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Under the MACRAscope: CCM
Past, Present and FutureBarry C. Allison, CIO, Center for Primary Care
Objectives
1. Learn the impact of our CCM program, since its launch in 2015, using our
real data
2. Learn about new CCM reimbursement opportunities, and strategies for
tweaking workflows to capture new reimbursements
3. Discover how CCM workflows are extensible to other value-based incentive
and reimbursement programs
The Center for Primary CareFamily and internal medicine practice with 42 providers
offering comprehensive healthcare services in 9
locations across Georgia and South Carolina
24K Medicare patients
78% with 2+ chronic conditions
Adding 2K patients/year over next 10 years
10K patients in upside-only enhanced care commercial
5K patients in upside-only enhanced care MA
4.4K patients in Medicare CCM
Patients Programs
CPC’s Chronic Care Management
Journey
Our Timeline
DEC 2016
Later Results
DEC 2015
Early Results
MAR 2015
Implementation
DEC 2014
Opportunity Assessment
NOV 2014
CCM Program Announced
CCM Program Announced
“In 2015, the Centers for Medicare
and Medicaid Services will
introduce a non–visit based
payment for chronic care
management — the most
important broadly applicable
change it has made to primary
care payment to date.”The New England Journal of Medicine
November 27, 2014
Opportunity Assessment
Assumptions:
• 78% MC population with 2+ chronic
conditions
• 75% CCM program opt-in
• 75% CCM completes
Approximately $80K
incremental monthly revenue,
roughly $1M per year
125K patients
14K MC patients (11%)
Implementation: Workflows &
Technology
WORKFLOWS
New roles
The Chronic Care Management workflow
Eligible beneficiaries
Consent to receive CCM
Deliver the five specified capabilitiesUse a certified EHRElectronic care planBeneficiary access to careTransitions of careCoordination of care
Non-face-to-face care management services
TECHNOLOGY
Cohort identification
Task management
Time tracking
Reporting
The Results
About 32K in incremental revenue per
month
Nearly 4X the rate of CCM program
participation, compared to national
average
Minimal impact to workflows, staffing,
and existing IT infrastructure
Later Results - 2016
Lessons Learned
Enabling technology is crucial
Really understand your ROI
Develop workflows and competencies that are extensible to other value-based
programs
Chronic Care Management in 2017
Complex Chronic Care Management
New Reimbursement Opportunities!
Billing Code Description
CPT 99487 For complex CCM, requiring 60-minutes of non-face-
to-face care management services per month, as
compared to 20 for CCM
CPT 99489 An add-on code for complex CCM, billed in 30-
minute increments beyond the initial 60-minutes
G0506 An add-on code to pay physicians for care plan
development, which is to be billed separately from
monthly care management services
CPT 99358 For prolonged E/M service (the first 60-minutes) in
which a physician spends significant time outside of
the usual office visit addressing a patient’s needs
CPT 99359 An add-on code for prolonged E/M service, billed in
30-minute increments beyond the initial 60 minutes
Applying CCM Principles To Other
Value-Based Programs
Closing Gaps In Care
Using technology to surface gaps in care
Bringing Medicare shared savings data into the EMR
Use cases for Medicare wellness visits / Physicals
Medicare preventive services tracking
Cohort Management
Managing populations by risk-based contract
CCM Populations within risk-based contracts
CDC 6|18 Initiative – Comorbidity Commercial Payer Tracking
Thank you!Barry C. Allison, CIO, Center for Primary Care