Chronic Care Management Benefits Patients and Their Providers

Natalie Benner
Natalie Benner
Assistant Vice President

Many patients are unable to manage their chronic condition(s) on their own. We know patients are more likely to achieve their health goals with support from chronic care management services. That’s one of the primary reasons in 2015 Medicare expanded covered benefits to include chronic care management services under Part B if patients have two or more chronic conditions. 

Another driver of this benefit expansion is the costs associated with chronic disease. A RAND study showed patients with one or more chronic conditions are responsible for 90 percent of healthcare spending while those with five or more represent about 12 percent of the population and 41 percent of health costs. 

The Centers for Medicare and Medicaid Services (CMS) evaluated the Chronic Care Management program and determined that it improved outcomes and reduced costs. The retrospective claims analysis of two years of data that included every enrolled patient research showed:

Chronic Care Management Improved Outcomes

  • Hospitalizations decreased by nearly 5 percent.
  • Emergency Department visits decreased by 2.3 percent.
  • Preventive care evaluation and management (E&M) encounters increased by 8 percent. 

Chronic Care Management Reduced Costs

  • Taxpayers saved $74 (gross) and $30 (net) per patient per month when patients enrolled for at least a year. 

The program also provides revenue to primary care providers, compensating them for work many say they have long been doing. In the words of one internist cited in Medicare’s two-year claims analysis, 

“We were already providing these services before we were allowed to bill for it. We spent a lot of time on the phone with our chronically ill patients. It was good news for us that we could finally be paid for it.”

How Cadence Clinical Design Helps with Chronic Care Management

In short, Cadence Clinical Design provides clinical RN expertise and the infrastructure to identify, enroll and manage patients. That’s because many providers do not have the Medicare volume to support a full-time RN to coordinate care and services. We also prepare detailed monthly reports for outcomes measurement and billing. 

Our chronic care management shared services enable primary care practices of all sizes to participate, helping their patients and themselves. The value of chronic care management is:

  • Ongoing patient engagement and support
  • Designated patient care team  
  • Care coordination as an extension of provider
  • Timely and transparent communication among care managers & providers 
  • Increased patient connectivity with health system, PCP and specialty providers
  • Promotion of health literacy & advocacy
  • Improved overall quality of care and health outcomes
  • Provider satisfaction and support
  • Increase in practice revenue

We have three types of chronic care management services:

  1. Chronic Care Management (CCM) for Medicare beneficiaries with two or more chronic conditions which place them at risk 
  1. Principal Care Management (PCM) for patients with a single high-risk chronic condition
  1. Transitional Care Management (TCM) a 30-day transition for patients discharged from hospital

Each of these services uses the same general operational model: