One of the biggest hurdles to implementing a Chronic Care Management (CCM) program at most practices is the fear of failure.
Practitioners fear they don’t have the staff or time to run such a program or they’re concerned about the rules and regulations.
All of these fears are valid but are not a reason to shy away from implementing a CCM program.
Well for one, the benefits of starting a CCM program are numerous. CCM programs are considered vital components of primary care, resulting in better health outcomes for patients while reducing overall healthcare costs.
But like any important implementation process, having a well thought out strategy can make the difference between success and failure.
We provide tips and best practices we’ve learned from other successful programs while simplifying the sometimes complex rules and regulations for them.
Our hope is to do the same for you.
In this article, we’ll walk you through some of the most common reasons CCM programs fail and give tips on how to avoid those all-too-common pitfalls.
Do You Have The Appropriate Staff Size?
You need to ensure you have the clinical staff available to manage a successful CCM program without overburdening your practice.
The Centers for Medicare and Medicaid (CMS) requires that a care manager for a CCM program be either a practitioner or one of the following certified resources:
It’s not uncommon for a care manager to be managing 150 patients each month. With at least 20 minutes per patient, that adds up to at least 50 hours of time spent managing patients each month.
Whether you can shift one of your current clinical staff into a full-time role as a care manager or hire a new one, being prepared on the staff side will go a long way.
Regardless of which route you go, having a dedicated care manager is all but essential to your success.
Do You Have Enough Qualifying Patients?
This one may seem obvious, but it’s an important consideration that can often be overlooked.
You will want to ensure that not only do you have enough patients currently qualified to receive CCM care, but also enough influx of new qualifying patients that will sustain the program in the long term.
As a reminder, the Centers for Medicare and Medicaid Services (CMS) defines a qualifying patient as those with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Rest assured, you most likely will not have a hard time finding enough qualified patients to sustain a successful CCM program.