What is care coordination? Understanding the basics
You may have heard or even used the term care coordination but struggle to define it. Exactly what is care coordination? It’s the process by which providers and patients work together to manage multiple conditions, prioritize healthy decisions, and organize healthcare activities for improved outcomes, greater safety, and more effective care.
According to the Centers for Disease Control and Prevention (CDC), six in 10 Americans have at least one chronic condition such as heart disease, cancer, or diabetes. Not only can chronic conditions lead to death and disability, they drive up healthcare costs. Of the $3.5 trillion in annual U.S. healthcare expenditures, 90% applies to people with chronic or mental health conditions.
By providing care coordination services, your practice can help patients manage multiple chronic conditions. Care coordination services are important for practices to understand and implement because they lead to success in value-based care.
The CCM fee
Because the Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a key component of effective care, it pays the CCM fee for certain services.
CCM covers a broad swath. It may include assessing a patient’s needs, encouraging patients to come in for preventative visits, or reconciling medications. In general, care management tasks align with CMS’s approach to supporting care that occurs outside the office.
Take a look at our infographic that breaks down requirements for the CCM fee. Meeting these requirements can lead to practices receiving $43 per patient per month for Medicare patients with two or more chronic conditions.
Five core competencies
The fee applies to care that may not take place in the clinic but helps patients manage their conditions. By documenting care coordination encounters thoroughly, practices can collect the CCM fee.
The infographic includes the CCM five core competencies:
- Use of certified EHR technology
- Maintaining an electronic care plan
- Patient access to care
- Facilitated transitions of care
- Coordination of care
To establish a CCM program, a practice must enroll patients, bill for the service, and understand which patients are eligible.
Greenway Care Coordination Services
While payers are reimbursing based on outcomes rather than number of services provided, the way patients manage their conditions remains up to them. That’s why practices partner with Greenway Care Coordination Services (GCCS) — to improve care for patients with chronic conditions and qualify for the CCM fee.
GCCS coordinates and manages care on the practice’s behalf. Staff use a digital platform to interact with patients. They may provide digital counseling on nutrition, exercise, medication compliance, and other drivers of health. GCCS generates documentation of all care coordination encounters, allowing practices to collect the CCM fee with ease.
Integrated into the EHR, GCCS allows practices to find and enroll eligible patients without disrupting workflows. The result is a seamless view of patients and streamlined billing.
“Greenway is all about improving the ability of the providers to provide care for patients and give information to the community,” said Jennifer Rioux, Nurse Practitioner and Chief Administrative Officer, New Era Medicine. “We both have that similar value.”
By choosing GCCS, practices can help keep their patients healthy and achieve their goals for value-based care.
For more information, CLICK HERE to schedule a conversation with a Greenway representative. Or watch our 3-minute overview video HERE.
Additional Resources
Patients win with PCMH model, 4X growth of telehealth providers
6 chronic care management practices to drive success
Addressing disparities in healthcare during COVID-19
