The Centers for Medicare & Medicaid Services (CMS) allows billing practitioners to collaborate with third-party care management service companies. This arrangement can provide external clinical staff and non-clinical staff to perform certain care tasks.
CMS considers these as “incident to” services and supplies, which are those “provided as an integral, although incidental, part of the physician’s or nonphysician practitioner’s personal professional services during diagnosis and treatment.”
Outsourcing various care management responsibilities supports a provider’s goal to achieve the Quadruple Aim, including:
- Improved patient experience
- Improved patient and population health outcomes
- Reduced healthcare costs
- Improved provider experience
Medicare care management programs seek to streamline care coordination. They use remote communication and monitoring to deliver enhanced, personalized access outside office visits.
Outsourcing most of these activities enables providers to add reimbursable services and improve quality of care and outcomes
How outsourcing care management services supports the Quadruple Aim
Working with a care management service company provides a complementary extension to services and staff.
By working with a seasoned third-party vendor, providers can realize improvements in the following four areas.
1. Improved patient experience
Research provides strong evidence that care management increases adherence to treatment guidelines and improves patient satisfaction. Team-based care also has a positive effect on patient satisfaction compared with usual care.
Care management programs provide personalized attention beyond the in-clinic appointment.
Outsourced care managers can provide tailored care coordination, leveraging technology and data analytics to ensure timely follow-ups. They also support medication adherence, goal coaching, and education to promote disease self-management.
Through reliable and consistent remote communication, outsourced call centers and care managers offer continuous patient support, answering concerns and providing guidance outside of traditional office hours. Third-party services complement those provided by the physician and staff, giving patients a sense of security and additional support.
2. Improved patient and population health outcomes
Care management is seen as a fundamental vehicle for managing population health.
Outsourced care management service providers should have robust technology to support population health management, including:
- Predictive analytics and risk stratification to identify high-risk patients and patient population trends
- Proactive chronic disease management
- Preventive care strategies to close care gaps and meet care standards
- Care planning standards and evidence-based assessments
- Advanced data analytics, reports, and tools to focus interventions on rising-risk patients
Research highlights that patients who report better care coordination also receive higher-quality service.
For example, a report published in Health Affairs found that patients with congestive heart failure who participated in Chronic Care Management were more knowledgeable about treatment. They used recommended therapies more often, visited the emergency department less frequently and spent 35% fewer days in the hospital.
Third-party care management companies offer complementary services, thereby extending provider capabilities to specific patient populations. This is true by risk level, disease state, or other prioritized population variables.
3. Reduced healthcare costs
Care management focuses on regular patient engagement and intervention to prevent the need for high-cost care like hospital admission or readmission. In a cohort study, Transitional Care Management (TCM) reduced mortality from 1.6% to 1% and decreased healthcare spending by 11%.
Other studies found an 86.6% drop in readmission risk among patients receiving TCM services.
Outsourced care management helps patients receive preventive care, symptom control, and avoid disease exacerbation, unnecessary ER visits, and hospital stays.
Also, by handling administrative and non-emergency care tasks, outsourcing allows in-house staff to focus on critical patient needs.
Improved patient outcomes and cost controls also help providers reach performance targets and share in savings through value-based contracts.
4. Improved provider experience
While physicians must maintain specific responsibilities as the Medicare billing provider of record, outsourced teams can manage tasks such as patient outreach, follow-ups, and data documentation. This helps physicians focus on direct patient care.
Fee-for-service care management services help offset increased costs while extending capacity. By offloading tasks, providers can achieve greater job satisfaction and reduce burnout.
ThoroughCare offers care management expertise
Care management services can help providers fulfill the Quadruple Aim
ThoroughCare offers the tools and support to make care management effective.
We help providers and care management companies build programs or scale existing services by offering:
- A comprehensive software platform, featuring evidence-based tools for engagement, care planning, SDOH assessments, billing, and remote vital monitoring
- Clinical advisory expertise to help build processes, train staff, and understand policies
- A technology partnership to help providers and service companies report and improve quality with data, featuring integrations with leading EHRs and health information exchanges
Key questions answered
How can care management services help providers achieve the Quadruple Aim?
The Quadruple Aim focuses on four objectives, including:
- Improved patient experience
- Improved patient and population health outcomes
- Reduced healthcare costs
- Improved provider experience
Outsourcing aspects of a Medicare care management program to a third-party service enables physicians and their care teams to achieve the Quadruple Aim through personalized care coordination and coaching, using data analytics for population health management and timely intervention, reducing the risk of high-cost and higher-acuity care channels, and enabling new services and revenue streams for providers without added hiring and technology costs.