Under the MACRAscope: CCM

Past, Present and FutureBarry C. Allison, CIO, Center for Primary Care

Objectives

1. Learn the impact of our CCM program, since its launch in 2015, using our

real data

2. Learn about new CCM reimbursement opportunities, and strategies for

tweaking workflows to capture new reimbursements

3. Discover how CCM workflows are extensible to other value-based incentive

and reimbursement programs

The Center for Primary CareFamily and internal medicine practice with 42 providers

offering comprehensive healthcare services in 9

locations across Georgia and South Carolina

24K Medicare patients

78% with 2+ chronic conditions

Adding 2K patients/year over next 10 years

10K patients in upside-only enhanced care commercial

5K patients in upside-only enhanced care MA

4.4K patients in Medicare CCM

Patients Programs

CPC’s Chronic Care Management

Journey

Our Timeline

DEC 2016

Later Results

DEC 2015

Early Results

MAR 2015

Implementation

DEC 2014

Opportunity Assessment

NOV 2014

CCM Program Announced

CCM Program Announced

“In 2015, the Centers for Medicare

and Medicaid Services will

introduce a non–visit based

payment for chronic care

management — the most

important broadly applicable

change it has made to primary

care payment to date.”The New England Journal of Medicine

November 27, 2014

Opportunity Assessment

Assumptions:

• 78% MC population with 2+ chronic

conditions

• 75% CCM program opt-in

• 75% CCM completes

Approximately $80K

incremental monthly revenue,

roughly $1M per year

125K patients

14K MC patients (11%)

Implementation: Workflows &

Technology

WORKFLOWS

New roles

The Chronic Care Management workflow

Eligible beneficiaries

Consent to receive CCM

Deliver the five specified capabilitiesUse a certified EHRElectronic care planBeneficiary access to careTransitions of careCoordination of care

Non-face-to-face care management services

TECHNOLOGY

Cohort identification

Task management

Time tracking

Reporting

The Results

About 32K in incremental revenue per

month

Nearly 4X the rate of CCM program

participation, compared to national

average

Minimal impact to workflows, staffing,

and existing IT infrastructure

Later Results - 2016

Lessons Learned

Enabling technology is crucial

Really understand your ROI

Develop workflows and competencies that are extensible to other value-based

programs

Chronic Care Management in 2017

Complex Chronic Care Management

New Reimbursement Opportunities!

Billing Code Description

CPT 99487 For complex CCM, requiring 60-minutes of non-face-

to-face care management services per month, as

compared to 20 for CCM

CPT 99489 An add-on code for complex CCM, billed in 30-

minute increments beyond the initial 60-minutes

G0506 An add-on code to pay physicians for care plan

development, which is to be billed separately from

monthly care management services

CPT 99358 For prolonged E/M service (the first 60-minutes) in

which a physician spends significant time outside of

the usual office visit addressing a patient’s needs

CPT 99359 An add-on code for prolonged E/M service, billed in

30-minute increments beyond the initial 60 minutes

Applying CCM Principles To Other

Value-Based Programs

Closing Gaps In Care

Using technology to surface gaps in care

Bringing Medicare shared savings data into the EMR

Use cases for Medicare wellness visits / Physicals

Medicare preventive services tracking

Cohort Management

Managing populations by risk-based contract

CCM Populations within risk-based contracts

CDC 6|18 Initiative – Comorbidity Commercial Payer Tracking

Thank you!Barry C. Allison, CIO, Center for Primary Care