In 2010, almost half of all Americans (147 million people) were living with a chronic condition and were responsible for 84 percent of all U.S. healthcare spending. Despite advances in diagnostic testing and initiatives to identify preventable diseases, the number of individuals with chronic diseases is expected to continue to grow – that is, unless the chronic care management initiatives currently being implemented in the healthcare industry achieve their desired goals.
One reason that chronic care management has taken such an important role in healthcare is the shift to fee-for-value care delivery models versus fee-for-service. Whereas fee-for-service is an antiquated system that pays healthcare providers for each service performed regardless of its benefit to patients, value-based models emphasize care coordination, communication and patient engagement. They hold providers accountable for the quality and cost of the services that they deliver, and they reward quality of care through payment incentives.
Accountable care organizations (ACOs) are one of the most prominent examples of a value-based model. One of the most significant contributions of the Affordable Care Act, ACOs are networks of healthcare providers, including primary care physicians, specialists and hospitals, that coordinate patient care. If an ACO succeeds in improving care quality and reducing care costs for Medicare-eligible patients, Medicare rewards it with a share of the savings. ACOs are growing at a rapid rate, with dozens of new ones getting added each year.
Coordinating Care for Improved Outcomes
While Medicare compensates ACOs for reducing healthcare costs while meeting performance standards, it also provides incentives for providers who have not yet joined the ACO fold. Starting this year, for example, Medicare is allowing providers to bill for chronic care management services using CPT code 99490 for patients having two or more chronic conditions.
Improved care coordination and chronic condition management leads, ultimately, to better treatment outcomes. If this is to be achieved, however, providers must take the time to follow-up with patients to ensure that care plans are being followed.
With many health organizations lacking the resources to effectively deliver chronic care management services, care coordinators will play a pivotal role. In fact, studies involving care coordinators are already showing positive results. In Texas, in a study of 22 diabetic patients placed under the care of a care coordinator for just six months, hemoglobin A1c goals rose by about 50 percentage points. The responsibilities of the care coordinator included creating individualized goals for patients and facilitating diabetes care training, among others.
Some other examples of the services that care coordinators provide include:
- Implementing care plans set by the provider.
- Helping patients track vital signs and achieve health goals.
- Engaging with patients at their level of activation.
- Responding to patient questions.
- Promoting ongoing medication adherence and reconciliation.
- Facilitating appointment scheduling for preventive services.
- Supporting patient engagement initiatives for Meaningful Use Stage 2.
- Providing quality reporting.
It is important to note that the care coordinator does not necessarily need to be a nurse or other licensed healthcare professional, meaning that the cost of hiring a care coordinator is relatively low. The level of experience required will depend on the care coordinator’s level of involvement in the care plan. Organizations also have the option of working with companies that provide care coordinator services for a fraction of the cost of hiring a full-time employee, many of which are offshore businesses.
With the cost of hiring a care coordinator largely offset by chronic care management incentives, coupled with the fact that patient portals are helping to facilitate coordination of care, it is no wonder that hospitals and medical practices have started to take note.
If your organization hasn’t yet weighed the benefits of hiring a care coordinator, what are you waiting for? Shared savings and incentive payments are waiting.