Synergy: Chronic Care Management & Value Based Care
Value-Based Care vs Fee-for-Service
The U.S. healthcare system is changing. Specifically, it is moving away from Fee-for-Service (FFS) models. Providers are now shifting toward Value-Based Care (VBC). By 2030, CMS will require all physicians to adopt this strategy. Therefore, VBC is no longer just a trend. Instead, it is a mandatory requirement for Medicare claims. Ultimately, this shift ensures that healthcare focus remains on the patient’s long-term wellness.
Value-Based Care: Quality Over Quantity
In traditional FFS, providers are reimbursed based on each patient visit. However, VBC focuses on the quality of those visits and whether they lead to better patient outcomes rather than the number of visits. Medicare has set quality measures that must be met for reimbursement. According to a 2023 Humana report, 20.3 million more patients have received VBC in the last decade, with 30.1% fewer hospitalizations compared to those on traditional Medicare.Value-Based Care: Saving Costs
VBC reduces unnecessary services and duplicative tests, which cuts down on administrative costs. A similar study found that VBC saved 23.2% in costs compared to traditional Medicare, averaging $527 in annual savings per patient.
Value-Based Care and Chronic Care Management.
VBC aims to improve the quality of care for Medicare recipients, with Chronic Care Management (CCM) playing a central role. However, less than half of primary care physicians are involved in VBC programs, and only 5% of eligible Medicare patients are enrolled in CCM programs. CCM is focused on managing chronic conditions and preventing emergency room visits by guiding patients to their Primary Care Physicians. Providers are reimbursed for this service in 20-minute increments. Medicare has increased the payment for the most common CPT code from $40 to $63. Even a brief, 20-minute call can help patients better navigate their healthcare needs and meet Medicare’s goals.Let’s follow patient John through his healthcare journey with CCM in place.
Quality Measures
1. Reduce Hospital Readmissions
Hospital readmissions are a significant cost to healthcare systems. An estimated $25-$45 billion is spent annually on complications and readmissions that could be avoided with better care coordination. For example, the University of Texas Medical Branch saw a 14% decrease in hospital readmissions and saved $1.9 million by improving care transitions and communication between patients and their healthcare teams.2. Better Patient Communication
Woodside Medical in Arkansas implemented a CCM program that connects patients directly with their healthcare team. This program, supported by ChronicCareIQ software, ensures that patients have a reliable point of contact, guiding them through their healthcare journey. By improving communication, patient satisfaction and outcomes have also improved.
The Bigger Picture of Chronic Care Management (CCM)
CCM is a key player in moving towards value-based care, focusing on coordinated care, proactive management, and the integration of technology. By adopting this model, healthcare providers can deliver personalized care plans that not only improve patients’ lives but also reduce overall healthcare costs.
As we embrace VBC, it may present some challenges, but the potential benefits, including better patient experiences and sustainable healthcare systems, make it a vital step towards improving the future of healthcare.
CCM Nurse Susie
Hello John! How are you feeling today?
John
I’m doing better now that I talked to that PA. Thank you for setting that up.
CCM Nurse Susie
No problem! I see that she ordered some labs.
John
Yes! My daughter will come pick me up tomorrow. We will get some breakfast and then she will take me to get me labs.
CCM Nurse Susie
John, you have to be fasting for those labs. You know that right?
John
Oh now I do! Ok so we will go to breakfast after.
Chronic Care Management is helping shift the focus of healthcare from episodic treatments to long-term wellness and proactive management. This approach not only improves the patient experience but also ensures that the healthcare system is more sustainable, patient-centered, and cost-efficient.
WellWink Health, LLC is a leading technology company that specializes in providing innovative solutions for the healthcare industry. With a dedicated focus on patient engagement and care coordination (CCM/RPM), our mission is to empower medical practices and healthcare facilities to deliver exceptional patient experiences and improve overall health outcomes.
To get in touch call us right now at (848)-291-2430 to learn more about our CCM program or you can also book a 30 min free consultation.
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