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Outsourcing Chronic Care Management

To outsource or manage in-office? What is in the best interest of practice and patient?

The most expensive segment of Medicare, accounting for over 93% of spending, is directed at patients with multiple chronic conditions; people with one or more chronic conditions will number at over 171 million by 2030, according to a Rand Corporation report. Yet health care services are not delivered in a coordinated manner, for most. Often, patients’ health care providers are not a part of integrated delivery networks (IDNs), and often are not highly experienced in coordinated efforts. And even those who are working in a coordinated system still find that some services are obtained outside the IDN. The lack of coordination among many health providers results in potential duplicate and even unnecessary or conflicting care, adding to the heavy financial burden on the health care system.

Still, many health plans have piloted and implemented innovative chronic care condition management initiatives. These include disease management as well as overall lifestyle and wellness; some include behavioral health. These programs tend to be more patient-centric, holding the belief that increasing patient engagement will result in greater positive health outcomes.

But other overbooked physicians are concerned about how to handle chronic care management effectively with finite resources. Among the requirements for chronic care management outlined by the Centers for Medicare & Medicaid Services (CMS) is at least 20 minutes of care management consultation and coordination each calendar month. These communications and services can either be face-to-face or remote via phone, internet, or another telemedicine device.

The Care Coordinator’s Role

A provider’s designated care coordinator should not only reach out to the patient at least once a month, ideally they should also verify that the referrals are working smoothly, and that the patient’s entire care team knows what each other is doing and can share relevant clinical information. A clear care plan must be shared not only among the care team, but also with the patient and caregivers. Each chronic care contact or service is then documented and billed to Medicare.

The Value of Chronic Care Management

Medicare believes that by incentivizing population management and care coordination, the overall total cost of care will be markedly reduced. But health providers fear that the total time spent for all patients will add up quickly, resulting in the potential need for increased staff — not only for consultations, but for documentation and billing requirements. Also, the care coordinator will need a technology platform that can aggregate data from numerous care team sources, and that is able to share that data with everyone involved. The return for providing chronic care management coordination is around $40 per month for each care beneficiary. Providing chronic care management under CPT code 99490 could result in additional revenue to a practice of $100,000 annually; but the overhead added for such a service clearly must cost less than $40 per patient per month.

These considerations make outsourcing to a trusted chronic care management service provider an attractive alternative, since an outsourced provider can act as an extension of the practice. They can build care team connections and engage patients; they can assure that appointments are made and that data flows both ways. However, outsourcing also comes at a price.

Outsourcing chronic care management is a distasteful alternative to some, who feel that it is akin to relinquishing the ethical practice of continuous, comprehensive and compassionate medical care. Matt Ethington, CEO at ChronicCareIQ says, “ caring for your chronic patients is delivering your ‘core competency’ to your ‘core clientele,’ and outsourcing your core competency is disparaged by virtually every management expert for good reasons including losing connection with your clients (patients), losing control of the product (the care your patients receive), and damage to your brand (your reputation).”

If a small practice elects to provide chronic care management within their own office, how can they do so effectively, without increasing burden on staff already short on time? How can they provide this service not at a financial loss, but at a profit? In attempting to provide direct chronic care management, where can the provider find an easy-to-use data collection and billing system, and also one that assures effective team and patient interaction?

Choosing In-House CCM

The Diary CareProTM  is a robust care coordination solution. It empowers practices to maintain their high quality chronic care services and stay closely engaged with their patients, rather than risk losing touch through outsourcing. In tandem with the patient’s personal Diary Premium and integrated data, The Diary CarePro encourages active involvement and communication among the patient and the entire care team. The interaction of these apps is sophisticated enough to satisfy the needs of health care providers, and easy and user-friendly enough to positively engage patients suffering multiple chronic conditions. Patient outcomes improve when they are personally better able to track their medications, vitals, symptoms, lifestyle activities, and other health data, and are assured that the data can be shared among their entire care team.

An effective and affordable tool for providing chronic care management service removes the need for outsourcing. The minimal additional time invested in order to track and bill for care can be shared among multiple staff members, and a provider gains a new revenue stream for work their staff is already doing. Partnering with patients through the use of a complete tool empowers the individual to take ownership of their health outcomes, and keeping chronic care management in-house assures the closest communication and collaboration. This is a win-win for health providers and patients alike.


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