UPDATE (1/8/2025): In its 2025 Final Rule, CMS changed the rules pertaining to HCPCS code G0511. Read here for the latest information. Since Medicare introduced care management programs in 2015, coverage has evolved to provide expanded opportunities for Rural Health Clinics and Federally Qualified Health Centers. Historically, however, new care management programs have been launched without initially including RHCs and FQHCs or with significant restrictions.

Several factors, including supply chain costs and competitive pressures, make it harder for independent pharmacies to realize profits and growth. From 2016-2022, the average independent pharmacy gross profit margin was 20.8% to 21.1%.

Increased economic pressures squeeze health plans, and providers seek relief from burnout and revenue loss while wanting to improve outcomes. Both parties are looking for ways to achieve cost reductions, enhance quality, and better the healthcare experience.

ThoroughCare offers more than a software platform for care delivery.

There are numerous benefits to launching a care management program. These include measurable results for patients, such as improved healthcare access, efficiency, and health outcomes, as well as cost savings for Medicare, Medicare Advantage, and even commercial payors.

Nearly half of all American adults have multiple chronic conditions, accounting for $1.1 trillion in healthcare costs annually. Additionally, two-thirds of Medicare beneficiaries have two or more chronic conditions. Yet, in recent surveys, 85% of physicians felt they didn’t have adequate time to provide needed care to these patients, and over 90% wanted help to ensure that patients with multiple chronic conditions could adhere to their care plans.

Comprehensive care coordination provides professional support to patients, helping them navigate healthcare and manage their health better. To that end, research on SMART goals has demonstrated its value toward patients creating healthier habits and achieving better health outcomes. When combined with motivational interviewing techniques, SMART goals establish clear, internally-motivating, and measurable goals that align with what’s most important to each individual.

As a nurse or clinician, creating and updating a care plan is crucial to effectively coordinating patient services and interventions, and overseeing medication management.