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Chronic Care Management Solutions

Chronic care management (CCM) is integral in the healthcare industry, but it’s not getting any easier to perform. As the fallout from the COVID-19 pandemic depletes an already-shorthanded workforce, medical teams find themselves stretched thin. On top of that, the patients who need the most care—typically, people with chronic conditions—often suffer the most from staff shortages in the healthcare world. 

Why is this the case? Because patients with chronic conditions face significant challenges, including: high medical bills, low emotional energy, and hard-to-manage treatment plans. These factors, among others, make chronic care management a challenge for both patients and healthcare providers.

How is healthcare responding to these issues? Chronic care management platforms are one answer. But while there are many options available, only a few CCM solutions provide the breadth and depth needed for quality service. The best CCM solutions combine technology and human connection, and TimeDoc Health does just that. Keep reading to learn more about CCM solutions, what they entail, why they matter, and how TimeDoc Health aims to improve the lives of patients—and their care providers.

What Is Chronic Care Management (CCM)?

Chronic care management is what it sounds like: the management of medical treatment plans for patients with chronic conditions. Patients with chronic conditions require personalized treatment plans due to the unique health concerns and needs of each individual. Additionally, approximately 75 percent of the 133 million Americans with chronic conditions suffer from more than one chronic condition. They often take multiple medications, have strict physical regimens, eat highly regulated diets, and are required to monitor their vital signs consistently. Since these treatment plans are quite complex, CCM aims to help patients follow their assigned plans—usually with the assistance of care coordinators via phone check-ins and chronic care management software.

Why Does CCM Matter For Patients?

Simply put, CCM matters because chronic conditions are hard to manage—for both patients and healthcare providers—and everyone deserves the medical treatment and access to care they need to thrive. For people with chronic conditions, though, that is a challenge for multiple reasons:

  • Cost of Care: Having a chronic disease can feel like dumping money into an endless void, and in some ways, it is. Certain medical conditions can put you in a never-ending cycle of spending money—and a lot of it—which adds up over time. Medical bills are not only stressful for the patient, but they add financial stress to our healthcare system, which affects everyone. CCM companies can help lower those costs by making care more efficient, as well as keeping the patient on track to succeed. This prevents patients from spending more money later, due to failed treatment plans.
  • Emotional Gravity: There’s only so much time a person can spend being sick before it starts to wear on them. When you pair that with rising medical bills and the undoubted drain on the body, a patient’s mental health can be severely impacted. Thus, TimeDoc Health places high value on the human side of CCM solutions. It’s not enough to simply provide the technology: to really care for a patient, you have to provide them with empathy, authenticity, and human connection. Good care coordination makes it possible for patients to receive as much contact as possible, and TimeDoc Health provides that while also providing the technology to power operations.
  • Care Coordination: Caring for more than one condition at a time becomes complex, and very quickly. If a patient suffers from diabetes and high blood pressure, for example, their chronic care model for diabetes may not have much overlap with their high blood pressure treatment plan. That can be a hard burden to bear, and ultimately, the patient is forced to take on a lot of responsibility for treatment to be successful. There are medications to take, vitals to run, diets to adhere to, and many other tasks they need to accomplish. CCM helps offset that complexity, but only when it’s executed properly. TimeDoc Health’s technology seamlessly integrates with electronic health records (EHR) systems, making the care coordination process much easier for the provider—and their patient.

What Is the Main Purpose of CCM?

CCM exists to improve patients’ quality of treatment, provide financial value, and drive positive patient outcomes. Let’s examine how each of these benefits impact every patient:

  • CCM Improves Treatment Quality: No matter how you look at it, having chronic conditions is hard. Patients who suffer from them must deal with challenging treatments, expensive procedures, and several other things that can affect their quality of life. Having CCM ensures patients get the care and support they need to not only perform their treatment plans, but do so with an improved quality of life. A good CCM solution will provide both the technology required to track treatment well, and the human connection to help patients feel less alone on their journey to improved health.
  • CCM Drives Patient Outcomes: Even if a CCM patient is fully motivated to complete their treatment, plans can be challenging to follow. Keeping track of vitals, taking the right combinations of meds at the right time, and performing the proper tests—often without a healthcare professional at their side—is overwhelming, or even scary. This results in extra trips to emergency rooms, more visits to the doctor, readmission to the hospital, or the patient simply abandoning the treatment plan altogether. Not only are all these outcomes bad for the patient, but it puts unnecessary strain on our healthcare system, which is already suffering. CCM providers like TimeDoc Health help keep patients on track to complete the treatment they need to stay out of the hospital, freeing up more resources for other patients.
  • CCM Provides Financial Value: The monetary benefits of CCM are twofold: it’s good for the provider, and all other patients in the healthcare system. First, the provider not only saves on resources that would be spent on a recurring patient, but they could be reimbursed for CCM services rendered (depending on certain specifications). Second, the less money spent on chronic conditions, the lower costs can be for patients overall. While chronic care patients are a small percentage of hospital visits, they comprise over two-thirds of the total cost spent in treatment. CCM solutions like TimeDoc Health help lower those costs for everyone.

What Conditions Qualify for Chronic Care Management?

The Centers for Medicare and Medicaid Services (CMS) lists 21 chronic conditions for which “prevalence and Medicare utilization and spending are presented.” Which conditions are considered chronic by CMS? Eligible CCM patients will likely suffer from two or more of the following conditions:

  • Hypertension (high blood pressure)
  • Diabetes
  • Depression
  • Cancer (Breast, Colorectal, Lung, and Prostate)
  • Drug Abuse / Substance Abuse

The CMS describes chronic care patients as “patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.” These patients should expect to receive some form of regular care each month.

What Are CCM Services?

CCM treatment plans can look vastly different for each patient, but essentially all of CCM services are conducted outside of regular office visits. As such, these services are typically not provided face-to-face. Below are just a few examples of what CCM offers:

  • Remote Patient Monitoring (RPM): As technology advances, the need for in-person doctor visits is decreasing. Many conditions, such as high blood pressure and diabetes, can be monitored through RPM, cutting down on cost, travel time, and many other spent resources. RPM is a vital piece of comprehensive CCM care, and managing that data is just one of the many benefits a CCM solution like TimeDoc Health can provide.
  • Medication Management and Adherence: Care coordinators help patients take their medication properly. This includes when to take it, how often, and what medications can (and cannot) be taken together. While this may seem simple for someone without a chronic condition, it can become quite complicated, especially when multiple chronic conditions are at play.
  • Patient Education: Since most treatment for chronic conditions happens outside the doctor’s office, the patient needs to stay (and feel) informed. CCM providers can schedule regular telehealth follow-ups with their patients to ensure they understand their treatment plans, answer any questions, and provide whatever resources the patient needs to feel more knowledgeable—and hopefully, at ease.

Other examples include care planning, shared decision making, bi-directional communications, preventative services, and management of care transitions.

What Is the Difference Between Chronic Care Management and Remote Patient Monitoring?

The difference is that one is a process, while the other is a technology used for that process.

Remote patient monitoring (RPM) is the technology that allows medical professionals to monitor a patient’s health from a distance—namely, while the patient is at home. Chronic care management, on the other hand, is a comprehensive list of methods and tactics to treat patients with chronic conditions. 

Chronic care management and remote patient monitoring may sound like the same thing, but the best way to remember the difference is that RPM is just a piece of chronic care management. Combining both can be valuable to the patient and provider. 

Is Chronic Care Management Worth It?

Absolutely! Not only does chronic care management matter to the patient, it also matters to the healthcare provider. Here are just a few positives of working with a CCM provider like TimeDoc Health:

  • Additional help with care coordination that can be scaled up or down, depending on staff needs
  • Automated care planning to streamline processes, leaving more time to connect with the patient
  • Medicare program compliance, regularly maintained with vital data sent straight into the EHR
  • Reduced time spent on billing, accounting, and documentation of transactions
  • Comprehensive training for medical staff on the TimeDoc Health platform

CCM solutions help healthcare providers improve their patients’ quality of life, achieve better patient outcomes, and save on costs for everyone involved. What’s not to like about that?

TimeDoc Health: Powered by Software, Driven by People

Complex problems don’t require complex solutions. At TimeDoc Health, we’ve created a tech-enabled service that simplifies CCM and makes it easy for a provider to implement. Not only that, but we bring something that most CCM solutions do not possess: a human element. At TimeDoc, we put the “care” in healthcare. Our CCM solution gives patients access to the connections and empathy they need to work through a challenging period in their lives. 

Make every minute count in your chronic care management workflow—starting today. Request a demo now, and see how simple (and rewarding) CCM can be for you and your patients.