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Current and Future Trends in CCM

Posted by The CareSync Team

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May 26, 2016 9:16:21 AM

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One-on-One with Amy Gleason: Part 3

In part 3 of a special series, Amy Gleason, RN, Co-Founder and Chief Operating Officer of CareSync, and Mark Nalywajko, VP of Client Solutions at CareSync, discuss the evolution of Chronic Care Management (CCM) since January 2015. What lessons have been learned and where do we think the future of CCM is headed?

Mark: Amy, the last year and a half of CCM has been a compelling time for us at CareSync and for the medical community as a whole. CPT Code 99490 is building an incredible amount of momentum and interest. Can you tell me what some of your thoughts are as you look back over this time period? What's really stood out to you?

Amy: CareSync already had a web and mobile application, as well as a nursing staff, to provide CCM services to patients so we were actually able to enroll our first patients on January 1, 2015. The code did require a few new workflows specific to 99490 and CMS regulations, but we were able to immediately apply our experience.

We billed a whopping 22 patients in January 2015. There was still quite a lot of confusion around the requirements and what they exactly meant at that time. For example, what was a comprehensive visit as it pertains to CCM? What was the date of service to use with the code that represented a month-long period? There were many swirling questions in the early part of 2015, but by May, most of those questions had been clarified in FAQs and other documentation by CMS.

I think we, at Caresync, originally underestimated some of the importance of workflow best practices that we would later create. For example, we developed sample scripts for providers to use only after we realized that many physicians needed guidance on how to approach this service. This was different than telling a patient to take medication or get an X-ray. It was a different concept to them and they needed some coaching on how to talk to patients about it.

After a year plus, we are starting to get out of the early adopter phase and use our experience to guide new clients with our best practices, which are becoming the industry standard.

Amy: Mark, you get a lot of questions in the field while developing solutions. Is there one that stands out to you?

Mark: There are three areas that any competent organization must consider when reviewing potentially investing in CCM: patient care, revenue opportunity and compliance. We are frequently asked, “How are you truly bettering care?” There's still a lot of data to come, but the information we do have so far is very enlightening.

We’ve found that 64% of our members have been able to avoid duplicate tests. I think that speaks very well to some of the experiences you discussed in part 1 of this series. Your daughter Morgan had a lot of tests being done. Today, her providers could just plug in to Caresync and, more often than not, the test would have already been there.

Additionally, two-thirds of our members have found a significant error in their medical records. And 84% said we helped them remember follow-up items after a visit. Most people forget things the doctor tells them. I walk out of my doctor's office with five things to do. By the time I get home to my wife, I don't remember any of them. If I get a phone call to follow up on that, it's a huge win.

Amy: Mark, you're on the front line talking to practices that are interested in engaging in chronic care management. What are some things you're seeing as trends while talking to them in the marketplace?

Mark: It's been really fun to watch over the past year. In the first year of CCM, the early adopters were mainly those 1 to 2 doctor practices, to maybe the 4 to 6 doctor practices. We love working with them; they have a lot invested in the solution. But something has happened in the last five to ten weeks. We have seen a shift from family size practices to now significantly larger groups taking interest. For example, I was in Tennessee recently talking to a group from a 50 doctor practice. The following week we were talking to one of the biggest health systems in the northeast. So that is another indication that CMS and value based care are moving in this direction.

The other trend we’re seeing has to do with reasons to participate. In 2015, what really got a lot of early adopters and press was, “Wow, I can make a whole lot of money. Revenue, revenue, revenue!” That is not the focus anymore. In fact, now when I sit down with a provider, whether it be large or small, part of the conversation is asking them, “What's driving you? Is it care coordination, is it revenue, or is it compliance?”

What I've found is I generally get answers in thirds across the board. When they answer, “It’s revenue; we’re going to build a new building off of this” or whatever the case is, I have to say, “This isn't the code for you.” If you are primarily researching this for revenue, for what you'll make off of this code, that isn't what CMS had in mind. You aren't going to be successful. If you are looking for positive patient outcomes, surrounded by compliance and, yes, some incentive to go with it, then you're going to be successful. That's where we have seen practices achieve the most success.

Mark: Amy, from an operational standpoint, what trends have you seen in the last six to eight months?

Amy: We’ve seen several examples where patients have received the true benefit of chronic care management service. The more these examples occur, the more physicians start to see this as a value based solution rather than a revenue source as you said.

For example, we had a patient who told her case manager that her provider had encouraged her to get a therapy dog for her Parkinson's disease. She had been told for quite some time that this would be helpful, but she didn't really know how to go about getting a therapy dog. You don't just go to CVS to pick one up like you do for other prescriptions. Her case manager went to work, figured out the process, found some local resources, and even found someone to pay for part of the training costs. Experiences like that get back to the provider and they start to feel the value of CCM on a personal level.

Additionally, many Medicare plans, especially Advantage plans, are now starting to pay for CCM 100% when they didn't pay much for it in 2015. For example, Horizon Healthcare in New Jersey went from 0% coverage to 100% and Humana Gold went from 0% to 100%. We had one client who actually called a payer who was charging patients a $30 copay, and when she asked the payer why they would charge for such a valuable service, the payer decided to change the policy and paid at 100%. I like to remind providers that they have the power to influence the payer as well.

Mark: As we look into the future of CCM, value based care, and the “dark space,” where do you think this is all going and why?

Amy: Obviously, we truly believe the future of healthcare is value based care… that CCM is providing the carrot to incentivize people to move in that direction, versus the stick phase, which will come later when there will be penalties if you aren't moving into value based care.

As you know, the dark space you mentioned is a relatively new term that refers to patients who go into a doctor’s office, clinic or ER and then drop out of the healthcare system. It’s the space where we really don’t know what’s going on with them until they re-enter the healthcare system in another place. CareSync wants to use our system to shine a light in that dark space and clear up some of that time when the patient isn't in the office or the hospital.

We’re seeing more Medicare Advantage plans covering CCM at 100%. Our hope is the copay options will become better and eventually be removed. That’s certainly a hot topic in CCM. And we’re also hoping to see some commercial plans start to offer this to their patients as well.

The choice is yours

Mark: If history is any indication, and we know it is in this industry, when CMS rolls out an initiative like this, they start with the carrot to incentivize physicians to move in a particular direction. That’s where we are right now. What’s going to come next, and sooner rather than later, is the stick. This is the phase where instead of receiving incentives for work you’re doing, you’ll start to see penalties if you aren’t already doing that work. Whenever I am presenting to a large group and mention that type of historical flow that has taken place, I see a lot of physicians nodding their heads.

When you start to evaluate CCM and the possibility of implementing it, keep that historical perspective in mind. You can do it now, institutionalize it, perfect it, and make it part of your common workflow. And, yes, get incentivized appropriately for it. Or you can wait for the stick. For a growing number of practices, that choice is an easy one.

To learn how CPT Code 99490 helps doctors transition to value-based care, download our free MACRA white paper.

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