(Last Updated On: December 2, 2016)

There are clear connections between Chronic Care Management and the patient centered medical home (PCMH) model. PCMH’s emphasize care coordination and communication to transform primary care into “what patients want it to be.” Chronic Care Management is another tool through which this coordination can occur and equally importantly centered on the patient and the patient’s specific needs, both the clinical and the non-clinical).

In the article referenced below, David Harlow outlines how the Medicare Chronic Care Management Program (CPT 99490) enables providers to shift towards PCMH concepts. Mr. Harlow outlines that outsourcing Chronic Care Management allows smaller practices to take advantage of resources that benefit their patients without incurring the staggering overhead costs that are associated with launching a Chronic Care Management program from scratch.


Outsourcing CCM: a solution for the masses
A novel approach for helping practices manage their care coordination activities is emerging. A universal patient-centered health information exchange is needed in order for care coordination to work efficiently, as is a layer on top of this technology platform comprising a “full stack” service of chronic care management, including care coordinators, taking advantage of scale by aggregating the needs of many subscribing clinical practices.

Thanks to the economies of scale, such an outsourced CCM solution can deliver the service, and handle the related administrative work (documentation and billing), for less than the Medicare-budgeted fee. The net result is that a medical practice can provide CCM services to its eligible patients without incurring the costs associated with building the service from scratch. A practice can contract for coordinators to act as extensions of the practice, engaging patients on behalf of the practice, building the care team connections, making sure appointments happen and that data flows both ways, and netting positive income from Medicare for the service.

Such an outsourced CCM service, available to any practice (large or small) that wants to provide this new Medicare benefit to its patients, can, in essence, bring the care-delivery quality advances of PCMHs to the individual or small community practice level. Much of healthcare is delivered in this setting. And Medicare is betting that by incentivizing population management and care coordination, the overall total cost of care will be measurably reduced