A: Chronic care management (CCM) is a type of healthcare service that aims to provide ongoing support and coordination to individuals with chronic health conditions. Chronic health conditions are long-term conditions that require ongoing medical attention and management, such as diabetes, heart disease, or asthma. CCM can help individuals manage their chronic health conditions and improve their overall health and quality of life. CCM typically involves the coordination of care among different healthcare providers and can include activities such as:

• Providing education about the individual’s chronic health condition(s) and how to manage them
• Assisting with medication management and adherence
• Facilitating communication and coordination among the individual’s healthcare providers
• Providing support with self-management activities such as diet, exercise, and stress management
• Arranging for additional services or resources as needed, such as home healthcare or transportation to appointments

CCM can be provided by a variety of healthcare professionals, including primary care doctors, nurses, and other healthcare providers. It may be provided in a variety of settings, including in the individual’s home, in a clinic or hospital, or remotely through telehealth services.

A: Services for chronic care management are crucial to enhancing the standard of care for Medicare beneficiaries and lowering medical expenses. CCM is a preventative style of medical care. The majority of healthcare expenses in the United States are incurred by patients who have two or more chronic diseases. These patients do not receive adequate preventive care. Medicare people typically see their doctor three times a year, with the remaining 362 days spent on their own. It has been demonstrated that high-quality CCM lowers expenses and raises quality. CCM promotes primary care visits while reducing hospitalization and ER visit rates.

A: Chronic care management (CCM) is important for healthcare providers because it helps to improve the quality of care and outcomes for individuals with chronic health conditions. These conditions often require ongoing medical attention and management, and CCM can help to coordinate and streamline the care process.

CCM can help healthcare providers to:

• Provide more personalized and comprehensive care: CCM allows healthcare providers to focus on the specific needs and goals of the individual rather than just treating their acute health problems. This can lead to better health outcomes and improved quality of life for the patient.
  
  
• Improve communication and coordination among healthcare providers: CCM helps to ensure that all of the individual’s healthcare providers are working together and are aware of the individual’s current health status and treatment plan. This can help to avoid duplication of services and reduce the risk of errors or adverse events.
  
  
• Enhance patient satisfaction: CCM can provide individuals with the support and resources they need to effectively manage their chronic health conditions, which can lead to increased patient satisfaction.

A: Patients who have several (two or more) chronic illnesses that are likely to persist for at least a year or until the patient dies and who are at high risk of passing away, suffering an acute exacerbation or decompensation, or losing their functional capacity, are eligible for CCM treatments.

A: Chronic care management (CCM) is typically designed for individuals with chronic health conditions that require ongoing medical attention and management. Chronic health conditions are long-term conditions that cannot be cured but can be managed through medical treatment and self-care strategies. Some examples of chronic health conditions that may qualify for CCM include:

• Diabetes
• Heart disease
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Hypertension (high blood pressure)
• Chronic kidney disease
• Bladder Function Problems (incontinence, prolapse, bladder pain, interstitial cystitis)
• Arthritis
• Depression
• Anxiety disorders
  
  

It is important to note that the specific conditions that qualify for CCM may vary depending on the individual’s healthcare plan and the specific CCM program being used. Healthcare providers can help individuals determine whether they are eligible for CCM based on their specific health needs and circumstances.

A: Yes, prior patient permission is necessary to ensure that the patient is informed of cost-sharing (if applicable) and actively involved throughout the procedure. Consent from the patient helps to prevent redundant cost-sharing. Patient consent may be expressed orally or in writing, but it must be recorded in the patient’s medical file.

A: Yes, specialist physicians can provide chronic care management (CCM) to individuals with chronic health conditions. CCM is a type of healthcare service that aims to provide ongoing support and coordination to individuals with chronic health conditions, and it can be provided by a variety of healthcare professionals, including specialist physicians.

Specialist physicians, such as cardiologists, endocrinologists, and pulmonologists, often have expertise in the management of specific chronic health conditions and can provide valuable guidance and support to individuals with these conditions. In addition to managing the individual’s medical care, specialist physicians who provide CCM may also coordinate with other healthcare providers and offer education and support to help individuals manage their conditions.

It is important to note that CCM is typically provided in addition to, and not instead of, care provided by a specialist physician. Individuals with chronic health conditions will often continue to see their specialist physician for regular check-ups and treatment, and CCM can help to enhance and support this care.

A: The specific requirements for chronic care management (CCM) may vary depending on the individual’s healthcare plan and the specific CCM program being used. However, there are some general requirements that individuals may need to meet in order to be eligible for CCM:

• Chronic health condition: CCM is typically designed for individuals with chronic health conditions that require ongoing medical attention and management. Chronic health conditions are long-term conditions that cannot be cured but can be managed through medical treatment and self-care strategies. Examples of chronic health conditions that may qualify for CCM include diabetes, heart disease, asthma, and chronic obstructive pulmonary disease (COPD).
• Two or more chronic health conditions: Some CCM programs may require individuals to have two or more chronic health conditions in order to be eligible for CCM. This is because CCM is designed to provide ongoing support and coordination for individuals with complex medical needs.
• Medical necessity: In order to be eligible for CCM, individuals must have a medical need for this type of care. This may be determined by a healthcare provider based on the individual’s health status, treatment needs, and other factors.
• Enrollment in a healthcare plan that covers CCM: CCM is typically covered by certain healthcare plans, and individuals must be enrolled in one of these plans in order to be eligible for CCM. It is important to check with the individual’s healthcare plan to determine whether CCM is covered and what the specific requirements are.

A: Not all insurance companies provide coverage for the outreach services that are typically found in Chronic Care Management.  However, patients still need specific care and attention to help them reach their health goals.  Patient Navigation strategies can be designed for patients who don’t have coverage for CCM but can benefit from a specific engagement strategy.  Typically, these strategies involve more complex therapeutic goals that may include costly diagnostic tests, third-line surgical interventions, or other desired outcomes that can be more challenging to manage, but which offer a desired outcome for the patient and create benefits for all providers.

A: Two critical challenges in healthcare involve the availability of providers to perform additional patient outreach and patient fatigue with their conditions.  By implementing a patient navigation program medical practices and health systems can support patients in a more robust way to eliminate patient drop out from targeted therapies due to lack of engagement or fatigue.

A: While there are specific CPT codes and available reimbursements for CCM, RPM, TCM, and RTM, such codes do not exist for Patient Navigation outside of these programs.  However, there are many patients who need additional engagement but who do not qualify for these programs.  CaseSherpa helps our clients by offering Patient Navigation services that align to specific patient goals and/or programs that can provide meaningful benefits to medical practices or health systems.