In the sphere of value-based healthcare, chronic care management (CCM) is a critical component of primary care and population health management. Targeting the Triple Aim goals of better health and care for individuals while reducing spending, CCM is viewed as a stepping-stone to success under Medicare's Quality Payment Program that launched January 1, 2017.
2017 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.
This 40-page report, based on responses from 110 healthcare organizations to HIN's industry survey on chronic care management, is the second comprehensive assembly of metrics on CCM stratification requirements, reimbursement models, promising protocols, challenges and ROI.
This 2017 market data also captures participation trends and feedback on CMS's Chronic Care Management services for Medicare beneficiaries with multiple chronic conditions that launched in 2015. In late 2016, CCM updates by CMS enabled reimbursement for more complex and more time-intensive chronic care coordination effective January 2017.
Supported with dozens of graphs and tables, these market metrics document emerging trends in chronic care management, resulting in a comprehensive set of best practices and benchmarks on managing patients with complex health conditions.
New Chronic Care Management Metrics for 2017:
- Chronic care management of individuals diagnosed with a behavioral health condition;
- The use of predictive modeling to stratify patients for chronic care management;
- The role of the RN care manager in chronic care management;
- Impact of chronic care management on per-patient costs;
- Percentage of respondents billing Medicare under Chronic Care Management codes;
- Most challenging hurdle of the Medicare Chronic Care Management program;
- Clinical and financial outcomes achieved through the Medicare Chronic Care Management program; and
- Expectations on the ability of Medicare's Chronic Care Management program to reduce administrative burden.
Breaking down findings by high-responding industry sectors, this report also includes the following data points:
- Prevalence of programs for chronic care management;
- Criteria for admission to a chronic care management program;
- Tools to identify and risk-stratify individuals for CCM;
- Key components of chronic care management initiatives;
- Primary responsibility for CCM;
- Frequency of CCM patient visits in 12-month period;
- Modalities for CCM interactions;
- Reimbursement trends for CCM, including structure of CCM payments;
- The most successful tools, process or workflows employed in chronic care management, in respondents' own words;
- Challenges and successes resulting from CCM;
- Impact of CCM on the key metrics of clinical outcomes, care quality, medication adherence, patient experience, hospice use, hospitalizations and readmissions, ER visits, mortality, and reimbursement;
- The complete March 2017 Chronic Care Management survey tool;
and much more.
This benchmark report is designed to meet business and planning needs of health plans, employers, health coaching and disease management, case management, managed care organizations, physician organizations, health systems, health IT companies and others by providing critical benchmarks in managing patients with chronic illnesses.
This report is part of the Healthcare Benchmarking series, which provides continuous qualitative data on industry trends to empower healthcare companies to assess strengths, weaknesses and opportunities to improve by comparing organizational performance to reported metrics.
Results and ROI
Successes Achieved with Chronic Care Management
About the Survey
Using This Report
Responses by Sector
The Hospital/Health System Perspective
The Health Plan Perspective
Respondents in Their Own Words
Outcomes Achieved Under Medicare CCM
Additional Comments on Medicare CCM
Non-Medicare CCM Reimbursement
Most Effective CCM Tools, Workflows and Protocols
Greatest Successes Achieved with CCM
Responses to Questions
List of Figures
Figure 1: All - Ongoing CCM Program
Figure 2: All - Future CCM Program
Figure 3: All - Populations Targeted for CCM
Figure 4: All - Diagnostic Criteria for CCM Admission
Figure 5: All - CCM Risk Stratification Tools
Figure 6: All - CCM Program Components
Figure 7: All - Primary CCM Responsibility
Figure 8: All - CCM Visit Frequency
Figure 9: All - CCM Delivery Modes
Figure 10: All - Billing Under Medicare CCM
Figure 11: All - Medicare CCM Hurdles
Figure 12: All - Non-Medicare CCM Reimbursement
Figure 13: All - CCM Challenges
Figure 14: All - CCM Impact
Figure 15: All - Program ROI
Figure 16: All - Impact of 2017 Medicare CCM Changes
Figure 17: All - Organization Type
Figure 18: Hospitals - Ongoing CCM Program
Figure 19: Hospitals - Future CCM Program
Figure 20: Hospitals - Populations Targeted for CCM
Figure 21: Hospitals - Diagnostic Criteria for CCM Admission
Figure 22: Hospitals - CCM Risk Stratification Tools
Figure 23: Hospitals - CCM Program Components
Figure 24: Hospitals - Primary CCM Responsibility
Figure 25: Hospitals - CCM Visit Frequency
Figure 26: Hospitals - CCM Delivery Modes
Figure 27: Hospitals - Billing Under Medicare CCM
Figure 28: Hospitals - Medicare CCM Hurdles
Figure 29: Hospitals - Non-Medicare CCM Reimbursement
Figure 30: Hospitals - CCM Challenges
Figure 31: Hospitals - CCM Impact
Figure 32: Hospitals - Program ROI
Figure 33: Hospitals - Impact of 2017 Medicare CCM Changes
Figure 34: Health Plans - Ongoing CCM Program
Figure 35: Health Plans - Future CCM Program
Figure 36: Health Plans - Populations Targeted for CCM
Figure 37: Health Plans - Diagnostic Criteria for CCM Admission
Figure 38: Health Plans - CCM Risk Stratification Tools
Figure 39: Health Plans - CCM Program Components
Figure 40: Health Plans - Primary CCM Responsibility
Figure 41: Health Plans - CCM Visit Frequency
Figure 42: Health Plans - CCM Delivery Modes
Figure 43: Health Plans - Billing Under Medicare CCM
Figure 44: Health Plans - Medicare CCM Hurdles
Figure 45: Health Plans - Non-Medicare CCM Reimbursement
Figure 46: Health Plans - CCM Challenges
Figure 47: Health Plans - CCM Impact
Figure 48: Health Plans - Program ROI
Figure 49: Health Plans - Impact of 2017 Medicare CCM Changes
Appendix A: 2017 Chronic Care Management Survey Tool
Reflecting the merit of chronic care management (CCM) in the delivery of highvalue healthcare, CCM adoption rose from 55 percent in 2015 to 69 percent in 2017, according to the April 2017 Chronic Care Management survey. In the sphere of value-based healthcare, chronic care management (CCM) is touted as a critical component of primary care and population health management that contributes to better health and care for individuals while reducing spending. The majority of CCM outreach continues to be conducted telephonically, say 88 percent of 2017 respondents.
Reimbursement levels for CCM remained steady at 35 percent from 2015 to 2017; however, this second comprehensive CCM survey found that 32 percent currently bill Medicare using CMS Chronic Care Management codes introduced in 2015. Although 40 percent of Medicare CCM participants believe CMS’s 2017 program changes will reduce administrative burden associated with CCM, more than one-fifth still encounter challenges when it comes to engaging providers and staff in the Medicare program. Three-fourths of 2017’s responding CCM programs target either the Medicare population or individuals with chronic comorbid conditions. Management of care transitions is the top CCM component for 86 percent of respondents.
A diagnosis of diabetes remains the leading criterion for CCM admission, said 92 percent, but congestive heart failure (CHF) rose in CCM importance from 81 percent in 2015 to 90 percent in 2017. Use of healthcare claims as the top tool for identifying or risk-stratifying individuals for CCM continues at 2015’s 70-percent levels, this year’s survey found.