Chronic Care Management Reduces Costs, Provides Better Support

A new study shows that a government program for managing chronic care cuts costs while also improving care for the chronically ill.

A federal program for chronic care management (CCM) slows the increase in Medicare costs, helps keep people out of the hospital, and connects them with community-based resources, according to a recent report from the Center for Medicare and Medicaid Innovation (CMMI).

The program results could be replicated by private health plans.

The Centers for Medicare and Medicaid Services (CMS) established CMMI in 2015 to help provide support for patients with multiple chronic conditions in-between their provider visits and episodes of care, creating a new Medicare benefit. The program helps beneficiaries with two or more chronic conditions by providing new “in-between visit” payments to participating providers.

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That revenue encourages healthcare providers to focus more on goal-directed, person-centered care planning, and to provide "aging-in-place" resources such as proactive care management, the report explains.

Over 684,000 beneficiaries received CCM services during the first two years of the new payment policy, the report says. They were generally concentrated in the South and had poorer health status than the general Medicare fee-for-service (FFS) population.

“About 19% percent of beneficiaries only received one month of CCM services; however the majority of beneficiaries received between four and ten months of CCM services, on average. Primary care physicians (PCPs) billed for 68% of CCM claims and 42% of CCM billers were solo practitioners,” the report says. “ Individual providers billed for $105.8 million in CCM fees during the first 24 months of the program and, on average, managed about 47 patients per month.”

The report notes, however, that the median number of patients was 10, indicating that the average was skewed by a small number of providers delivering CCM services to many beneficiaries.

Participation in the CCM program was associated with a lower growth in total costs to Medicare than the comparison group. Patients in the CCM program had lower hospital, emergency department and skilled nursing facility costs., along with a reduced likelihood of hospital admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection, and pneumonia.

The CCM program was also associated with increased access to advance care planning, 10% among CCM participants versus 1% in the general Medicare population. The study authors concluded that "CCM is having a positive effect on lowering the growth in Medicare expenditures on those that received CCM services."

Interviews with 71 eligible professionals revealed that providers and care managers perceived several positive outcomes for beneficiaries from CCM. They included improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department visits.

“Most noted patients’ enhanced access to the practice through the care manager, which enabled telephonic condition monitoring between visits and more time for medication monitoring and reconciliation,” the report says. “While several providers, particularly those caring for numerous complex patients, noted that the CCM payment amount was inadequate for the CCM work required, some providers, small practices in particular, were pleased with the new payment policy, noting that they were finally receiving at least some payment.”