Chronic Care diseases and conditions- such as heart disease, stroke, cancer, type 2 diabetes, obesity, arthritis, Alzheimer’s or other types of dementia- are among the most common, costly, and preventable/manageable health problems. Seven of the top 10 causes of death in 2014 were chronic diseases. Two of these chronic diseases – heart disease and cancer – together accounted for nearly 46% of all deaths.

So, what is Chronic Care Management (CCM)? CCM helps primary care physicians, doctor offices, and hospitals increase their revenue while providing exemplary service to their clients. Medicare pays physician offices roughly $43 per beneficiary per month for Chronic Care Management services. This covers Medicare beneficiaries with 2 or more chronic conditions and can address one of the common complaints about fee-for-service: failure to pay for non-acute care coordination. The program requires 20 minutes per month of non-face-to-face interaction with care coordinators, when the patient is able to discuss case management issues such as:

  • Symptom management
  • Medication management
  • Review of care gaps
  • Coordinated care, which can include care transitions and coordination between two or more physicians

The care coordinator can be an RN, LPN, or certified MA (among other skill levels). Along with the 20 minutes of asynchronous patient care and the creation of a health plan, all patient information must be recorded in a certified EHR and patients must have 24/7 access to care.

For a primary care physician with 250 eligible and enrolled beneficiaries, this could generate $130,000 in net revenues.

Once the 20 minutes is completed and recorded in the EMR the patient is flagged and our system bills Medicare for your office. Our services remain available to the patient even when the 20 billable minutes are satisfied.

This service allows for better management of patients with chronic care. Patients with 2 or more Chronic illnesses are contacted on a monthly basis for a 20 minute non-face to face communication to monitor the patient’s status and progress.  Information from monthly calls is fed into Physician’s EHR so that physician can bill Medicare.

Value Proposition: A physician with 250 Medicare patients can see gross revenues go up by $130,000 with no work on the physician or nursing staff.

Who Can Benefit? Any Primary care physician.