Chronic Care Management Patient Costs: Justifying Their Investment

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Chronic Care Management Patient Costs: Justifying Their Investment
by Lucy Lamboley

Lately, some areas of healthcare seem to be evolving at lightning speed, with the COVID-19 pandemic accelerating progress with relative ease. Adopted just a few years prior to the pandemic's onset, chronic care management (CCM) has now been solidified as a service and emerging care model — one that is bridging distance gaps and helping chronic disease patients reach and sustain better health for longer.

Yet adoption has been slower than one might expect for a service with so many patient care benefits. Is the near-sighted perceived cost of this multifaceted solution deterring patients from taking advantage of it? Before we answer this question, and provide some reasons why patients and practitioners should embrace chronic care management, let's gain a better understanding of CCM.

Chronic Care Management: A Brief Overview

Chronic care management was adopted by the Centers for Medicare & Medicaid Services (CMS) in 2015. CMS quickly realized the real potential and value of CCM and has since thrown its full weight behind it, making the service a permanent offering and expanding on early guidelines to incorporate and qualify more eligible Medicare beneficiaries for the service.

To qualify for chronic care management participation, patients must be diagnosed with two or more covered chronic health conditions which are expected to last for at least 12 months or until the death of the patient. With a high prevalence of chronic disease among older patients, there is no shortage of CCM-eligible patients over the short and long term.

In a nutshell, chronic care management is an easier way to provide qualifying patients with wraparound care that helps to effectively manage their chronic diseases. But CCM is not only good for patients. It can also help practitioners achieve higher quality and patient satisfaction ratings while generating an additional, consistent practice revenue stream — one that received a sizable boost in the 2022 Physician Fee Schedule final rule.

Aside from the revenue, the chronic care management service can also improve patient engagement and practice efficiency, allowing practitioners and their teams to provide quality care more effectively for more patients while still ensuring they have time for all other competing demands and responsibilities.

Chronic Care Management: Patient Cost vs. Value

While chronic care management is revealing its overall cost-effectiveness as a service, practitioners may find it difficult to help their patients understand this fact and get patients to consent to joining a CCM program. For Medicare beneficiaries, CCM is covered under Medicare Part B and is subject to the beneficiary’s annual deductible ($233 in 2022) and the 20% coinsurance. Participation in CCM will typically cost patients between $7 to $10 each month depending on geographic region once their deductible is met for the year. Note: Many secondary insurances currently cover this cost. For example, patients who are dual enrolled in Medicare/Medicaid or patients with Medicare supplemental plans may not receive a bill for these additional services.

While any out-of-pocket expense might initially act as a deterrent to enrollment in a chronic care management program, a candid conversation can be had with patients to discuss the tangible value of CCM and help patients understand that overall, enrollment and participation is likely to save them money — potentially substantial money — during the year.

In addition, you may consider offering financial assistance programs for those need cases where patients are unable to pay but you and the patient strongly believe a patient's health depends on participation in the program.

Getting Patient Buy-In for Chronic Care Management

To help you facilitate conversations about chronic care management with patients, here are five of the reasons why CCM is worth their investment.

1. Fewer dollars spent on hospital bills

Consider this the golden ticket. While the out-of-pocket cost of chronic care management might feel overwhelming for patients on a fixed income, the actual price tag is nominal at best compared to the out-of-pocket costs of a trip to the emergency room or hospital admission — both of which may be avoided through the delivery of CCM.

According to Consumer Health Ratings, the cost of a hospital stay for all diagnoses in 2021 is estimated to average over $13,000, excluding physician fees. When subject to the deductible and 20% coinsurance, the cost of a single hospitalization dwarfs the cost of CCM if it can prevent the need for even just a single hospitalization.

2. Better management of medications and control over symptoms

Americans spend more on prescription drugs than anyone else in the world, and the expense associated with medications is often the top expense every year for patients. A report published by the Pan Foundation highlights that in 2017, Medicare beneficiaries spent an average of $3,200 out of pocket on prescription medications. With effective chronic care management, the provision of greater care oversight can help practitioners dial in on what medications work for the patient and eliminate potentially harmful drugs. Practitioners may also be able to switch patients from an expensive drug to one that is less expensive but just as effective.

Also worth mentioning is that with better control over medications, the patient should experience better control over their symptoms, thus making chronic care management a win-win for cost and symptom control. And with better symptom control comes the reduced need for healthcare services.

3. Enhanced access to the care team and other resources

Chronic care management provides a direct link to the patient's care team, better ensuring that when a care or medication issue or question arises, the patient can get the support and answers they need directly from a knowledgeable source. By enrolling in a CCM program and drastically increasing communication with their dedicated care team, there is reduced likelihood that a patient will experience runaround with front office staff, phone tag with floor nurses, or other obstacles that get in the way of receiving potentially time-sensitive information and instructions. This more direct, around-the-clock access to the care team can also keep patients connected with other useful resources, helping patients stay engaged and feeling more accountable for taking control over their health.

4. Convenience and improved quality of life

Chronic care management can be performed across different modalities, such as telephone or through secure telehealth platforms. This means care can be provided anywhere the patient is rather than requiring patients to meet in person with practitioners. Patients will take fewer trips into the office, and they will spend less on transportation costs and less time in traffic.

When a practice incorporates telehealth services, such as remote patient monitoring, into a CCM program — thus creating a comprehensive remote patient care management program — the patient and care team will also have current information about the patient's health status and vitals. This further helps the patient remain engaged and accountable for their lifestyle choices and allows the healthcare team to make more timely decisions that could potentially prevent the need for emergent or urgent medical care, saving the patient time and money.

5. Improved coordinated care

Finally, chronic care management can help the entire care team, from the primary care provider to specialists, stay current on a patient's health status. This increases effective care coordination and decreases the likelihood of duplicated services. According to the University of New Hampshire, duplication of services, such as labs and imaging, wastes as much as $20 billion in healthcare costs annually. Better coordinated care across all providers better ensures patients receive the right services at the right time from the right practitioners. When care is optimized, so are costs.

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