Should Your Health System Develop a Chronic Care Management Program?

nurses from a chronic care management company
nurses from a chronic care management company

Should Your Health System Develop a Chronic Care Management Program?

Choosing to implement a Chronic Care Management (CCM) program through a specialized Chronic Care Management Company can be an important decision. But with more people struggling to regulate their chronic medical conditions, more hospitals and health systems will begin to see the benefits of having a CCM program that can help them provide better long-term care for their patients. 

Currently in the U.S., more than 60 percent of Americans have one chronic disease, and four in 10 have two or more, according to the Centers for Disease Control and Prevention (CDC). The American Hospital Association predicts that by 2030, 170 million people will suffer from some form of chronic illness. That’s half the population of the U.S. Not surprisingly, this has put a huge strain our healthcare system in terms of costs and medical personnel. Right now, 90 percent of the nation’s annual $3.8 trillion healthcare costs can be directly tied to people with chronic diseases and mental health conditions, according to the CDC.  

Added to these amounts is the healthcare costs surrounding the 23 million Americans who now suffer with long-haul or post-acute Covid syndrome. David Cutler, a Harvard University economist estimates the cost to the U.S. economy to be $3.7 trillion for the chronic malady, with additional medical costs accounting for $528 billion. He estimates annual individual patient costs to be between $3,700 to $14,000. (Source) 

Given these eye-popping numbers, having a CCM program can offer a multitude of positive elements that can not only help your health system better manage patients with their chronic illnesses, but also make a healthy profit in doing so. A quality CCM program can enhance treatment for patients through personalized care plans and individualized care coordination, improving overall health outcomes, optimizing medical personnel and staff time, and cutting costs. This can be achieved while significantly generating additional health system or practice revenue. The right CCM program offers a holistic approach that leads to reduced healthcare costs and deeper patient engagement. And with today’s cost-effective outsourcing options, you don’t have to break the bank—or go through the process of implementing a CCM program alone.  

Improving Patient Care and Satisfaction 

A CCM program places the quality of patient care at the center of treatment for better disease care management. Patients can achieve improved health outcomes by having care plans tailored to their special needs. CCM programs also should connect patients to monthly calls with a nurse care manager to review the patient’s health, align upcoming appointments, assist with any medication refill issues, and conduct medication reconciliation to ensure the patient is taking their medication and following their treatment plan. Remote patient monitoring (RPM) can be a useful addition to a CCM program to monitor and collect patient data trends.  

This combination of personalized care plans and timely access to treatment professionals can help patients manage their symptoms, stay on their medications, minimize complications by preventing gaps in treatment, and lessen or eliminate visits to the emergency department. Best of all, implementing a CCM program can free up staff time and reduce non-billable hours for a practice. 

Chronic care management programs also improve patient satisfaction scores, which can result in longer term relationships and enhanced revenue for health systems. In fact, a recent 70 percent of survey respondents said that their CCM program improved patient satisfaction. While satisfaction is often an essential element of value-based care payment models—and must be taken into consideration where revenue is concerned—patient satisfaction goes beyond the numbers. Yes, greater satisfaction makes for an improved long-term relationship between the patient and the health system. But higher satisfaction also contributes to more conscientious adherence to treatment plans and lower hospital readmission rates, all of which leads to better overall health outcomes and increased revenue for the health system. 

Reducing Healthcare Utilization 

Perhaps one of the most significant benefits of having a quality CCM program is in providing continuous quality care, while reducing healthcare utilization, particularly in patients making emergency department visits or having to be readmitted to the hospital. Frequent users of emergency departments, known colloquially as “frequent flyers”, use EDs in a disproportionately high number.  

And those visits don’t come cheap. According to HealthPayer Intelligence, an emergency room visit now averages $2,453 using large employer-sponsored health insurance. The data also shows an upward trend of emergency department use and out-of-pocket spending, which has grown 85 percent and 51 percent respectively from 2012 to 2019. 

In 2017, the Centers for Medicare & Medicaid Services (CMS) released data it collected over a two-year period that included all patients enrolled in a CCM program across the U.S. The numbers showed real promise. Hospitalizations were reduced by almost five percent and emergency department visits were reduced by 2.3 percent. Perhaps even more compelling, the study found that fee-for-service plus shared savings for providers earned $348 annually per patient.

Signallamp Health’s own research reveals that 93 percent of patients reported health issues sooner and 86 percent had better medication adherence in health systems using a CCM program. 

Another important component of having a CCM program is the continuous interaction between providers and patients. Because patients are monitored and in frequent communication with their healthcare professionals, escalation of disease complications can be kept to a minimum. And since their care is well coordinated and consistent across healthcare providers, fragmented care, duplication of services, medical errors, and lapses or gaps in treatment can be curtailed or prevented. A CCM program also provides real-time intelligent data into the overall aspects of a patient’s condition and treatment, which allows providers to analyze current information that can lead to more discussion about effective treatments.  

Put simply, the cornerstone of a CCM program engages patients to become active champions of their own healthcare in partnership with the health system. By supporting them in taking charge of their chronic condition, patients can feel empowered to engage in the kinds of conversations that result in proactive action where their health is concerned. Ultimately, this ensures continuity of care and better outcomes between patient and provider. 

 Maximizing Financial Performance

Since most healthcare systems are contending with tight budgets, limited resources, and on-going labor shortages, it’s imperative that a CCM program help lighten the load, without additionally straining financial resources. Your CCM system should seamlessly integrate into your primary workflow, thereby streamlining operations between various departments, and enhancing the overall efficiency of the organization. Your CCM program should utilize your existing technology, optimize resources, and maximize personnel, so your health system can increase efficiency and amplify your revenue.  

A good CCM program can help you reimagine all of it. 

Attribution should also be considered. Attribution, the process in which a provider is assigned to own the responsibility for a patient’s overall healthcare, has steadily increased in importance since the passage of the Affordable Care Act in 2010. Because attribution is more heavily used in government payer programs like Medicare, attribution has shifted more to primary care providers. Patients develop a more trusting relationship with their doctor when they are connected personally and frequently. These patient-centered conversions not only build deeper trust and empathy, but also result in long-term patient “stickiness.” Keeping these relationships strong helps patients better manage their chronic condition, helps providers stay on top of the patient’s care, all of which fortifies attribution. This continuum creates more stable revenue over the long term for the health system. 

For those health systems who operate under a fee-for-service system, a CCM program can uncover additional revenue opportunities in billing that result from increased primary care and preventative care services, e.g., annual wellness visits, colonoscopy, mammography, etc. As the CDC has reported, four in 10 people have two or more chronic conditions that need to be managed. In many cases, services and treatments can be better tracked and coded and billed separately under many insurances , including Medicare and most Medicare Advantage plans. 

Also see: 2024 Medicare CPT Code Reimbursements for Chronic Care Management

A CCM program can also help you to maximize your performance in value-based care, which, according to HealthPayer Intelligence, outperforms fee-for-service in revenue. In 2021, 59.5 percent of healthcare payments were tied to value and quality, while the remaining 40.5 percent were from fee-for-service models, according to data from the Health Care Payment Learning and Action Network.  Increases in value-based revenue performance are achieved for health systems by keeping patients healthy and addressing problems before they become much bigger issues, thereby reducing costly emergency room visits. Signallamp Health customers have seen average reductions in total cost of care of 15-20% overall across their CCM-enrolled population year over year. 

Don’t Go It Alone 

A robust Chronic Care Management program can add immeasurably to your health system’s patient treatment success and revenue growth. Implementing a quality CCM can strengthen relationships between patients and providers, improve care coordination, enhance healthcare outcomes, reduce healthcare costs, and generate significant additional revenue. It’s a win-win.  

If you would like to implement a CCM program, but don’t want to start from scratch, outsourcing to a Chronic Care Management Company is a viable and recommended path.  

Ready to improve patient care with a Chronic Care Management Company? Learn how Signallamp Health can help you Take Care Further™ with remotely embedded Chronic Care Management. Schedule a consultation with us, here.  

Our experienced nurses work inside your EHR workflows, delivering personalized care that achieves over 90% patient retention, without creating provider burden. 

With no out-of-pocket costs, we maximize patient engagement, outcomes, and satisfaction, ensuring improved financial performance without the risk.