chronic care management (ccm): understand how to capture incremental revenue

2015 Diagnotes, Inc. – Confidential & Proprietary

Chronic Care Management (CCM):

Understand how to capture Incremental revenue

November 10, 2015Presented by:

2015 Diagnotes, Inc. – Confidential & Proprietary2

• Introduction

• A problem in healthcare

• The research

• The opportunity for CCM

• The requirements For CCM

• A solution you can leverage

• Next steps in working together

Welcome

Presenter: Todd Melioris, Executive Vice President


• Highlight the current issues surrounding care for patients with chronic diseases

• Understand CMS requirements for the new Chronic Care Management reimbursement code

• Learn how you can improve care for patients and increase revenue through CCM

• Discover tools that can help you leverage the manpower and practices you already have in place

• Information from public domain:

– Center for Medicare and Medicaid Services (cms.gov)

– Center for Disease Control (cdc.gov)

Objectives


• 130+ million Americans have chronic diseases

• 7 of the top 10 causes of death in US in 2010 were chronic illnesses

• 85% of healthcare spending goes to the treatment of chronic illnesses

• 2/3 of Medicare dollars are spent on patients with 5+ chronic conditions

The Problem


• 76+ % of Medicare beneficiaries have 2 or more chronic diseases, resulting in: 80+ % of hospital admissions 90+ % of prescriptions filled 75+ % of physician visits

• Providers historically have not been reimbursed for non-face-to-face care coordination services

• What is the outcome for this environment?

The Research


• Chronic disease patients are often left to themselves to coordinate care between visits

• Gaps in communication cause:– Fragmented health data

– Duplicated tests

– Increased healthcare expenses

– Increased likelihood of poor health outcomes

Effective Chronic Care Management:

Reduces the costs of care for chronic disease patientsImproves their overall healthIncreases quality of life

The Research - continued


The Opportunity

• Importance of Chronic Care Management (CCM)• Impact that it has on healthcare expenses • Improved patient outcomes

Centers for Medicare & Medicaid Services (CMS) recognizes:

• Medicare beneficiaries with 2+ chronic conditions• 20+ minutes of non-face-to-face chronic care coordination• Services can be fulfilled by the provider or performed by

subcontractor• Pays approximately $42 per patient per month to providers

New Chronic Care Management CPT Code 99490

Medicare has not recognized CCM as a rural health clinic (RHC) or federally qualified health center (FQHC) service


• Only 1 provider can receive CCM reimbursement for a patient

• Average Family Practitioner or Internal Medicine Practitioner has 2000 patients and roughly 500 qualify for CCM

• A large percentage of qualified patients have supplemental insurance – resulting in no cost to patient

• 450 patients per provider at $42 per month

The Opportunity – continued


The Math

Providers are likely already performing many of the required services – and are not getting paid for it.


Providers:

• From Reaction to Improvement and Prevention

• Improved patient compliance

• Medication management / monitoring

• Care Plan monitoring

• Increase Revenue – 99490 + Additional office visits

Patients:

• Decrease ER Visits and Hospital Admittance

• Frequent interactions and support

• Reinforcement of desired behaviors

• Reduce long-term healthcare costs

• Improved quality of life

The Benefits


• Creation of Patient Centered Care Plan

• 24/7 Patient access to clinical staff involved in Care Team

• Certified EHR that includes Care Plan accessible 24/7 to Care Team Providers

• Continuity of care with designated Provider

• Perform Medication Management / Reconciliation – Adherence

• Ongoing care management for all chronic conditions

• A comprehensive care plan that includes all current records from all the patient’s providers

• Management of care transitions between and among all providers

The Requirements


• Certified EHR – Any provider billing for CCM is required to use an EHR that

satisfies the 2011 or 2014 criteria of the EHR Incentive Program.

• Maintain a regularly updated, electronic Care Plan– Should include all of the patient’s healthcare providers, family &

caregivers, all health conditions - not just those considered chronic

– Be aligned with the patient’s choices and values

– CMS recommendations for the Care Plan:

Comprehensive problem list, including expected outcome, prognosis and measurable treatment goals

Symptom management and planned interventions

Outline Accessible community and social services available

Plan for care coordination among all providers

Medication management, including current medication list and allergies, reconciliation, and oversight of patient self-management

The Care Plan


• CMS has left the ruling open to discernment by provider.

• The guideline require:

– Two or more chronic conditions expected to last at least 12 months, or until the death of the patient

– Chronic conditions that place the patient at significant risk of death, or acute decomposition

• CMS maintains a Chronic Condition Warehouse (CCW) with 27 chronic conditions listed to provide researchers with beneficiary, claims, and assessment data, however, it is not an exclusive list.

https://www.ccwdata.org/web/guest/medicare-charts/medicare-chronic-condition-charts

Eligible Patients and Chronic Conditions


• Alzheimer’s Disease• Anemia• Arthritis• Cancer• Depression• Diabetes• Glaucoma• Heart Disease• Hypertension• Obesity• Osteoporosis• Etc…

Examples of Chronic Diseases that Qualify for CCM


What you need to do:

• Collect medical records from all patient providers to build a comprehensive Care Plan and health summary that includes the CMS-required elements.

• CMA, Nurse, PA or Physician at practice spend a minimum of 20 minutes per patient, per month assisting with care coordination tasks including scheduling medical visits, reconciling medication lists, updating care plans.

• Have a clinical care team member available 24/7 by phone, online, and through mobile messaging to help patients with acute chronic care issues and care coordination tasks.

• Facilitate care transitions, document the information, and keep all members of the care team up-to-date.

• Record medical visits and provide access to the documentation to other care team providers.


Explain the CCM program and benefits to qualified patients

during Annual Wellness Exam.

Checkout:• Patient signs the

Consent Form• Care team verifies

contact information

Build Care Plan and share with patient

Call patient monthly• Internal and external

communication must equal 20+ minutes

Continue with your acute care

management as usual

Bill monthly for CCM patients that meet the

20+ min care coordination

Your workflow for CCM

2015 Diagnotes, Inc. – Confidential & Proprietary


Diagnotes is a HIPAA-compliant communication platform that drives effective care team collaboration

Patients, providers and staff can send secure text

messages with patient data to individuals or groups.

Alerts and messages can be routed to providers based on specialty, care location and availability.

All activity can be documented, reviewed and archived for care continuity and billing.

Phone calls and voice messages can be

securely handled by call center agents or by an

auto-attendant.

Key patient data from medical records can be automatically retrieved and delivered to message recipients.


Diagnotes is easy to learn and effective to use

Seamlessly collaborate with care teams and automatically track and retain all communication to protect your program during audits.


Diagnotes makes CCM reimbursement possible


Diagnotes satisfies the entire enterprise

iOS, Android, and web-based BYOD-enabled: no cached data on mobile devices

SaaS-based, cloud-hosted Makes it affordable

EHR-agnostic Links to any EHR, HIE or other data source

HIPAA-compliant No worries about sending or receiving PHI

Administration-friendly Includes call scheduling, audit trail and analytics


• Diagnotes improves communication and coordination among patients, providers and staff

Proven Solution

• Increase revenue• Decrease cost• Enhance patient and provider satisfaction

Clear compelling

value

• Award-winning, cost-effective solution• Top notch service and support• Experienced team

Positioned for your success

Why choose Diagnotes?


Our customers are solving problems


• Call (317) 395-7080 for a:– CCM Evaluation for your practice

– Demonstration

• Visit our website at www.diagnotes.com

Next Step

THANK YOU

http://www.diagnotes.com/

chronic care management (ccm): understand how to capture incremental revenue

Healthcare