The US has an aging population. Chronic Care Management means there are more and more patients each year suffering from aging ailments and chronic pain. According to the National Center for Complementary and Integrative Health, around 20% of US adults suffer from chronic pain issues.
While most of us will visit the GP for an annual wellness visit, those struggling with pain or other age-based ailments will need more regular check-ins.
To ensure these vulnerable patients have the right access and attention they need, health organizations need to find a way to manage the workload and use preventative or value-based solutions to care for service users. The easiest way to do this is to hire a chronic care management company. To help you get started, we’re sharing this ultimate guide for implementing a chronic care management program into your service.
A step-by-step Guide to Chronic Care Management
1. Create a list of Eligible Patients
The first stage of implementation is creating a list of eligible patients for chronic care management. While this seems like an easy job at first, electronic health records are very complex, making it difficult to ascertain who is eligible without proper data analysis. This analysis will require collecting any demographic and clinical data which is missing and reconciling each record.
Not all patients will be eligible for the care management program, so identifying these people is just as important as finding those suitable, as you don’t want to be billing anyone that will later be denied access.
What makes a patient eligible? The first point is Medicare enrollment (or Medicare Advantage). They should also have seen a healthcare provider for at least two chronic conditions in the past year. Conditions include diabetes, arthritis, COPD, or anything else that significantly impacts the patient’s functionality or risks death.
In order to keep your patient eligibility lists up to date, you’ll need someone who can create custom reports and refresh the list based on patient age and Medicare enrollments.
2. Raising awareness amongst patients
Without raising awareness about the management program, patients will easily miss out on reaping the benefits. That’s why the second step of implementing chronic care management is awareness and patient education.
Providers should look to educate patients on the benefits of the program via marketing materials and in-person discussions. Without having all the facts, several eligible patients may choose not to sign up in fear of paying more or not having serious enough conditions to be eligible.
Try to speak to patients through a number of mediums to find the most appropriate way to start the conversation for each individual.
Even when patients have enrolled, the education shouldn’t end there. New service users could be offered a welcome pack that gives them all the information they need, so they can refer back to it when needed.
Once you have gathered information about who is eligible for the program and informed these patients of the benefits, the next step will be to enroll each individual. You’ll have to gain written or verbal consent from each patient before signing them up (this is required by Medicare and should be documented on their medical record).
Enrollment often requires patients to share the cost of a subscription (around $8 a month), of which they should be informed prior to signing up. If subscription prices are higher than $8, it is more likely that patients will choose to drop off the program entirely. Coinsurance can be the biggest hurdle in enrollment and patient retention, which is why having trained specialists on board will help to ensure service users know exactly what they’re getting themselves into is essential.
Health organizations that do not work hard to retain patients or enroll new users each day will struggle to maintain their program and suffer from significant patient churn.
4. Time management
Once patients are enrolled, the clinical team must schedule at least 20 minutes with each patient per month. Nurses, clinicians, and other health care professionals will need to provide patients with advice or treatment with these regular appointments to keep up their side of the service.
The 20-minute appointments don’t have to be solely on a single treatment. It can be used to advise a patient on self-management for their health conditions, or even to consolidate their care plans and prescriptions. Time management for the chronic care program is crucial, and this designated time for each patient can be used for administrative processes as well as in-person contact. For example, you may use said time to research the best prices for medications or write up referral letters for other services.
As well as keeping records up to date and ensuring compliance, the program’s main focus should be the physical and psychosocial needs of your patients. This involves reaching out to patients to work with them to create goals or a plan of action to prevent their conditions from worsening. The clinical team – or program coordination team – should also be able to provide 24/7 support for enrolled users as and when is needed.
Providers should also aim to create a holistic approach to chronic care management and consider other social and environmental factors that may impact the patient’s physical and emotional well-being.
5. Claiming reimbursements
To ensure you receive reimbursements as quickly as possible, it’s better to organize billing throughout the month rather than waiting till the end. Medicare process payments and reimbursements with a 10–14-day turnaround, meaning it’s better to stay on top of claims to not delay any billing. Consider automated billing integration to reduce your billing team’s workload. That way, the whole practice can work as efficiently as possible while still providing the best level of care to patients.
6. Maintaining a quality service
The final step of implementing a chronic care management program is quality maintenance. Ensuring the quality of the care provided will help with patient retention and satisfaction. Everything from patient calls’ quality to documentation and compliance falls under program maintenance, so it’s best to put practical processes in place to manage the workload.
Using a call recording system will help when auditing quality and archiving, as well as helping to provide the best care to your patients. At any point, patients should be able to request access to their records and recorded phone conversations, so it’s vital to keep on top of filing and administrative work. Medicare may also request information, giving you more reason to ensure documentation and audits are kept up to date.
There is a lot to consider and manage when creating your program. But with the right management company on board, you can reduce the pressure and focus more on providing great quality care.