Providers spend a significant amount of time in between visits managing their most complex cases and chronically ill patients without reimbursement. This expectation changed in 2015, when the Center for Medicare and Medicaid Services (CMS) began paying for Chronic Care Management (CCM) services. However, many providers still choose not to participate in CCM due to layers of complicated requirements.

According to the Center for Medicare and Medicaid Services, it is estimated that only 9% of Medicare fee-for-service beneficiaries received Chronic Care Management, Transitional Care Management, and Advance Care Planning services. CMS acknowledged that the resources were underutilized and encouraged providers to get more involved with them in 2019, but the most significant change occurred in 2022 when CMS dramatically increased CCM reimbursement.

The average South Carolina Medicare Reimbursement for CCM increased from approximately $40 per call to $60 per call- a 50% increase.  This change signified CMS acknowledging the value that CCM services have as a driver for better patient outcomes, reduced healthcare costs, and increased quality of life for the millions of Americans living with chronic conditions. The considerably larger reimbursement can also impact healthcare programs that span the spectrum of fee-for-service and risk-based programs.

Providers are strongly incentivized to implement programs for managing patient care between office visits, particularly those in the rising-risk population. Rising-risk patients may have multiple chronic conditions but are unaware, unwilling, and/or unable to access the care they need to prevent them from falling into the highest-risk population. These services are beneficial for all patients, but particularly valuable for the rising-risk demographic; intercepting and addressing the needs of these patients can prevent a catastrophic health event that would push them into higher-risk territory.

According to The American Hospital Association, only 20% of overall health is determined by clinical care. We truly believe the path to better healthcare for all is what takes place in between clinical care appointments. Chronic care management services between provider visits create a more complete picture of an individual’s health, including socioeconomic factors and health behaviors that often go undetected and have a major influence on overall patient health. Without any insight into these factors, it’s impossible to work toward better, more consistent person-centered primary care.

If you think you might be interested in implementing CCM within your organization and need assistance with the process, WebsterRogers has a team of dedicated healthcare consultants on standby ready to help.

Contact our Healthcare Services Team for more information or to get assistance: [email protected].