When deciding to start a new care management program or scale an existing one, there are many questions to answer, including:
- Should I administer my own program or outsource it?
- Who on my team will drive the program and lead patient interactions?
- What technology will be key to its success?
- Will there be enough patient activity to amount to billable time?
- Who of my patient base will indeed take part, and how so?
While we’ve provided guidance on answering these questions and on how to evaluate the economic value of your program, a primary question leaders raise is, “How will we pay for launching this program?”
Starting small and building a successful Chronic Care Management (CCM) program is the keystone to providing financial backing for new or expanded care management programs.
This strategy is exceptional, particularly when considering a Remote Patient Monitoring (RPM) service.
RPM has been proven clinically effective and profitable. When combined with other care management programs, it provides a level of care and revenue that supports team and operational expansion.
Year one: Start small and establish success
Scalability will be driven based on the initial roll out, which breaks down further in the program’s first year.
First 3 months: Concentrate on identifying, enrolling, and care planning with a small patient cohort.
Identify patient cohorts that could use care management support. This would include patients with one chronic illness (Principal Care Management) or two or more illnesses (Chronic Care Management).
How many patients could use ongoing regular care coordination support?
Triage that list of patients and decide which of those patients should be invited to enroll with the initial launch.
At 6 months: Take time to assess progress against initial rollout goals. What is working? What improvements could enhance outcomes or move the program closer to goals? Explore ways that ThoroughCare’s clinical services can support at mid-year to make program enhancements or go deeper in the software to ensure the second half of year one achieves its goals.
At 12 months: Now is the time to use robust analytical data to improve workflows, identify program strengths, report on measurable results, and outline growth opportunities within the same program and by adding other care management services.
Examples like rural healthcare case studies highlight how care teams can utilize existing staff to share some care management duties in the first year based on the program requirements and available staff licenses.
Another example shares how River Bend Medical Associates, a family practice from Northern California, began its CCM program with 100 patients who were assessed as the highest risk and need. After establishing their operations and demonstrating improved outcomes, they were able to scale to larger cohorts.
How ThoroughCare supports this phase
ThoroughCare offers numerous care management programs at the ready. Simply choose the desired program and enroll patients to get started. Plus, a payor or provider can get started quickly with our 120-day kick-off playbook and training, professional clinical staff and technology support.
Our standardized workflows, task tracking, time logging, and dashboards provide everything needed to start managing a patient population and billing for care management services.
Robust analytics and comprehensive reporting enable leaders to assess the program’s performance, make changes, and improve outcomes, as well as grow revenue.
Months 12-15: Use profits to scale
After the initial program phases, you should see regular monthly income and an increase in enrolled patients. Once programs reach 100-200 patients, practices look to add more staff so that they can scale and grow. The initial profits from the first year can fund this expansion. Others add a Remote Patient Monitoring (RPM) program at this point.
Combining RPM with PCM and CCM programs can add considerable value to patient outcomes, ongoing care coordination, and clinical decision-making while generating a new revenue stream. Practices use profits from PCM and CCM services to purchase RPM devices that can then be prescribed to patients and reimbursed through CMS RPM coverage.
How ThoroughCare supports this phase
Like other care management programs on our platform, the RPM module is available at any time. Simply enroll patients. Devices can also be ordered and delivered to patients from within the software.
Our RPM module is built on CMS rules and requirements, making time and device logging easy and streamlining billing. ThoroughCare helps the care team capture, visualize, and interpret patient data to inform complex care decisions. And, because our platform integrates with more than 400 digital devices, a practice can launch a comprehensive program that covers all prevalent chronic conditions.
Through Healthwise, ThoroughCare also provides accessible, evidence-based education that care teams can use to support RPM use.
Months 15-18: Combining services to build a ecosystem
Ultimately, an organization can create a care management ecosystem all from one platform. As each care management program expands, the care team can use our analytics tools to assess patient cohorts and determine which program to implement next.
For example, a provider may start with PCM or CCM and, once established, add RPM.
From there, the care team can work to the top of their licenses by implementing an Annual Wellness Visit program, an Advance Care Planning program, Transitional Care Management, and screening for social determinants of health—all for the same patient populations and from the same single platform.
Providers can add Behavioral Health Integration to round out their care management ecosystem.
With this final program, a healthcare organization can address all areas of a patient’s chronic illness journey, including wellness, preventive, physical and behavioral healthcare, and end-of-life planning.
Research shows characteristics of CCM at-scale
According to a study by Mathematica Policy Research Group practices that master CCM programs at scale have certain characteristics in common, including:
- The primary care provider directly introduces the services by engaging the patient in an initial conversation
- They have buy-in from their leadership team to start taking a population health management (PPM) approach to their chronically ill patients
- The program contributes to CCM enrollment among healthcare professionals outside of the practice
These programs manage 500 to 2,000 patients, developing a significant gross revenue stream by billing $42-90 per patient per month.
One example is CareMount Health Solutions, a multi-specialty, physician-owned practice in six New York counties and a subsidiary of CareMount Medical. Its goal is to deliver CCM services to 10% of its patients while branching out beyond primary care to its specialists.
How ThoroughCare supports this phase
The beauty of the software is that a patient’s information from one care management program can be made available for other programs, maximizing each program’s value to others.
When viewed through dashboards and reports, care managers and clinicians can be well-informed across programs and even different care teams or clinics.
From one comprehensive platform, care leaders, providers, and care managers can work seamlessly across programs and patient populations. Built on Medicare’s rules and requirements, ThoroughCare makes managing multiple care management programs realistic, straightforward, and compliant for billing.
