Almost half of the adult population in the US is affected by at least one chronic disease and more than half of Medicare reimbursements are spent on senior patients with more than one chronic conditions. These are not pretty statistics nor is this financially or socially sustainable.
As a response, albeit late response to this rise in cost and fall in population health statistics, CMS has devised a program to control the epidemic. The CMC Chronic Care Management program was designed to promote a ‘healthy’ and sustainable long-term care delivery model which will incentivize providers for providing care above and beyond traditional. The program will identify patients with more than one chronic condition as it is defined by CMS and will provide care as these patients have the most risk and thus the most expensive to treat.
It has been little more than a year and a half since this new program was introduced and yes, it is too early to evaluate. But as far as we can see the take away from the program is largely positive. Reports state that the program has been successful in increasing the patient’s participation in their health, improving patient-provider relationship and overall health outcome. Yet this might not be the right way of evaluating a program. The better way to look at this is to look at the overall picture of what the program promises not just for patients but for all stakeholders.
Chronic care management is proposed to set a new approach to healthcare and its expenditure, value-based model is taking over the fee-for-service model and is connected to provider reimbursement.
Some ‘‘other’’ benefits of CCM are as below
Reactionary care to proactive care
Beyond the four walls of a care facility
Reduce readmission chances
Promotes the use of telehealth technology
1. Reactionary care to proactive care:
The use of medicine has always been more or less reactionary, healthcare did not actively participate in eliminating the chances of getting a disease or condition but always reacted to the symptoms resulting out of these diseases as it is explained by patients or observed by the healthcare professionals.
Those with multiple chronic conditions are at a greater risk of accumulating other health concerns as time progresses. Chronic care management aims to highlight this factor by looking at the overall health of the patients.
2. Beyond the four walls of care facility:
Chronic care management forces providers to look and reach beyond their office walls and provide care. It’s a conventional idea but in practice, this is rather a new concept.
For example, CCM program elements highlight that the provider or a qualified staff must contact the patient regularly for at least 20min of face-to-face care over a period of one calendar month. This is a new manner of engaging with patients for many physicians allowing them not only to look at the symptoms but sometimes be actively participating and engaging along the recovery period of the patients.
3. Reduce readmission chances:
Patients with more than one chronic conditions have a higher chance of getting admitted to a hospital than a healthy patient. For a chronic patient it is a never-ending journey to the hospital and from the hospital, not being able to put the constant shift, it gets hard to settle down post discharge. Continuous contact and monitoring of patient condition help in avoiding unnecessary readmission which not only affects the patient financially but also their morale.
4. Promotes the use of telehealth technology:
Telehealth means the use of various information technology tools to connect and contact with patients when they are geographically separated from the location of the provider or the facility. Chronic care management program promotes the use of such technologies, it has shown that such technology can improve the patient health outcomes. Such technologies need not be limited only to CCM program but can be successfully used for achieving better results with other patients in general.
5. Holistic approach
This is the whole point of the exercise, to have a holistic approach towards healthcare. CCM program aims to look at a patient as a whole rather than a list of conditions and complications. Our healthcare professionals have been doing a great job within the bounds of what they could do but with the introduction of CCM providers being incentivized to do the best they can for the health and welfare of their patients.
So, why should we care about CCM after the many acronyms that have come out before?
Acronyms proposed by many new laws and out of many agencies and they all came short of what was promised.
We should care about CCM because it is a new idea which came out of a new way of thinking, which if everything goes as well as it does on paper can positively impact the lives of many people who are forced to choose between health and financial well-being, having to watch their loved ones suffer helplessly; between pursuit of hospital bed and pursuit of happiness.