We're hiring! Check out our open positions here.

Lessons Learned in Year 1 of Chronic Care Management

Posted by Travis Bond

Find me on:

Nov 2, 2015 8:00:00 AM

We always love the opportunity to talk about CCM with smart people. That’s why we were incredibly excited when Kareo invited us to host a CCM-focused #KareoChat last week, specifically, around what we’ve learned now that we’re most of the way through the first year of CPT Code 99490.

fixing healthcare with chronic care management

The hour flew by, but we tackled a handful of topics, including:

  • The biggest changes during this first year of CCM
  • The obstacles that prevent providers from CCM
  • What needs to be done so providers implement a CCM program
  • How the patient fits into this patient-centered code
  • Expectations from CCM
  • How we can improve CCM

There is a general consensus that chronic care management has a lot of potential, and the numbers reflect that physicians want to offer CCM to their patients, but there are obstacles that have prevented them from implementing a program as quickly as we’d all hoped.

So, thanks for inviting us to host, Kareo, and thanks to everybody who spent their lunch hour to discuss the good, the bad, and the ugly around Chronic Care Management.

What have been the biggest changes we’ve seen during this first year of CCM?

At CareSync, we believe that one of the biggest changes that has taken place is the pivot in thinking required for all the stakeholders involved. The scope of care settings outside the exam room is broadening, and everybody is adjusting to care that happens between the visits.

What are the obstacles that keep providers from CCM?

As expected, this topic could have easily dominated the entire hour. Modern Healthcare recently reported that only about 100,000 CCM-eligible beneficiaries have been enrolled since CPT 99490 went into effect on January 1, 2015. That’s out of a potential 35 million eligible patients. Why so slow?

Mostly, it’s the lack of education and awareness. Most physicians want proof that the code is going to stick around, because it is a commitment to build an effective CCM program. They also wanted to know that the early-adopters who took the plunge into CCM are actually getting paid.

It’s also an education on the patient and caregiver side, as well. Joe Lavelle of IntrepidNOW mentioned that many of his mother’s doctors have sent letters about their new CCM programs, but the letters were confusing and took time to sort out what they meant. Most of the sample letters and consent forms that we’ve seen use complicated, intimidating language and don’t really convey the value.

patient education is key to CCM success

Which leads into the 20% (~$8) copay the patient is required to pay. Without a solid understanding of the benefits of CCM, most patients are confused when they get this new, monthly bill.

Our most successful physician partners get this, and invest time in understanding how to sell this service to their patients. Not surprisingly, these are the practices with the highest CCM enrollment numbers, the best outcomes, and new recurring revenue.

Compliance, fear of additional burden on office staff, and worries about the time and resources it will take to kick off a CCM program also ranked high on the list of obstacles.

What would make providers more likely to implement a CCM program?

There have been multiple recent reports with statistics that suggest most providers plan to implement a CCM program. Only 11% reported that they have no plans to implement CCM in PYA’s recent National Chronic Care Management Survey 2015.

We will see the numbers quickly rise once doctors have a better understanding of the requirements, they can effectively explain the services and their benefits to their patients, and feel confident that they’ll receive reimbursement.

What do patients expect from CCM?

We’ve already touched on the fact that CCM is a new way to provide and receive care. Back to that whole education thing, when patients understand the value of a between-visit service, they have high expectations for what they receive.

We are proud to report that a significant percentage of those 100,000 patients mentioned in the article above receive their CCM services from CareSync. Over the course of this year, we’ve learned that they really are looking for help to navigate the healthcare system. They want help getting the right information to the right people at the right time.

Patients also expect a CCM program to improve their overall experience with the healthcare system. They welcome the between-visit care coordination, and access to a person who is proactively checking in on them. Many of CareSync’s members have said that they love being able to call us, but would feel as if they were bothering their doctor if they called the practice.

The patients we talk to each and every day love that we’re reaching out to them to help them stay on top of their goals, manage their medications, and help them share information with their other providers.

Has CCM been what you expected when it was announced at the beginning of 2015?

The quick answer to this question is yes and no. With any new program, and especially when it presents a new way of thinking, there will be the super-early-adopters, and when they’re successful, then the early-adopters get started, eventually it becomes the norm.

This is what we expected, and has been our experience at CareSync. Most practices we talk to, both large and small, plan to offer a CCM program at some point in the future. During the first six months of 2015, many hadn’t even heard of CCM. As we approach the end of the first year, these same practices are coming to us with detailed questions on what to expect when offering the program.

Many of these questions focus on compliance. I think we all expected, or at least hoped for, quicker clarification around the details of the requirements than we’ve seen.

I think we underestimated the level of distraction that ICD-10 would cause, too.

If you could change/improve the program what would you do?

This is simple.

  1. Increase the reimbursement. Doctors want to do this for their patients.
  2. Remove the copay. It’s a barrier to adoption, and confuses the patient.
  3. Improve guidance on the requirements of the code.

To wrap it all up, I am grateful for the opportunity to share what we’ve learned about CCM so far this year, and excited for how these experiences and the initial knowledge gained will help practices of all sizes implement effective CCM programs.


If you're interested in learning more about CareSync, or would like a free CCM assessment for your practice, click here and tell us a little about you, or give us a call at 813-658-3749.

free chronic care management assessment

Travis-Bond-headshot-square.jpg Travis Bond is the founder and CEO of CareSync, the leading patient-centered engagement solution that combines technology with 24/7 nursing services to facilitate care coordination among patients, family and caregivers and all providers.

Join Our Communities!

Download the White Paper

Subscribe by Email

Most Popular Posts