receiving CCM services tend to have fewer missed days of work or activities, pay less in copays by reducing their number of office visits, are more likely to avoid the emergency room, and reduce the likelihood that they will need hospitalizations. CCM patients also receive the wraparound support from a team of healthcare professionals that help them better navigate common barriers to effective chronic disease management, like finding cost-effective medication solutions and adhering to complex treatment instructions.

Chronic care management providers can also expect to see a boost in their revenue. Depending on the number of patients participating in a CCM program, this boost in revenue can add significantly to the bottom line. Chronic care management services provided to just 150 Medicare beneficiaries can generate up to an additional $7,650 each month.

The value of providing chronic care management services to patients and providers will increase further when those services are part of a broader comprehensive care management program that also includes remote patient monitoring (RPM), behavioral health integration (BHI), and other care management services.

5. Chronic care management provides patients with personalized attention, individualized support, and opportunities for better patient engagement.

Patients who participate in chronic care management will gain direct access to their CCM and primary care team, which will contribute to improved continuity of care, better care coordination, and ultimately peace of mind. Patients have reported that they are happy with the added support and direct care team access provided by CCM participation as this helps them become more successful in their healthcare journey overall.

Consider that one of the most challenging aspects of healthcare for many patients is gaining access to the medications they need to help manage their chronic conditions. Depending on their financial situation, treatment requiring medications can leave patients choosing between their meds or groceries.

As noted, one key patient benefit of chronic care management is increased care coordination. Care coordination means the patient has someone skilled in healthcare to help them gain access to and navigate the care and services they need, even medications. In the chronic care management model, this may look like a provider helping a patient find ways around the medication adherence barriers encounter, with solutions including setting up a mail order pharmacy, helping patients find lower cost medications, or even helping patients connect with other services like food stamps so they no longer must choose between medications or groceries.

Patients who participate in chronic care management are assigned a care team and have direct support from that care team to help keep them on track between visits with their provider. Frequent check-ins, individualized support and care plans, and referrals to community resources all help to keep patients engaged and on track to better chronic disease symptom control.

6. Chronic care management provides easier care transitions for patients and happier, more productive staff.

One big benefit of chronic care management for patients is the way the chronic care management model provides for easy care transitions to outside providers and community resources. CCM allows the care team to better ensure the patient is being connected with appropriate specialists and community resources, managing their medications effectively and appropriately, and receiving screenings on time.

CCM care team members are like puppeteers — not always seen but always working their magic behind the scenes. In the case of CCM, that means helping ensure patients are well connected and cared for. Patients can rest easy knowing that their health information is being utilized on the back end to better ensure they receive the support they need to hopefully achieve healthy outcomes.

For organizations providing chronic care management services, CCM benefits from the development of a program structure, standardized workflows, and detailed protocols. At first, these elements may seem bothersome and cumbersome to staff, but the process elevates workloads across the entire team. This structured distribution of workloads and standardized workflows help staff feel more in control of their duties and keeps them productive, which can help lead to happier providers and staff overall.

Even better, providers can share some of the care load, like coordinating care transitions, with their qualified care team members, thus allowing providers to put time back into their day for other patient care activities and administrative responsibilities without compromising organization revenue.

7. Chronic care management helps patients achieve health goals, and providers are rewarded with improved patient engagement and compliance.

Patients with two or more chronic diseases who receive chronic care management services are generally more successful at decreasing the bothersome symptoms of their chronic disease, more likely to achieve health goals and stay on a path to better wellness, and often see more years of productive life.

One reason the chronic care management model helps patients achieve these positive outcomes is simply because patients feel heard, understood, and better connected to their healthcare team. CCM patients become part of a team focused directly on their own health and specific chronic diseases. Patients are provided with chronic disease education that they can understand and direct support in navigating everything they need for success. Since the focus is so direct, CCM patients are typically more engaged in their care and compliant with care plan recommendations.

Chronic care management providers have the perfect opportunity to boost their revenue simply because CCM generates more reimbursements by engaging patients in a regular and meaningful way. The chronic care management model promotes better health outcomes and helps ensure patients are receiving recommended screenings, tests, and even vaccines on time. And because CCM patients are better engaged, they are more likely to be compliant with health recommendations, which ultimately will boost quality measure scores overall, potentially leading to higher future reimbursements.

Chronic Care Management Model: A Win for All

The benefits of chronic care management for both providers and patients continue to draw the attention and support from the healthcare industry, including Medicare. We've known for a long time that care management services are highly effective, but when focused on fighting against chronic disease, care management services can take on a much greater value and importance. From providing better, more engaging access to quality healthcare to boosting revenue, the chronic care management model is proving its overall effectiveness and importance for all stakeholders.

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