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Chronic Conditions: What They Are and The Importance of Managing Them

July 2nd, 2020 | 5 min. read

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One of the simplest questions is also one that can trip up a lot of practices when starting a Chronic Care Management (CCM) program.

What exactly is a chronic condition?

A condition that qualifies as “chronic” has to meet two criteria:

  • The condition is expected to last at least 12 months, or until the death of the patient
  • The condition places the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

In order for practices to get reimbursed for CCM, The Centers for Medicare and Medicaid Services (CMS) require patients to have two or more chronic conditions as defined by the criteria above.

We’re sure you have some further questions. Most practitioners do.

We’ve helped hundreds of clients across the country navigate the murky waters of CMS rules and regulations, setting them on a path to running successful care management programs.

Below we’ll cover everything you need to know about chronic conditions to prepare you for starting your own CCM program.

What Chronic Conditions Does CMS Allow?

CMS has not defined a specific set of "Allowable Chronic Conditions".

This decision has been left up to the provider, as long as they meet the criteria established at the beginning of this article.

CMS does have a database regarding chronic conditions that you can use as a starting point. It’s important to note that this database is neither an exhaustive, nor definitive list.

The most common chronic conditions include diabetes, hypertension, cardiovascular diseases such as heart disease and stroke, cancer, and chronic respiratory diseases.

Even mental disorders, vision and hearing impairment, oral diseases, bone and joint disorders, and genetic disorders can all qualify as chronic.

As long as you clearly communicate within the care plan that the chronic conditions you are treating post a significant risk of death, acute exacerbation of decomposition, or functional decline and will last the expected length of time, the requirement is satisfied.

Chronic Condition Risk Factors to Watch For

By now, the medical community has identified the most common causes (risk factors) of chronic diseases.

The positive news is that there’s only a few risk factors that are responsible for the majority of the most common chronic conditions.

There are five big risk factors, three modifiable and two non-modifiable, that are major contributors to chronic conditions.

The modifiable risk factors are:

  • Physical inactivity
  • Unhealthy diet/lifestyle
  • Tobacco use

These risk factors are shared across men and women and can lead to intermediate conditions like elevated blood pressure and glucose levels, obesity, and abnormal blood lipid counts.

The non-modifiable risk factors can compound these issues and include:

  • Age
  • Heredity

When combining these risk factors together, they can explain the majority of serious health events that are classified as chronic conditions, such as heart disease, stroke, chronic respiratory diseases, diabetes, and even some cancers.

Beyond those attributable risk factors, we also account for a litany of underlying socioeconomic, cultural, political, and environmental risk factors.

These underlying factors have less of an impact and account for a smaller proportion of chronic conditions, but are important to identify in taking a holistic approach to a patient’s care plan.

The Importance of Managing Chronic Conditions

So now you know what chronic conditions are and the major risk factors attributable to them.

Now the question turns to the importance of managing these chronic conditions.

CMS estimates that approximately one in four adults, including 70% of Medicare beneficiaries, have two or more chronic conditions, qualifying them to receive CCM.

This is a large portion of your patient population that you can be treating.

The Centers for Disease Control states that chronic conditions are the leading drivers of the nation’s $3.5 trillion in annual health care costs, accounting for about 90% of that annual cost.

As we stated previously, the good news is that the major risk factors that contribute to these conditions are modifiable. And that is where CCM and a strong patient-centered care plan come into play.

When combined together, a patient-centered care plan and CCM can not only provide substantial revenue to your practice, but also result in improved health outcomes for your patients.

How Care Management Software Helps Manage Chronic Conditions

Having a user-friendly care management software to help manage your CCM program can make a world of difference.

Care management software can help in the following areas:

  • Identifying eligible CCM patients
  • Creating a patient-centered care plan
  • Establishing treatment goals
  • Creation of easily-shareable reports for patients and other practitioners
  • Patient-reported health information and alerts for continual monitoring
  • Integration with other care management programs

There are many care management softwares on the market that can help you manage your CCM program. In shopping around, look for software that does all of the above.

ThoroughCare Makes It Easy and Can Help You and Your Patients Today

ThoroughCare’s care management software was designed with clinicians in mind.

The hundreds of practices across the country working with us today chose ThoroughCare because we simplify the management of their CCM program.

Our CCM platform includes the following features:

  • Your own secure, HIPAA-compliant software portal
  • Unlimited users and patients
  • Live Dashboard showing current CCM minutes
  • Guided-interviews for CCM Care Plans
  • Task tracker (with timer) and Time Logging
  • Monthly Update interface for clinical staff and providers
  • Create Care Plan reports for patient and other providers
  • Easily download summaries and upload to your EHR
  • Integrates with Annual Wellness Visit Software
  • Easy Billing interface to easily submit Medicare reimbursement claims
  • Tech Support via email and phone

Our Care Plan now contains 37 of the most common chronic conditions that we see. The guided-interview questions help automate your care plan for you.

Each of the 37 conditions contain clinical content in the form of questions related to: Goals / Barriers / Symptoms and Expected Outcomes.

Due to the loosely defined nature of chronic conditions, you can always specify: Other Chronic Condition(s).

The list of chronic conditions with included clinical content in our care plans is continually growing. For example, new conditions being added soon include Multiple Sclerosis, Benign Prostatic Hyperplasia (BPH), Cirrhosis, and Rheumatoid Arthritis.

Our goal is to give you the tools needed to improve patient health outcomes and receive the financial reimbursement afforded to you through CMS.

Now that you know what chronic conditions are, learn what goes into a CCM program and the benefits of starting one at your practice.