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Care Management

Providing Gastrointestinal Disease Treatment with Care Management

July 23rd, 2024 | 7 min. read

Kathryn Anderton, BSN, RN, BC-RN, CCM

Kathryn Anderton, BSN, RN, BC-RN, CCM

Vice President of Clinical Operations, ThoroughCare

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Gastroenterology is a complicated specialty that helps patients with multifaceted clinical and quality-of-life issues. Yet, these providers face increased challenges, such as falling reimbursements, increasing patient demand, and physician shortages. 

In light of these trials, gastroenterologists need strategies to streamline effective gastrointestinal disease treatment and provide scalable and personalized care that enhances revenue.

Care management offers many benefits to patients and physicians. Combined with Remote Patient Monitoring, these programs provide a robust, data-driven approach. Patients find support to improve outcomes for their chronic conditions, and providers enhance satisfaction and experience scores while driving revenue through previously unreimbursed activities.

Care management addresses challenges and opportunities gastroenterology practices face

These specialists stand out because they not only treat digestive, esophageal, pancreas, and liver disease through surgery and medication therapies, but they strive to prevent disease through screening. However, a significant focus of their specialty is managing complex patients with a host of chronic diseases. 

Gastroenterology has a predominant focus on chronic illnesses

Chronic gastrointestinal disorders, like Irritable bowel syndrome, inflammatory bowel disease, pancreatic exocrine insufficiency, ulcerative colitis, and Crohn’s disease, have no cure. They require continual and active management to avoid exacerbations, maintain remission, and enhance patients’ quality of life. 

Because gastroenterology patients require extensive care coordination and monitoring, this specialty has traditionally invested a lot of unbillable time in it. Chronic Care Management (CCM) is a solution.

The program is suitable for many patients, and providers can use it to capture reimbursement for time and services delivered.

CCM leverages a personalized treatment plan and monthly touchpoints while supporting patients' self-management and motivation to make dietary and behavioral changes. With the right provider on the CCM care team, patients can also receive guidance on the interplay between the brain and the gut through education, coaching, and goal setting. 

Working collaboratively, CCM is successful at helping patients manage the effects of food, stress, sleep, anxiety, and depression on their GI condition.

Demand for gastrointestinal disease treatment is increasing

According to the Crohn’s & Colitis Foundation, nearly one in 100 people in the US have a form of inflammatory bowel disease. This is one of the highest national rates in the world, and it has gradually increased over the last decade. And, as life expectancy and an aging population increase, so too does the prevalence of IBD.

These and other digestive diseases are common and can lead to significant morbidity, mortality, and healthcare utilization, equaling more than $119.6 billion in annual expenditures and more than 472,000 deaths.

In 2020, patients with digestive diseases accounted for 30.5% of commercial beneficiaries and 53.1% of Medicare beneficiaries. Gastrointestinal disease treatment led to 126 million ambulatory care visits, 41 million emergency department visits, and 16 million hospital discharges annually. 

Chronic Care Management provides a structure and payment that supports scaling services via a multidisciplinary approach where a care manager acts as a bridge and patient advocate. 

Reimbursements for Gastroenterology are declining

Gastroenterologists face increased prior authorization requirements and decreased reimbursements, with the adjusted average reimbursement for GI procedures declining by 33% over 15 years. 

Policies have also become more restrictive in what types of IBD treatments are covered.

Many specialists seek ways to optimize care, increase capacity, and improve revenue. CCM can achieve all three by receiving reimbursement for previously unbillable services, providing team-based care management, and enhancing ongoing care access.

Gastroenterologists face high levels of burnout

Because gastroenterology is complex and demanding, many specialists experience burnout. Implementing a team-based CCM program can help alleviate some of the duties and responsibilities that specialists have traditionally carried alone.

Research shows why CCM and RPM are better for gastroenterology patients

When a care management program, such as Principle Care Management (for one chronic condition) or Chronic Care Management (for two or more chronic conditions), is supplemented with Remote Patient Monitoring (RPM), care teams can manage more patients effectively.

Research has demonstrated benefits when RPM is combined with CCM for gastrointestinal disease treatment, including:

ThoroughCare improves gastroenterology and revenue through CCM and Remote Patient Monitoring

ThoroughCare’s care coordination platform simplifies launching, managing, and scaling a Chronic Care Management program that can be seamlessly combined with a Remote Patient Monitoring program. 

It provides one place to manage all patients enrolled in care management or RPM programs. While ThoroughCare can integrate with EHRs, it can stand alone as a comprehensive, team-based care coordination, education, and analytics platform. 

Our software tool empowers the gastroenterology specialist and their care team to confidently manage more patients while reaping reimbursement for previously unbilled services. ThoroughCare provides everything needed to start with a small patient cohort and easily expand and bill as the program grows. 

Principal and chronic care coordination capabilities

Evidence-based care guidelines: ThoroughCare's CCM services are guided by evidence-based care guidelines and best practices in gastroenterology, supporting comprehensive disease and medication management.

Proactive monitoring, intervention, and analytics: Proactively monitor patients' health status, track symptoms, and intervene early to prevent disease progression and complications. When combined with RPM, care teams can receive automatic alerts when readings are out of bounds.

Multidisciplinary team collaboration: Facilitate harmonious communication and task management among internal and external care teams.

Lifestyle modification and goal-oriented care: Leverage integrated, evidence-based education to keep staff up-to-date and empower patients to self-manage, make informed decisions, and adopt healthy behaviors, such as  dietary changes, stress management techniques, and exercise recommendations.

Quality and billing reporting made easy: ThoroughCare automates time logging and billing reporting for reimbursement, quality performance, and regulatory compliance.

The power of ThoroughCare comes from the straightforward way that care teams can launch new care management programs.  Providers can simply enroll existing patients or enter/upload patients into a new program. When combined, CCM and RPM create a powerhouse for comprehensive coordination and personalized patient care. 

Learn more about Medicare’s CCM program, requirements, and billing rates.

Remote Patient Monitoring capabilities

Real-time health monitoring & early detection: Remotely monitor patients' vital signs, symptoms, and disease progression in real time. Detect potential complications and intervene to prevent adverse health events.

Enhanced patient engagement: Use data to engage patients in their care, empowering them to manage their health and adhere to treatment plans actively.

Customizable monitoring parameters: Tailor monitoring parameters based on individual needs and conditions, ensuring data is relevant and actionable.

Data-driven decisions: Have reliable and timely data that inform clinical decision-making, treatment adjustments, and personalized care plans.

Learn more about Medicare’s RPM programs, requirements, and billing rates.

Maximize impact and revenue by combining RPM with Chronic Care Management

Gastroenterology practices manage more complex patients who live with chronic illnesses. ThoroughCare is a platform that equips specialists and care teams with evidence-based care coordination capabilities. Our software provides comprehensive clinical, operational, and financial capabilities when used through a Medicare care management or RPM program. 

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