Guest Column | April 13, 2017

Putting Patient Relationship Management First To Help Those With Chronic Care Needs


Why practices don't need additional technology purchases or staff to enhance care with CCM.

By Jim Higgins, CEO and founder, Solutionreach

Managing chronic-needs patients is often a consuming effort for medical practices.

The Centers for Medicare and Medicaid Services (CMS) recognized this when it created an opportunity for practices to offer chronic-care management (CCM) services for reimbursement under CPT code 99490. The agency hoped providers would seize the chance to take advantage of the CPT code 99490 and further chronic care management clinical efforts.

However, practices didn’t necessarily pounce on the opportunity. Instead, many medical groups felt — and continue to feel — overwhelmed by the idea of having to shift their practice to accommodate patients who fall under the CCM umbrella. This article will highlight opportunities for practices to enhance patient care with CCM without adding staff or breaking the bank.

How To Manage The CCM Requirements
Currently, under the CCM CPT code 99490, a practice must provide at least 20 minutes of clinical staff time directed by a provider for high risk patients with two or more chronic conditions requiring long-term care. However, the act of piling additional tasks into the clinical workflow can be viewed more as a nuisance than a way to improve care.

An infamous study published in Annals of Internal Medicine suggests practices would need to collect CCM payments for over 100 patients to recoup typical setup costs, which includes hiring one full-time RN. With that in mind, it should be no surprise physicians have said, “Why bother?” or asked themselves, “Is it really worth it for us to get that reimbursement, and to make the effort to do the activities to qualify for CCM?”

What most practices don’t know is they don’t have to invest thousands of hours (or dollars) in hiring new staff or technology to reap the benefits of the program. Most medical groups just need to find new ways to use the resources they already have to focus on improving its approaches to patient relationship management (PRM).

Incorporating CCM Into Your Practice
Incorporating CCM successfully into your practice begins with a focus on your patient relationships, both inside and outside of the office through non-patient-facing encounters. While many focus simply on the revenue-generating side of CCM program implementation, what’s more important is for a practice to view CCM as an opportunity to improve efficiency, patient relationships, outcomes, and value.

After considering how many — and which types — of patients would qualify for CCM service, it’s important to consider ways they like to use technology. Do they tend to respond to emails (and do emails from the practice have a high click-through rate)? What percentage of patients with two or more chronic diseases subscribe to a practice’s portal?

While contrary to the image many people have of elderly CCM patients, seniors are increasingly digital-savvy consumers. The most recent Pew Research Center report on adult internet use reveals while older adults have lagged behind younger adults in their adoption, now a clear majority (58 percent) of senior citizens use the Internet on a regular basis.

If a practice has multiple patients with diabetes and hypertension, they could leverage PRM to send targeted emails or text-based reminders to these patients. The outreach can include reminders to check blood sugar levels and help patients create goals for when they visit the doctor’s office.

After narrowing down patients who qualify for CCM under the CPT 99490 code, a medical group has a better picture of its target demographic and can brainstorm ways to achieve CCM by engaging with patients between in-person visits. Perhaps there’s a function within a practice’s EHR or patient portal that allows clinicians to regularly check in with patients in smaller demographic pools (i.e., those with a primary condition of diabetes and a secondary comorbidity of hypertension) and send specific recommendations tailored to the unique needs of these patients. If a practice uses secure SMS messaging services, it could set up text messages in advance that can send timely medication reminders.

Group-focused outreach efforts accomplish the same goal as individual outreach efforts faster. Simultaneously, these efficient messaging efforts can encourage two-way communication between patients and their caregivers. A message sent to patients can provide clear instructions on who to call if their disease symptoms worsen, or if medication issues arise.

Continuing Patient Relationship Management With Chronic Care Needs
As we focus on improving outcomes in the midst of rising costs, looking for new ways to use existing technology is central to success. Encouraging a culture of two-way communication is one aspect of effective CCM, and it’s a step in the direction of the future. Incorporating CCM in your practice successfully hinges on personalizing your relationships with your patients.