Tag Archives: value based care

Medicare CCM Program: How HealthViewX Makes a Difference

Chronic illnesses, such as diabetes, hypertension, and heart disease, pose a significant healthcare challenge. Managing these conditions effectively requires ongoing care and coordination. To address this, the Medicare Chronic Care Management (CCM) program was introduced to provide comprehensive care for patients with multiple chronic diseases. It is a valuable initiative that aims to provide better care, reduce healthcare costs, and enhance the quality of life for individuals with complex health needs.

The CCM program not only provides better care for patients with chronic conditions but also offers healthcare providers an opportunity to improve their revenue streams. Under this program, healthcare providers are reimbursed for offering non-face-to-face care coordination services to eligible Medicare beneficiaries. 

However, delivering CCM services profitably can be challenging without the right tools and technologies. In this article, we explore how HealthViewX, a care orchestration technology platform, empowers clinicians to deliver CCM services profitably, all while enhancing patient care.

The Profitability Challenge

While the Medicare CCM program presents a unique revenue opportunity for clinicians, it also comes with its challenges. To deliver CCM services profitably, clinicians must navigate a range of complexities, including administrative tasks, data security compliance, managing care team and patient engagement. This can be daunting, time-consuming, and costly without the right support.

How HealthViewX Empowers Clinicians

HealthViewX is a transformative healthcare technology platform that offers a suite of features designed to streamline and optimize the delivery of CCM services. The platform capabilities empower healthcare providers to deliver more effective and personalized care to patients with chronic conditions, ultimately leading to better health outcomes. Here’s how HealthViewX helps clinicians deliver the CCM service profitably:

Automated Administrative Tasks: HealthViewX platform empowers clinicians to identify eligible patients, enhance patient enrollment process, create personalized care plans, capture and document accurate time spent with patients by tracking calls & emails. This automation reduces the time and effort required for administrative tasks, allowing clinicians to focus on patient care.

Care Coordination at Its Best: HealthViewX excels in care coordination, which is fundamental to the success of Medicare CCM. The platform streamlines communication among care team members and this synergy ensures that all parties involved in a patient’s care are on the same page, leading to more effective treatment plans and improved patient outcomes. Engaged patients are more likely to adhere to treatment plans, make healthier lifestyle choices, and actively participate in their own care.

Care Plan Customization: HealthViewX has got over 86 pre-defined care plan templates based on various conditions that helps clinicians to create personalized care plans tailored to each patient’s unique needs. This not only improves patient outcomes but also increases patient satisfaction, leading to better retention and profitability.

Targeting High-Risk Patients: Not all patients with chronic conditions have the same level of risk. HealthViewX employs risk stratification algorithms to identify high-risk individuals who require more intensive care management. By focusing resources on those who need it most, healthcare providers can allocate their resources and efforts effectively for improved outcomes.

Billing and Documentation: Billing and documentation are essential aspects of Medicare CCM. The platform simplifies billing and documentation processes, ensuring that clinicians efficiently document patient interactions and maximize their reimbursements for CCM services. It helps clinicians avoid revenue loss due to incomplete or inaccurate billing. It also lets providers generate billing reports based on CMS guidelines for guaranteed reimbursement. 

Secure Patient Data: HealthViewX prioritizes the security and privacy of patient data, ensuring that sensitive health information remains protected. Compliance with data security standards is critical to maintaining trust with patients and regulatory authorities.

Analytics and Reporting: HealthViewX offers robust data analytics tools that enable healthcare providers to track the performance of their CCM services and patient outcomes over time. By analyzing trends and patterns in patient data, providers can make informed decisions and adjust care plans as needed. This data-driven approach promotes evidence-based care, continuous improvement and increased profitably.

Cost Savings: By automating administrative tasks, reducing non-compliance risks, and improving patient engagement, HealthViewX ultimately saves clinicians time and resources, contributing to increased profitability.


Medicare’s Chronic Care Management program was introduced to help manage the health and well-being of beneficiaries with multiple chronic conditions. The Medicare CCM program is a unique opportunity for clinicians to provide better care for patients with chronic conditions and boost their practice’s revenue. By automating administrative tasks, ensuring regulatory compliance, enhancing patient engagement, and optimizing billing, HealthViewX emerges as a game-changing solution that empowers clinicians to achieve profitable outcomes while delivering high-quality care. As the healthcare landscape continues to evolve, technology solutions like HealthViewX will be instrumental in transforming healthcare practices, and also in making the CCM program more accessible and profitable for clinicians.

CMS’s Journey To Value-Based Care

Most people think of CMS (Centers for Medicare & Medicaid Services) as an insurance company that covers individual services provided by physicians, FQHCs, hospitals, and other health care providers. Some people even think of it as a policy-writing agency for Medicare. It is true that CMS reimburses providers for services to millions of individual beneficiaries. However, since the Affordable Care Act came into action in 2010, CMS has been developing focused payment strategies that shift from fee for services to value-based care and a focus on population health. 

Today, CMS’s second-highest strategic priority is prevention and population health. To this day, the agency is engaged in numerous activities to promote effective prevention of chronic diseases and not just its treatment.

In 2011, the federal government reported that fewer than half of all adults aged 65+ were regular in checking the core set of recommended preventive services. The Affordable Care Act took a big step towards improving the access to preventive care by eliminating out-of-pocket costs for these preventive services in most insurance markets. This resulted in guaranteed access to preventive services like diabetes screening and cervical cancer screening to almost 137 Million Americans without cost-sharing.

Despite improved access to care, the use of preventive services among seniors with traditional Medicare coverage has not changed significantly. There are several hindrances that inhibit the greater uptake of preventive services. A 2014 survey reveals that only 43% of adults were aware of the new clinical preventive benefits provided by the Affordable Care Act. Of those who were aware of the services, 18% cited cost as a barrier, even though the Affordable Care Act eliminated co-payments for preventive services. 

Another obstacle is that many Americans believe that preventive services are not important. Thus, even though many cost barriers have been removed, many Americans still might not perceive preventive services as valuable to their health and well-being. This mindset needs to change. 

Shifting the paradigm of preventive care requires CMS and other payers to provide incentives beyond individual services to broader value-based and lifestyle interventions that can change population outcomes. To address this issue, CMMI has developed 2 payment models:

(1) The Million Hearts Cardiovascular Risk Reduction Model:

Million hearts model

This model associates payment with population-based risk reduction. It is expected to reach over 3.3 million Medicare fee-for-service beneficiaries and involve nearly 20,000 health care practitioners by December 2021.

(2) The Medicare Diabetes Prevention Program:

Medicare Diabetes Prevention Program

This program ties payments to the achievement of weight loss through evidence-based lifestyle intervention.

CMS collaborated with sister agencies such as the Centers for Disease Control and Prevention (CDC) to develop these population health models, and they are good examples of how CMMI is using the Medicare payment structure to improve prevention and population health.

These path-breaking innovations offer an opportunity for CMS to test payment models that emphasize payment for population health outcomes rather than just individual outcomes, with the goal of better care and a healthier population.




How COVID-19 is changing the Healthcare Industry

The COVID-19 Pandemic has greatly challenged the existing capabilities of the Healthcare Industry. The rapid spread of the virus has brought the world to a standstill and has health leaders scrambling to find new approaches to healthcare. Despite the obstacles that have been thrust upon the industry, the prospect of technological advancement gives the healthcare industry an opportunity for accelerated growth.

Short-Term Impact of COVID-19

short term goal of healthcare during covid-19 pandemic

One of the main consequences of the Pandemic has been undermanned or under-equipped health staff. The intensity of the virus has left many clinics with less than the required resources to help COVID patients. Another related issue faced mainly by urban health clinics is Hospital Overcrowding. Non-COVID related patients will also see delays in their care journeys. The healthcare industry must also prepare for the following long-term impacts of the COVID-19 Pandemic.

Increasing Role of Virtual Health services

advancements of virtual healthcare services

The pandemic has revealed the importance of virtual health care services such as Telehealth and Remote Physiological Monitoring (RPM). The contagious nature of COVID-19 has forced many clinics to close their doors to non-COVID patients. Without virtual care technology, many patients with chronic or other severe conditions would lose access to essential healthcare. In addition, clinics would be losing a significant portion of their revenue. However, providers who utilize a virtual telemedicine platform are still able to connect with their patients. As of 2017, some form of Telemedicine platform is employed by over three-quarters of hospitals in the US. The pandemic will cause that number to increase while encouraging existing users of telehealth to make their platforms more extensive. 

Eliminating the Traditional Care Journey

Eliminating the Traditional Care Journey

The emergence of telemedicine has allowed for the virtual exchange of high-quality health services. By using virtual technology, physicians are able to provide check-ups, patient education, and care plans. Patients can access these services from the comfort of their homes. This new development due to the pandemic has brought into question the future of traditional clinical visits. Hassle-free telemedicine solutions have exposed the inefficiencies of conventional care journeys. Previously, patients might waste an entire day for a simple check-up due to long wait times and large clinical facilities. In the end, they may not even receive conclusive treatment if they are referred to another practice. These inefficiencies contribute to a high patient no-show rate, which costs the American healthcare industry over $150 billion/year. Convenient telemedicine platforms remind patients ahead of their appointments and provide them with effective and timely care. 

Altering the future of Value-Based Care

 future of Value-Based Health Care Services

While the “Value-Based Care” movement has been gaining momentum for a few decades, the COVID-19 pandemic might slow down the shift. The decrease in elective surgeries and non-COVID related care has been financially crippling for many practices. While RPM and Telehealth reimbursement codes cover for some of these losses, clinics are still seeing a decline in revenue due to the pandemic. The deal-breaker for most clinics involves the financial risk involved in a Value-Based model. Many Value-Based contracts involve a great deal of downside risk, or potential financial shortcomings due to missed targets. This financial risk may have over half of Accountable Care Organizations (ACO) consider abandoning this model. This may also encourage current fee-for-service providers to avoid adopting a Value-Based platform in the future. In order to mitigate a large-scale exodus from the Value-Based scheme, the CMS could subsidize providers by removing downside risk clauses for the near future.  

Accelerating the Adoption of Artificial Intelligence

 Adoption of Artificial Intelligence in healthcare

Artificial Intelligence (AI) is emerging as a new solution for the current healthcare-related issues. AI involves the use of machines to perform human activities such as learning, interpreting, and analyzing. While AI in healthcare has not yet reached its full potential, investment in this field is expected to grow tenfold between 2014 and 2024. While AI systems are still in an early developmental stage, they are already used by many providers in areas such as diagnosis, patient education, and predictive analysis. 

Robotic machines are an example of how AI could be put into action in a healthcare setting in the near future. These systems could carry out tasks like patient engagement, or even remote surgery. When dealing with infectious diseases like COVID-19, AI based robots could eliminate unnecessary human interactions, thus decreasing the risk of transmission. When used for diagnosis and treatment, these machines are significantly more accurate than existing technology. In the long run, AI could lead the way for virtual/augmented reality to make its way into mainstream healthcare. 

The COVID-19 pandemic has proven to be a watershed event in the history of medical care. While the industry continues to face immense challenges, greater opportunities for growth lay ahead.

Talk to us to understand how HealthViewX is transforming the Care Journey for both patients and providers!

Emerging Technologies that will shape the Future of the Healthcare Industry

The Healthcare Industry has witnessed a great deal of innovation over the past few centuries. Some pioneering breakthroughs include the discovery of vaccines, antibiotics, and insulin. Developments such as these have drastically increased the overall quality of life for billions of people across the planet. These substantial improvements over the past two centuries have led to the emergence of recent tech-based health innovations.  

How the move to Value-Based Care affects Innovation

The Healthcare industry has witnessed a shift towards “Value-Based Care” over the past few decades. This model focuses on the patient outcome more than any other factor. This has influenced technological innovations to be patient-centric rather than purely profit-focused. 

RPM Devices

how remote patient monitoring helps to achieve value based care

Remote Physiological Monitoring (RPM) is a form of real-time telehealth that employs the use of technology in the live collection of vital parameters such as heart rate, blood pressure, weight, or any other relevant measure. These compact gadgets track and send these parameters to qualified health professionals who can analyze the results. RPM devices give patients the opportunity to monitor their condition on a daily basis without constant clinical visits. These devices have allowed providers to remain updated with their patients when a physical visit is not possible. Effective use of these devices is proven to decrease the number of readmissions, which costs the industry over $41 billion a year. The RPM market is expected to grow to $2.7 billion by 2020, per a projection by Research and Markets. If RPM devices can prove their value in a competitive health tech market, they may become an integral part of human life. Their compact nature can allow them to become as ubiquitous as a wristwatch, especially for aging populations. 


what are new advancements in telehealth

Telehealth involves the transfer of healthcare services through a telecommunications platform. While it includes monitoring and education, it is most commonly used as a tool for virtual appointments between providers and patients. Commonly used Telehealth platforms involve the use of a video/audio system with the ability to send EHR/EMRs or other health records by message. Telehealth acts as an added revenue stream as the CMS reimburses providers who employ telehealth services. For patients, telehealth means they can access high-quality healthcare from the comfort of their homes. The use of telehealth has rapidly grown over the past decade as 75% of hospitals utilized a telehealth platform in 2017 as opposed to 35% in 2010. In the long run, telehealth can help eliminate nonessential patient visits which waste both time and resources. With technological advances, telehealth might soon adopt a “virtual reality” based format. This can increase patient-provider interaction while enhancing the quality of care.  

Artificial Intelligence

how Artificial Intelligence hep in healthcare industry

Artificial Intelligence (AI) involves the use of machines to perform human activities such as comprehension and analysis. In a healthcare setting, it can be used to make an advanced interpretation of health-based data. The amount of investment in health-based AI is projected to grow from $600 million to $6.6 billion between 2014 and 2021. AI can make patient-specific care plans by accounting for millions of variables involving the patient’s health condition and trajectory. AI could potentially open the door for “Precision Medicine,” which could be a landmark development in modern medicine. While this method is still highly experimental and embroiled in controversy, the prospects of an effective model remains promising.  

The Impact of COVID-19 on Health Tech Innovations

The COVID-19 Pandemic has placed a heightened focus on the current capabilities of the Healthcare industry. The pandemic has offered both challenges and opportunities for technological innovation. One of the primary flaws of the industry that COVID-19 has highlighted is the prevalence of unnecessary and inconvenient patient visits. As health centers across the country have been focused on tackling the pandemic, patients with other conditions have been encouraged to stay home and receive virtual care. Many patients are able to mitigate their existing conditions without time-consuming visits to a clinic. At the same time, this provides an opportunity for a widespread adoption of telehealth services. Many providers have experienced the efficiency of virtual health services and will continue to invest in these solutions. Clinics without such platforms will likely adopt telehealth to address their lack of virtual care services. The pandemic will no doubt leave an enduring mark on the healthcare industry. The lessons learned from the pandemic will surely shift the focus of innovations towards virtual health solutions. 

Talk to us to understand more about Value-Based Care and we will guide you to achieve our common goal “Quality Care for All” seamlessly.

Technology’s Role in the Shift Towards Value-Based Care

Value-Based Care is an increasingly popular healthcare model in which providers receive reimbursement that reflects the outcome of the patient. This concept emphasizes the importance of improved patient health and accordingly benefits providers who are able to deliver to their patients. The traditional “Fee-For-Service” model which involves flat rate payments irrespective of patient outcomes or care quality has grown out of favor. 

The move away from a purely profit-focused model and towards a patient-centric model highlights the trend of developments in the US healthcare industry. This seismic shift towards Value-Based Care is not possible without some of the modern health tech innovations which are at the forefront of the movement. 

The move towards Value-Based Care

For quite some time, the healthcare industry was known as a purely profit-based industry. In order to shift the care focus towards the patient outcome, the Centers for Medicare & Medicaid Services (CMS) has laid the groundwork for various Federal Acts that incentivize providers who adopt a value-based model. The most notable of these was the 2010 Affordable Care Act (ACA). This aligns with the “Triple Aim” framework promoted by the CMS:

Triple Aim framework promoted by the CMS

The increase in concrete support from the Federal Government influenced many providers in shifting to a Value-Based model. 

Why Value-Based Care?

The attractiveness of the Value-Based structure can be attributed to its numerous benefits for both patients and providers. This model is highly popular amongst patients as it highlights provider accountability for the outcome of their care. Patients can achieve peace of mind knowing that the improvement of their health is the primary goal. 

For providers, this model offers a larger patient outreach while handing out incentives for better performance. The increased use of technology has helped practices use reliable data to make informed business decisions. While this structure is inherently appealing for all parties involved, the advancement of technology has fueled its widespread acceptance. 

Achieving Value-Based Care through Enhanced Care Journey Mapping

Enhanced Care Journey Mapping involves the tracking of patient activities throughout their care process. It is used to conceptualize the process and eliminate any tedious or redundant tasks. Journey Mapping is a prime example of Value-Based care as it seeks to improve patient outcomes. Providers can identify areas where patients face inconvenience and take measures to address them. By analyzing the overall care journey, providers can optimize the patient experience.

What technology solutions are involved?

The large-scale move to a Value-Based Care model has been made possible by the following solutions:

    • Telehealth: Telehealth involves the exchange of virtual health services (such as video conferencing) using an electronic platform. The emergence of telehealth software has given patients high accessibility to quality care. Providers can open a new revenue stream while staying up-to-date with their patients, even when a physical meeting is not possible. 
    • Remote Patient Monitoring: Remote Patient Monitoring (RPM) is a healthcare practice that uses technology to monitor patients in a virtual manner. RPM allows patients to monitor their health daily and encourages them to be more involved with their care. The adoption of RPM services can be directly attributed to a decrease in readmission rates. RPM gives providers valuable insights into the patient’s current condition.
    • Chronic Care Management: Chronic Care Management (CCM) involves the facilitation of patients suffering from two or more chronic conditions. Virtual health software services have greatly improved the quality of CCM. Providers save time and money by using these services to connect with their chronic care patients. Patients with chronic conditions can eliminate unnecessary clinic visits and receive timely health feedback from the convenience of their homes.  
    • Referral Management: Providers have increasingly adopted software systems that streamline their patient referrals. Patients can expect increased efficiency while not having to worry about documentation and processing issues. This has greatly decreased referral leakage which can cost individual practices millions of dollars each year. 

Challenges in shifting to a Value-Based Model

While providers across the nation have welcomed the value-based model, some significant obstacles remain before it becomes the industry standard. 

  • Technological Disparities: Many practices do not have the necessary tech infrastructure to operate a value-based model. Many practices lack programs like RPM and EHR Integration, which are integral to the operability of the model.
  • Government Support: While the CMS has supported many value-based initiatives, it remains to be seen how the Federal Government will include all patients and providers under the triple aim
  • Financial Risk: This shift, like any large financial investment, comes with a moderate level of risk. Many smaller practices cannot afford to gamble on a move that may not pan out.  

Nonetheless, the Value-Based model has shown great promise in bringing change to provider-patient relationships. The response to these issues will determine the success of the model in the long run. 

Talk to us to understand more about Value-Based Care and we will guide you to achieve our common goal “Quality Care for All” seamlessly. 

Transform Care Journey to Deliver Value-Based Care

The shift from volume-to-value-based is improving patient health outcomes and reshaping the relationship between patients and providers. With the increasing role of technology in the healthcare setting, patients extensively rely on digital sources to stay informed, engaged, and connected with the physicians and specialists involved in their treatment.

the use of healthcare technology solutions

This transformation with the use of healthcare technology solutions is progressively gaining importance across all stakeholders in the healthcare value chain, from patients to health systems, and payers. The key reasons are qualitative treatment modules and improved patient care which also contribute to potential cost savings. The transition from volume to value is expected to expand, despite concerns about providers’ slow adoption of technology.

Patient Journey Mapping

Today healthcare organizations are driven by Meaningful Use policies and regulations, meaning they are focusing on understanding and improving the overall patient journey. Both qualitative and quantitative data can be analyzed to improve smooth transition across care settings. This analysis will help providers further improve patient care, satisfaction, and experience.

The current setting has several limiting factors like the below

how patient mapping can help in gaining value based care

To stay competitive in today’s constantly evolving healthcare market, providers need to evaluate technology solutions and leverage patient journey solutions to streamline processes and provide excellent clinical care. Implementing processes and programs that deliver timely information will help improve pre and post clinical engagement and can help fill gaps that cause leakages in the patient experience

Benefits of Streamlining Patient Journey

how Streamlining Patient Journey can help in value based care

Patients and providers share information at different phases such as appointment scheduling, need for a specialist, or lab test results. Every healthcare organization has hitches that can happen anywhere, starting from appointment scheduling to post-care follow-ups. At each of these points, information flow between physicians, specialists, and the patient should be synthesized.

Patient journey mapping will help in streamlining the workflow, keeping track of the patient’s health conditions, and creating an opportunity for improvements in operations. Overall, it helps improve patient experience and continuity of care.

Talk to HealthViewX Solution experts to strategically build a patient journey map. Unleash the power of the HealthViewX HOPE Platform to layout all touchpoints and goals in terms of healthcare outcomes.