An Ounce of Prevention
Social Determinants of Health: Chronic Care Management Program RoleRead More →
Part two in a two-part series (access part one) Imagine calling your chronic care case management patient for their weekly check-in only to find out that they haven't taken their blood pressure medication in four days. While the direct effect of the missed medication is worrisome, even more concerning might be the reason why the patient is skipping doses in the first place. Within chronic care management programs, it's not uncommon to run into these types of patient problems, and these situations probably arise more often than we like, or we'd like to admit. Often, the cause or a significant contributing factor to patient non-adherence with a chronic care management program is social determinants of health (SDoH).
Part one in a two-part series It's been well-documented that social determinants impact the health and wellness of patients in numerous ways, but how do we more effectively address those issues that impact patients negatively? One path provider organizations are increasingly taking to help them overcome social determinants of health (SDoH) challenges is through the addition of chronic care management solutions.
The results of a survey suggest that upwards of about 85% of Medicare annual wellness visits (AWV) may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS). The results should motivate providers to verify that the tools they are using during AWVs for Medicare patients effectively prompts them to ensure no required components are missed. If a required element is missed, the AWV can be considered non-compliant by an auditor, potentially leading to clawbacks and other penalties. In egregious and willful cases, a non-compliant practice could even face exclusion from Medicare or criminal liability.
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.
If you read our previous post about the love affair between chronic care management and Medicare, then you already have a pretty good idea of how invested the Centers for Medicare & Medicaid Services (CMS) is in the provision of chronic care management (CCM) services. But what does this really mean for you and your patients, and why should you leverage this bonded relationship for the benefit of your organization?
Natural disasters are rarely expected but should be planned and practiced for regularly by everyone. In the medical world, being ready for a natural disaster means so much more than maintaining adequate staffing and supplies. It also means being able to connect with patients at a time when they may need you the most.
Thea Blystone, PharmD, is a clinical pharmacist at Meadville (Pa.) Medical Center, which implemented a remote patient monitoring (RPM) program supported by the Prevounce platform. Dr. Blystone was one of the leaders of this project. She spoke with Prevounce about a range of topics, including why she's such a strong proponent of RPM, results of the program, why RPM is a perfect fit for rural organizations, and the evolving role of pharmacists in rural hospitals. Note: Responses have been edited slightly for clarity.
We have learned a lot about how healthcare works — or sometimes doesn't work — over the course of the COVID-19 pandemic. As providers struggled to respond effectively to the fast-spreading virus it became very apparent that we have some outdated and broken components of our healthcare system. COVID stretched our tired healthcare infrastructure to its limits, forcing us to become creative in providing care while accepting and adapting to modern technologies once thought to be prohibitively expensive or else categorized as passing novelties.
Taking the time to prepare your Medicare patients for their annual wellness visit (AWV) can improve the overall experience. For patients, preparation helps to ensure the AWV meets their expectations, as well as feels less stressful and more productive. For you and your practice, prepared patients can expedite completion of the AWV in a manner that still meets patient needs and requirements.
Comprehensive care management — also known as "virtual care management" — combines aspects of chronic care management (CCM), remote patient monitoring (RPM), and other billable preventive services to allow providers to take a whole patient approach to managing the medical, functional, and psychological needs for medium- and high-risk patients. For clinicians, comprehensive care management provides patients with the wraparound care they need, not only promoting wellness but also treating and helping prevent acute exacerbations of chronic health conditions. To be successful, it is important that any care management approach be a team effort, eliciting buy-in from the patient's entire healthcare team as well as the patient themselves.