With Greenway Care Coordination Services (GCCS), you can improve care for patients with chronic conditions and increase value-based reimbursement for Chronic Care Management (CCM).
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Chronic Care Management solution integrated in Greenway’s EHR
Greenway leverages the fully integrated chronic care management solution offered in partnership with MD Revolution — including a dedicated team of health coaches — to reach more patients in less time, without disrupting your current workflows.
Reduce need for hospitalizations
Through consistent health coaching and increased patient engagement, GCCS enables practices to achieve proactive management of chronic conditions, resulting in lower care costs from fewer ED visits and hospitalizations.
Provide greater access to care
Extend your practice's patient care by providing access to digital counseling on nutrition, exercise, medication compliance, and other factors influencing health outcomes.
Comply with Medicare requirements
Acting as an extension of your practice, GCCS helps practices maximize participation in the CCM program by performing eligibility checks, ensuring Medicare compliance, and fulfilling program requirements.
What is Chronic Care Management?
The Centers for Medicare & Medicaid Services (CMS) introduced the CCM program to encourage a value-based model for reimbursement. CCM contributes to improved care and overall health outcomes for Medicare patients with two or more chronic conditions.
66%
of Medicare beneficiaries have two or more chronic conditions
86%
of healthcare spending is attributed to patients with chronic conditions
CCM Requirements
Core competencies required of providers
To be eligible for the CCM fee, providers must:
- Be on a certified EHR for specified purposes such as symptom management, social resources, and medication management.
- Maintain a comprehensive electronic care plan accessible to all relevant care members — including the patient — and shared according to HIPAA regulations.
- Ensure the patient has 24/7 access to care through secure messaging portals, phone, texting, etc. This gives patients the opportunity to communicate beyond the office.
- Facilitate transitions of care by managing referrals, providing post-discharge transitional care management, and sharing a patient’s information electronically with other relevant clinicians.
- Coordinate care with their patients by assessing health, implementing care, and reassessing and adjusting care plans accordingly.
What conditions qualify for chronic care management?
Through over 100 clinically validated care plans with diagnosis-driven goals and protocols, GCCS addresses chronic conditions including, but not limited to, the following:
- Alcohol use or abuse
- Alzheimer’s and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer (breast, colorectal, lung, and prostate)
- Chronic kidney disease
- Chronic obstructive pulmonary disease
- Depression
- Diabetes
- Drug/substance use or abuse
- Heart failure
- Hepatitis (chronic viral B and C)
- HIV/AIDS
- Hyperlipidemia (high cholesterol)
- Hypertension (high blood pressure)
- Ischemic heart disease
- Obesity
- Osteoporosis
- Schizophrenia and other psychotic disorders
- Stroke
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