Care management aims to individualize health care to meet each patient’s specific needs. Health care systems that are patient-centric and outcome-driven are well-equipped to succeed in this work.
Learn how this innovative care delivery, can help your practices thrive in meeting the quadruple aim of health care—better patient outcomes, lower costs, improved patient experience and improved clinician experience.
Care management refers to activities you and your team perform with a goal of facilitating coordinated patient care across the health care system. These activities increase patient satisfaction and improve outcomes while reducing costs to the health care system by avoiding unnecessary hospital and emergency department utilization. Components of care management include:
When setting up a care management program, you first need to work with your team to identify the patients who would benefit from extra care. Risk-stratification and data are two methods for making this list.
Risk-stratified care management (RSCM) is the process of assigning a health risk status to a patient and using the patient’s risk status to direct and improve care. The goal of RSCM is to help patients achieve the best health and quality of life possible by preventing chronic disease, stabilizing current chronic conditions, and preventing escalation to higher-risk categories and higher associated costs.
Integrate Medicare's TCM and CCM programs.
In this approach, your practice:
In a practice panel of 1,000 patients, there will likely be about 200 patients who could benefit from an increased level of support. According to The Commonwealth Fund, this 20% of the population accounts for 80% of the total health care spending in the United States, with the very highest medical costs concentrated in the top 1%.
Efforts to implement RSCM have the added benefit of preparing a practice to respond to payment reform. With VBP tied to performance on quality, cost, and utilization, practices must understand which patients they are responsible for managing. RSCM allows the practice to focus valuable time, resources, and effort on patients most likely to benefit from increased support and care management.
Historical and real-time data, combined with a risk-stratification process and insights from your care team, will help you determine how to be most effective preventing emergency department visits and hospitalizations.
Watch a short Practice Hack video to learn more about two ways your practice can access timely data and act on it.
Access tools that make risk-stratified care effective.
The mnemonic I CARE offers an effective approach to managing care for high-risk patients:
Hear a family physician colleague’s practical review of and tips for using I CARE.
Family physicians have been managing chronic care for years, but they often didn’t get paid for it. Following AAFP advocacy, Medicare began covering chronic care management in 2015, providing payment for managing patients with two or more chronic conditions that covered activities such as care plan development, medication management, and care coordination. Learn how to use CCM codes.
You can also use AAFP’s CCM Toolkit to optimize your payment for care management. The toolkit includes easy-to-use customizable templates, resources, and a step-by-step implementation process to integrate CCM into your practice.
You're probably already providing elements of care management that you're not getting paid for. Learn about what you already have in place and can bill for with Medicare's CCM codes.
The resources needed to deliver care management vary widely depending on practice characteristics, patient populations, payer mix and the types of payment models in which the practice participates. Coming up to speed quickly on proper billing practices will help offset those costs.
However, the benefits of care management can include an increase in billable services and eventual shared savings due to the effectiveness of care management on reducing health care costs.
