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How small practices can earn Chronic Care Management revenue

One third of the U.S. population has at least one chronic disease, such as cancer, asthma, diabetes or heart disease. Chances are good that we, or people we love, have experienced the challenges of coordinating care for these complex conditions.

Clinicians recognize the importance of staying connected to their patients. But teams at small practices may not have enough volume – or stability of volume – to justify hiring additional clinical staff to coordinate care for complex patients.

Taking full advantage of the new reimbursement opportunity

In 2013, Centers for Medicare and Medicaid (CMS) launched a program to begin reimbursing for non-face-to-face care coordination services. It’s called the Chronic Care Management program, and its goal is to improve care for patients with two or more chronic diseases.

CMS has a list of about 22 things the practice needs to do to comply, including engaging with each patient over the phone for 20 minutes each month to coordinate care. It doesn’t have to be one phone call, but could be a five-minute phone call each week, for example.

On these calls, clinicians find out what’s going on with patients and help them figure out what care they need and where they can get it. In return, CMS will pay about $40 per member, per month.

Decision: Invest in staff or outsource?

For a practice that has a high, steady volume of chronic disease patients, it might make most sense to hire additional staff to manage it. Let’s say the practice has 480 CMS member patients who have two or more chronic diseases. One five-minute phone call to each of these patients would require 40 hours every week, or one full-time employee.

Assuming this practice meets all criteria for the program, it would earn about $19,000 per month in revenue for these 480 patients, or $230,000 per year. Subtract the total cost of the full-time employee, and the practice can see its net revenue for this program.

But what if you don’t have that many patients? Or what if you don’t want your staff to take on this responsibility? Allscripts has partnered with Citra to help practices outsource this work. You just have to identify the patients who are willing to participate, and our care coordinators will engage them every month on the phone. (A recent news release highlights one of these partnerships.)

Bottom line is better population health management

No matter which model you chose, better care coordination is a win for everyone. The complex patient receives better care, the clinician knows they are providing higher-quality care, CMS reduces its overall costs and rewards the practice financially.

To find out more about how Allscripts can help you with chronic care management or other value-based care projects, contact us.

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