Chronic Care Management - Greenway Health · - Care Reports: practice receives a PDF monthly for...

Chronic Care Management

Improving Patient Outcomes & Driving Additional Practice Revenue

Objectives for today’s Webinar

• Define CCM

• Benefits of CCM– For Providers

– For Patients

– For Health Systems

• Program Implementation – Enrollment

– Overcoming Challenges

– Integration

• Financial Opportunities– CCM & Related

Our Company

Experienced data analytics and health care communications team with a track record of delivering measurable results

Headquartered in Atlanta, GA

2014 - 1.1M patients processed on the PREMEDEX platform

2014 - 12M+ minutes of care coordination time logged on the PREMEDEX platform

Geographically dispersed client base covering the U.S.

Changing trends are driving the need for increased patient management & communication

Chronic Care Management (CCM)

• Introduced in 2015

Why Chronic Care Management (CCM)?

Poll question

Do you know how many of your patients have more than one chronic condition that could debilitate them?

a) Yes, and we know who they are

b) Yes, but we don’t know who they are

c) No, but we could find out easily

d) No, and we don’t know how to find out

Benefits of CCM

For Providers

• Non-face-to-face reimbursable opportunity

• Improved patient population health care outcomes

• Minimal impact on existing practice workflow

• Better educated patients are healthier patients

• Off-load questions and clinical work related to educating patients about self management

• Improved physician revenue

• Identification of ancillary revenue opportunities

Benefits of CCM

For Patients

• Additional time and sense of patient-centered focus from the Practice

• Medication review & oversite

• Specific care coordination among providers

• Process to assure certain preventive care services are received in a timely manner

• Master electronic care plan

• 24 x 7 access to provider services

Benefits of CCMFor Systems• Improve patient population health care outcomes• Increase Patient Loyalty and Reduce Outmigration CCM

encounters count as E&M visits and decrease member turnover due to shifts in attribution

• Provides monthly interaction / infrastructure for TCM billing & other CPT’s such as remote monitoring

• Ability to apply strategy for patients with high drug costs which could facilitate an outpatient pharmacy strategy

• Identification & capture of ancillary revenue opportunities

• Supports Clinical Integration Initiatives and prepares organization for bundle payment requirements

Poll question

Do you bill for the chronic care management fee today?

a) Yes

c) Not yet, but we plan to in the next 1-2 years

d) Not sure

Program Implementation - Enrollment

• Must discuss CCM with patient during E&M level 4/5, AWV, IPPE or TCM visit

• Obtain patient signature on consent form and document decision to accept of decline the service in EHR

• Opportunity to enroll eligible patients with existing appointments

• AWV is excellent opportunity to create eligible visit

• PREMEDEX Turn-Key Enrollment Plan Optimizes Participation

Program Implementation – Enrollment / Ongoing

• Need physician endorsement but can be a simple script to advise patient of program – Minimal Physician Time Required

• Monthly scheduling, outreach and patient assessment required

• Minimum of 20 minutes with each eligible beneficiary, general supervision, NOT direct supervision is acceptable

• Review and update to beneficiary care plan

• File claims on a monthly basis

Poll question

How prepared are you to reach out to patients for the chronic care management fee?

a) Totally prepared, workflows are in place

b) Somewhat prepared, need to train

c) Not at all prepared

d) Not sure

Program Implementation - Challenges

• Understanding of Regulations for CCM

• Identification and enrollment of patients

• Practice resource availability

• Scalability and patient coverage

• Notification protocols & risk management

What About Clinical Protocols & Escalation Rules?

Practice specifies escalation protocol preferences (method and frequency of communication) by issue:

☐ Urgent Pain☐ Depression☐Medication Non-Compliance☐Medication Side-Effect☐ New Provider

☐ Appointment Needed☐ Transportation Needed☐ Environmental Problem☐ Dietary Need☐ Shelter Required

Upon discovery of an urgent / life threatening issue, patient is told to dial 911 or to visit nearest ER/ Emergency practice contact is notified via automated secure message, direct phone call, or other preferred method.

How Does My Practice Receive Non-Urgent Information?

Report are delivered to practice via secure message:

- Activity Report: practice receives list of patients who received 20+ minutes of

CCM services and summary by type of call activity. Used for billing purposes

- Care Reports: practice receives a PDF monthly for each CCM patient that

highlights of new patient needs, action steps, and details of each call. Used for

updating patient care plan.

As we progress together, the practice has other options in Phase II:

• Receiving PDFs after every call / contact

• Grant access so care coordinators can upload PDF to medical record

• Full interface for more frequent and “user friendly” information

• Direct integration to Greenway system via API

How Do We Help Manage Risk?

1. Business Associate Agreements

2. Certified work environment:

• Computer encryption

• Locked office

• Timed out sessions

3. All PHC communications via secure

messaging

1. All calls recorded & stored for 7

2. 100% initial monitoring of calls

3. Random ongoing monitoring

4. Permanent documentation of calls

and call findings

5. Track actual time spent – not self-

reported time

6. Onsite support in case of audit

We provide sample policies and procedures that can be used to modify your operating manuals.

HIPAA Program Integrity

Practice Policies & Procedures

Poll question

How prepared are you to implement the chronic care management fee?

a) We’re ready to rock and roll

b) We’re halfway there

c) We have some work to do

d) We don’t have our heads around it

e) This is mission impossible

Program Implementation - Integration

• Greenway / PREMEDEX API streamlines workflow

Flag as Enrolled

Upload Consent

Organize Data for Patient

Outreach

Create Visit & Schedule

Engagement

Review History & Conduct

Upload Call History & Care Plan

Review, Sign & Bill

Sample Financial Opportunities

January February March April May June July August September October November December

AWV 170.82$ n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

CCM 42.60$ 42.60$ 42.60$ 42.60$ 42.60$ 42.60$ 42.60$ 42.60$ 42.60$ n/a 42.60$ 42.60$

TCM n/a n/a n/a n/a n/a n/a n/a n/a n/a 232.67$ n/a n/a

RPM ? ? ? ? ? ? ? ? ? ? ? ?

$872.09 per patient per year w/ CCM, AWV, & TCM

Pricing: $21 - $24 PMPM, based on volume

Sample Financial Opportunities

CCM:4 Physicians x 250 Patients x $42.60 x 12 months = $511,200.00

TCM:4 Physicians x 10 Patients / mth x $232 x 12 months =$111,360.00

AWV:4 Physicians x 200 Patients x 170.82 = $136,656.00

Program Considerations

• Many reasons to outsource• Process & technology efficiencies• Clinical requirements• Staffing• Legal & regulatory requirements• Quality communications & relationship building• Integration with other value-based contract initiatives• ROI

• Time to start now with minimal upfront cost leveraging your Greenway investment!

• Offer: Waive $1,500 set-up fee for Greenway clients

Greenway Community

Greenway Exchange

Integrated care

management

Visualized analytics

QUESTIONS

Thank You!For more information, call 678-285-3100

Chronic Care Management - Greenway Health · - Care Reports: practice receives a PDF monthly for...

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