Strategies to Successfully Implement CMS Chronic Care Management Services
CMS Chronic Care Management (CCM) program provides opportunities for patients and providers to improve health outcomes and improve self-care. The CMS guidelines for Chronic Care Management Services assist practices to deliver comprehensive services in management and monitoring of their patients. We will be discussing the challenges, and how to overcome them to have a successful CCM program.
Challenges in Implementing CMS Chronic Care Management Services
Implementing Chronic Care Management (CCM) services can come with several challenges that healthcare professionals and organizations may face. Some common challenges include:
- Patient Engagement: Encouraging active patient participation and engagement in their own care can be challenging. Patients may have difficulty understanding the advantages of CCM services. Additionally, if you are utilizing remote physiologic monitors with patients they may have difficulty using or transmitting the information back to the practice. We found that having patients use cloud-based devices versus bluetooth devices may be more helpful since sometimes the patient will not know how or forget to pair the blue-tooth device and the data will not be sent to the practice in a timely manner for review. Additionally, they may face obstacles such as limited health literacy or access to technology.
- Care Coordination: Coordinating care among multiple healthcare professionals and ensuring smooth communication can be a complex task. Fragmented healthcare systems, inadequate information exchange between electronic health records (EHRs), shortage of chronic care staff, and limited communication can affect patient care coordination.
- Provider Workload: Offering CCM services can increase healthcare providers workload, especially in terms of care coordination, documentation, and patient communication. Providers may require additional resources or support to effectively manage the expanded workload.
- Reimbursement and Financial Sustainability: Navigating the reimbursement landscape and ensuring proper reimbursement for CCM services can pose challenges. Complex billing codes and documentation requirements can lead to administrative burdens for providers. The financial sustainability of offering CCM services may require careful consideration.
- Medication Compliance: Access to and management of medications is by far one of the most common barriers to chronic condition management compliance due to a variety of factors, including rising drug prices.
- 25% of patients are paying more for their medications than they did a year ago, and 14 percent of those patients did not fill a prescription due to cost, according to data from Consumer Reports Best Buy Drugs.
- 1/4 of patients are unsure they will be able to afford their medications in the future.
- Technology Adoption: Implementing CCM services often requires technological solutions, such as electronic health records (EHRs), chronic care management software, and remote monitoring tools. Healthcare organizations may encounter challenges associated with technology adoption, such as infrastructure requirements, staff training, and ensuring data privacy and security.
- Workflow Integration: Integrating CCM services into existing practices and workflows can be disruptive. Healthcare workers may need to adjust documentation, train staff, and allocate resources to implement CCM services effectively.
To overcome these challenges, we need to involve stakeholders. We also need to provide education and training to change workflows to all healthcare professionals. Other important aspects are using technology and collaborating with payers and regulators.
By overcoming these challenges, healthcare organizations can effectively implement CCM services and enhance care for patients with multiple chronic conditions.
Strategies to Overcome Barriers to Implementing CMS Chronic Care Management Services
To overcome barriers to implementing Chronic Care Management (CCM) services, healthcare organizations can consider the following strategies:
- Provider and Staff Education: Offer comprehensive education and training programs to Providers and staff on the benefits of CCM services. Review adjusted workflow processes, documentation requirements, and effective use of technology. This will increase their understanding and buy-in, fostering a supportive environment for implementation.
- Medication Compliance: Care managers can keep a list of generic medications and which pharmacies they can be found to ensure that individuals can access the lowest-cost options for their care. If a care manager can help reduce a copayment of $500 to $20, this is a win-win for the practice and the patient to keep the patient involved in receiving ccm services.
- Addressing Behavioral Health and Mental Health Issues: The population with the likelihood that an individual will respond to a certain strategy or intervention, may not align completely with who has the highest spending or comorbidities, says Community Care of North Carolina (CCNC). Only 53% of the 5,000 patients studied in the NC Medicaid population with highest impactability scores were the highest risk of inpatient admission. Highly impactable patients are characterized by abnormal utilization patterns and clinical complexity along with 80% have 3 or more chronic conditions and 70% have mental illness. We have found that mental health and behavioral health conditions have an impact on patient compliance and encourage these conditions adequate time being spent to address these conditions to help patients stay engaged and improving their health.
- Patient Engagement and Education: Develop patient education materials and communication strategies to promote the benefits of CCM services. Encourage patient participation and provide clear and accessible information about Chronic Care Management services. Communicate the importance of patient-centered care, and how patients can actively participate in their medical management.
- Workflow Redesign: Assess existing workflows and identify opportunities for seamless integration of CCM services. Adjust processes to accommodate care coordination, communication, and documentation requirements. Simplify administrative tasks to reduce provider burden and optimize efficiency.
- Technology Adoption: Invest in user-friendly technology solutions that effectively support CCM services. Tools such as electronic health records (EHRs), patient portals, secure communication platforms, and remote monitoring devices will assist transition to technology. Ensure training and support to both providers and patients to facilitate the effective use of technology.
- Collaboration and Care Coordination: Promote collaboration and communication among healthcare professionals involved in the patient’s care. Primary care providers, specialists, and community resources contribute to patient care coordination. Implement patient engagement solutions, establish standardized communication channels, and conduct regular care team meetings to ensure a coordinated care approach.
- Reimbursement Optimization: Stay updated on reimbursement policies, coding guidelines, and documentation requirements related to CCM services. Ensure proper documentation and billing processes optimize reimbursement. Actively collaborate with payers to address any reimbursement challenges or seek alternative payment models, such as value-based care arrangements.
- Continuous Quality Improvement: Implement a quality improvement program to consistently assess and maximize the delivery of CCM services. Gather feedback from providers and patients, measure outcomes, and make necessary adjustments to enhance the effectiveness and efficiency of CCM services.
Healthcare organizations can use these strategies to overcome barriers and effectively implement CCM services. These strategies can improve care coordination, patient outcomes, and the management of chronic conditions.
