June 2, 2022

Highly Effective Yet Super Impractical: Why Chronic Care Management (CCM) is Hard to Manage

Jean Michaels
June 2, 2022
min read

60% of Americans have at least one incurable disease, and approximately 90% of all health care expenditures are spent managing chronic symptoms – nearly $3.7 trillion in total. Medicare and Medicaid debuted chronic care management (CCM) in 2015 in an effort to reduce ambulatory care through proactive monitoring.

When implemented and managed correctly, CCM significantly improves patient outcomes and clinic revenue. One meta-analysis reported that CCM reduced hospitalization and mortality rates by 18% for patients with heart failure.

Nearly 42 million Medicare beneficiaries are eligible to participate in a CCM program, but only 9% of qualified clinics offer it. Given the clear economic and health benefits, why are so few physicians taking part?

Slim margins, staffing challenges, technology barriers, and administrative hurdles… CCM faces several big challenges, but Welby Health offers patient-centered solutions to make it profitable:

Overcoming Slim Margins

Most small practices don’t have the time, money, or demand for a full-time CCM nurse specialist. Hiring, training, managing, and promoting a new CCM program is daunting, and it may be several years before clinics can recoup their investment. CCM reimbursement rates are relatively low, so it may not be financially feasible to run the program.

Welby increases profitability with remote patient monitoring (RPM) integrations. By monitoring vitals remotely and tracking real-time data, Welby helps physicians bill for both RPM and CCM codes.

Overcoming Staffing Challenges

With the current US nursing shortage, it’s already difficult to recruit and retain a complete care team. Nurses may not have the technical expertise or time to offer virtual case management, and training isn’t always possible.

Welby increases accessibility and scalability with a shared talent pool. Our registered nurses are experts in care planning, concierge care services, and community care coordination. Instead of hiring a full-time service provider, practices can outsource to Welby’s RN network and bill according to demand. Plus, we offer training for practice nurses to help providers transfer CCM care over time.

Overcoming Technology Barriers

Most patients have little-to-no experience using traditional health monitoring tools. Accurate monitoring and program compliance are tied to positive remote monitoring results. In fact, a 2018 study found that the top 95% of biometric data uploaders also had the best clinical outcomes by the end of the RPM program.

Welby uses intuitive, easy-to-use cellular devices that avoid common Bluetooth connectivity errors. Plus, our CCM and RPM programs include technology onboarding, device training, and troubleshooting with a trained nurse.

Overcoming Administrative Hurdles

Recordkeeping and time tracking for CCM reimbursement is yet another highly specialized skill. Faulty or inaccurate documentation can result in hefty fines and penalties, which scare many physicians away from trying at all. Just like nursing staff, clinics often don’t have the budget to hire a full-time administrative specialist to handle CCM billing and RPM program planning.

Welby takes care of everything with end-to-end administrative services and specialized software. Remote monitoring and care planning services are disparate in many ways; Welby Health has designed the only dashboard that seamlessly integrates the two. Easily generate reports for billing and reimbursement that are directly tied to real-time patient device data.

Positive RPM outcomes are the key to launching a profitable CCM program. Get in touch with a member of our staff to discuss how Welby can help your clinic overcome chronic care management hurdles.

Jean Michaels
11 Jan 2022
5 min read

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