Did you know that approximately 133 million Americans have at least one chronic illness? Now, this puts pressure on the healthcare systems. Therefore, healthcare providers have been forced to devise different strategies to prevent them from being overwhelmed. One of the strategies many medical practices have adopted is remote care. Through this program, they can offer their services without needing the patient to visit the hospital.
However, remote care models are still facing challenges. Remember that medics are used to offering facility-based care to help patients when they are sick. So, this makes it hard even for the patients themselves to switch to virtual care services. Not to mention remote services also have issues with reimbursements. Therefore, many physicians tend to avoid them as they aren’t fully compensated for their services most times. But, scalable care management could be the solution they need. Keep reading to learn about the economic benefits this program offers.
Challenges Facing Care Management?
Care management faces different challenges preventing its progress. One is that many patients do not enroll in such programs. And even those who register don’t stay in them for a long time. Additionally, there is a shortage of nurses, which forces medical practices to hire more. But this isn’t easy and takes a lot of time.
Again, practitioners find it hard to integrate technology platforms, and since these programs are generally costly, it’s challenging to cover them, considering the reimbursement rates are not that high.
Another challenge providers face is integrating tailored technology platforms that will make it easy to provide and bill chronic care management services. A recent piece of literature says that CCM models that only depend on technology-enabled approaches will have difficulty building a trusted relationship between clinical staff and patients, which is needed for better outcomes.
For this reason, many clinicians don’t pursue remote care. But this is unfortunate given that it could provide many benefits for providers and patients. A Mathematica Policy Research Group study revealed that providing CCM services can help reduce hospitalizations and ED usage, improve MIPS cost scores and increase patient connection.
How Can Scalable Care Management Help?
Scalable Care Management can help physicians and healthcare providers overcome the above barriers and improve healthcare in the given population. A program that manages several healthcare organizations can reduce these challenges. But it has to meet some principles to work. For one, it has to support seamless billing and generate profits for medical practices.
Also, it should include methods proven to increase the enrolment rates for qualifying patients. Lastly, the program must use technology that easily integrates with each EHR practice and workflow.
In other words, the program needs to encourage the patient to establish a trusted and ongoing relationship with their nurses under the supervision of a qualified doctor. That way, they can be compliant and satisfied with their treatment plan. As a result, they will engage proactively in their care.
When patients feel satisfied with what a medical practice offers, they won’t see a reason to change their provider. As such, the medical practice can enjoy new net revenues and relieve pressure from the staff as they won’t need to plan, launch and manage a program on their own.
How is a Program’s Value Measured?
Some online websites offer an economic value calculator that providers can use to calculate their expected revenue and savings. Such calculators use publicly available data to help measure the value of CCM. They take into account several data points from a healthcare organization, like inpatient discharges, net revenue, and ED, to calculate the impact of care management on an organization. But in general, once a company implements scalable care management, it can expect more revenue, and the staff will save time on administrative and clinical tasks.
What Reimbursement Do Providers Receive from CCM?
CCM reimbursements are divided into three categories and depend on the CPT codes being used. There is the basic CCM, where providers are compensated for CCM monthly for engaging patients in their CCM program. Providers can also bill for complex CCM offered to patients that need additional time and care. These are the individuals that require more interventions to reduce or prevent hospitalization. Lastly, physicians can bill for behavioral health, a crucial aspect of people with chronic conditions. Medicaid and Medicare now compensate providers that include behavioral health in their programs. But this is billed using a different code, and the patient must be enrolled separately.
Final Thoughts
Scalable care management benefits providers in different ways, as we have seen. One, it increases their revenue, and two, it leads to time savings since the program relieves the burden from the staff, which means they get to serve more people. This translates to more revenue.
