Patients who have at least two chronic conditions, defined as conditions that will last for at least 12 months or until the patient’s death, are eligible for chronic care management (CCM) services. CCM services allow a patient to receive optimal care. The services include developing a comprehensive care plan that outlines the goals of a patient, the medications they take and the community services they receive or are eligible to receive.
When patients agree to receive CCM services, it’s up to the provider to develop a care plan for them, providing support through various obstacles they may encounter in managing their health. CCM services are typically non-face-to-face services. Non-complex CCM services are billed by providers using CPT 99490. CPT 99490 allows for 20 minutes of clinical staff time per month and can only be billed by one of the patient’s providers.
Unfortunately, traditional electronic health record (EHR) systems are not set up to make CCM workflows and documentation efficient. In addition, a healthcare organization might not have the staffing levels or capacity needed to offer the non-face-to-face coordination that CCM requires. Fortunately, partnering with companies that specialize in CCM software and services allows many healthcare practices to offer chronic care management to their patients.
What Is CCM Software and How Can It Help?
CCM software should seamlessly integrate with a practice’s EHR system. The software platform allows providers to manage patient populations, identify high-risk patients, document time and create reports. The goal is to provide the best possible care to patients while seamlessly integrating CCM into existing workflows.
Software platforms should contain features that automate the care planning process, a necessary but time-intensive component to any chronic care management program. Other features of CCM software include information sharing between different care teams and monitoring of a patient’s adherence to their care plan. The features of the software help increase efficiency, improve outcomes and bolster patient satisfaction.
Dashboards should also be included in care management software. This feature gives visibility to leadership teams on the patient panel and the program at a glance to help increases the productivity and efficiency of the care management team. Having access to that information means a care team can prioritize patients based on problems, risk, or the number of minutes of care received.
Why Outsource Care Management?
Offering regular care coordination can improve the quality of care patients receive. That said, implementing such a program can present challenges to healthcare practices.
An organization might not have the staff on hand to provide one-on-one patient interactions or the services a CCM program requires. Outsourcing CCM helps a practice that might be stretched too thin provide the care and attention that patients with multiple chronic conditions need.
Outsourcing care management ensures practices reach the time requirement that is needed for reimbursement under Medicare CPT code 99490.
Evaluating Chronic Care Management Companies
Not all CCM companies are alike. Some offer more comprehensive services and more qualified staff members than others. When choosing the best chronic care management partner, there are several factors to keep in mind. Include the following in your review and evaluation of a company:
1. How Comprehensive Is the Company’s Solution?
A CCM company can offer a variety of solutions to your healthcare organization. Some companies provide only a care management platform, a software program that ideally integrates with your organization’s EHR. Some companies also provide access to a team that can serve as an extension of your practice’s staff. A CCM vendor might also offer a combination of software and service to increase efficiency and minimize the burden on your organization. In an ideal setting, the offerings of a CCM partner would be configured to your organization’s specialty, allowing a customizable solution to meet your unique challenges.
Once you have verified that the company offers both software and care management services, closely examine each aspect individually. When evaluating the software program, consider:
- Does it seamlessly integrate with your EHR? Ideally, the CCM software will integrate with your practice’s EHR, rather than operating as a supplemental program. Seamless integration means all of a patient’s data and encounter summaries are available in the patient chart.
- Does it offer care modules for chronic conditions? CCM software should come equipped with disease-specific care modules to help guide monthly conversations. A proper CCM software provider should have care modules built for the most common conditions.
- Does it allow you to document time easily? Time logging is critical for accurate billing but also can be crucial for your clinical workflows. CCM software should ideally allow your entire provider team to document time without causing disruption in their workflows.
- Does it streamline end-of-the-month billing? If you’d like to have your team spend less time on end-of-the-month billing, look for a CCM software program that automatically tabulates charges based on activities documented. Having charges automatically tabulated and pushed to your EHR can save billing teams hours upon hours each month.
- Does it improve efficiency? At the end of the day, a CCM solution should save your team time while also improving the quality of care you provide patients.
Along with evaluating the software, consider the range of other CCM services offered by the vendor if you are looking to outsource care management. Some factors to consider include:
- Will the vendor help enroll patients? Identifying and enrolling patients in a CCM program can be time-consuming. Ideally, the vendor you work with will identify eligible patients and take the steps necessary to enroll them.
- Will care coordination services schedule appointments on behalf of patients? Patients with multiple chronic conditions often need to see specialty providers but have trouble scheduling appointments and coordinating transportation. CCM service providers should be able to work with patients to help overcome these obstacles, ensuring they receive the care they need.
- Will care coordination services educate patients to help them better manage their conditions? Ideally, care coordination services will offer education and health coaching to patients to help them manage their conditions and improve outcomes.
2. What Are the Qualifications of the Care Coordinator’s Staff?
If a care management software vendor offers care management services, the care managers should be responsible for the following:
- Helping patients be proactive about their health: Care managers can help patients arrange transportation, obtain medical equipment, and schedule appointments.
- Keeping providers and patients on the same page: A care manager can be an intermediary between patient and provider. They ensure a provider is kept up-to-date on a patient’s health status.
- Educating and coaching patients: Care managers also provide patients with information about their conditions and the goals of any treatment plans. If a patient is struggling with treatment or needs additional support, the care manager should be able to work with the provider team to ensure the patient’s needs are met.
Who are care managers? To qualify for reimbursement from CMS, they need to be qualified health professionals. At some companies, that means a person who’s a certified nurse aid (CNA) has the credentials required to act as a case manager. Other vendors are more selective when it comes to the people they hire. For example, a vendor might require a care manager to be a medical assistant (MA) or a licensed practical nurse (LPN).
Another factor to consider is the selection process a CCM vendor uses when hiring care managers. Find out how comprehensive the hiring process is. For example, some vendors have a lengthy interview process and require clinical screenings to verify a candidate’s skill and suitability for the role.
3. Is the Technology Simple to Use?
Because your practice is busy, you never want to have your team struggling to work with a new CCM solution or use a solution that doesn’t smoothly integrate with your existing EHR.
One point to consider when choosing a vendor is the technology’s ease of use. How user-friendly is it and how complex will the setup process be? Does the company offer training — and if so, how many training sessions does it provide? What happens if you hire new staff members that need to be trained on the software?
Some CCM software companies begin the process by working with a healthcare organization to define goals and identify milestones. A company that understands what your organization needs from a CCM solution and has full knowledge of Medicare’s requirements is the one that’s most likely to provide the most effective, streamlined and simple workflows.
After your organization has successfully launched the software, the CCM solution provider must be there in the background to provide support as needed. The CCM partner might recommend adjustments as needed to improve the ease of use of the software solution.
4. How Does the EHR Vendor Integration Work?
A CCM solution should work with — not against — your organization’s EHR. Ideally, the software should become an extension of your EHR. It should integrate data directly into the patient’s chart and seamlessly push necessary documents to your existing system. When interviewing or requesting a demo from potential partners, ask how the EHR integration process works and which EHR vendors the company works with.
Another point to consider is whether your organization hopes to add behavioral health integration or remote patient monitoring services later on. If that’s the case, it can be easier to add initiatives if you’re already working with a solution that’s seamlessly integrated with your EHR.
5. What Are the Overhead Costs and Fees?
Outsourcing care management and using a CCM software program can help your healthcare organization save money, as you don’t need to hire a full-time staff member to act as a care manager. Additionally, if you have personnel limitations, outsourcing care can help you increase the size of your care management program, thus increasing revenue from your care program. With that in mind, software platforms and CCM services do cost money. Some might be more expensive than others or might have a variety of hidden fees that make them more costly.
Learn more about the pricing model used by the service provider. The provider may have a separate fee for the software only and for full-service. Some companies offer a hybrid pricing model, which allows your organization to scale care services as needed or as you grow. It might be that when you’re first adopting the CCM solution that you only need software. As your program enrollment grows, you may realize outsourcing care management will help you reach more patients.
6. What Are the Included Security Measures?
One way to help ensure patient confidentiality and security is to use software that complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and choose a Health Information Technology for Economic and Clinical Health Act (HITECH)-certified vendor. When interviewing vendors, ask what protocols they use to protect patient data and ensure confidentiality.
7. Is There Adequate Training and Support?
There may be bumps in the road as a medical team learns to use CCM software and starts to work with care managers. In addition to working with a company that offers initial training, it’s useful to work with a vendor that provides ongoing client support. If there’s an update to the software platform, will the vendor be available to show you how to use new features or address changes made? If your team has questions or feature requests, will you have someone to call to provide you with this type of support?
Ideally, the vendor you work with will assign you a primary point of contact, such as a client success manager. The client success manager will provide initial training, answer any questions that come up and help you troubleshoot concerns along the way.
8. Is a Demo Available?
It’s always smart to try before you buy — and that sentiment applies to CCM solutions, too. Ask the company if they offer free demos of their solutions. Viewing a demonstration lets you and your organization’s stakeholders see how the software program works. Seeing the software in action can help you determine whether it’s the right choice for you.
What Is the Best Chronic Care Management Company for Your Organization?
The best chronic care management vendor is one that’s there for your organization every step of the way, from kick-off to plan development and beyond. Be as thorough as possible when reviewing and evaluating companies. Ultimately, you’ll want to choose the CCM partner that delivers an easy-to-use platform and offers solutions that scale and grow with your organization.
Learn About Our Solution for Chronic Care Management
TimeDoc Health’s platform easily integrates with many EHRs. We also have highly qualified staff who can serve as an extension of your organization’s clinical personnel. Learn more about our solutions. To schedule a demo, fill out our website’s contact form or call 1.844.784.8362 to speak to a representative.