Helping physicians help their patients
CMS CCM Billing Compliant
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The current climate of health care in the United States today is primarily reactionary. In most cases, patients only see or interact with their physicians as a result of illness, injury or office visits scheduled by the provider’s staff as a matter of routine follow ups, such as annual wellness visits. In many cases, even these much needed office visits are not done, leaving patients with large gaps between their physician interactions. Between these visits, patients experiencing declining health, often as a result of chronic medical conditions, seek urgent care at emergency rooms that can lead to hospitalizations. Regrettably, primary care physicians, such as family practitioners are not aware of these urgent visits until long after their patients have been discharged.
The Centers for Medicare and Medicaid Services (CMS) estimates that over 68% of its beneficiaries are afflicted with two or more chronic conditions.
The Center for Disease Control and Prevention estimates that one in four adults in the United States, approximately 60 million people, suffer from two or more chronic diseases. Furthermore, 7 out of 10 deaths result from chronic disease.
Chronic diseases such as high blood pressure, cancer, high cholesterol, heart disease, arthritis and diabetes are the most prevalent. Heart disease and cancer account for nearly half of all deaths in the United States.
Research has proven that chronic care management programs can have a positive impact on the overall health of chronically ill patients while reducing costs to the health care system.
CMS beneficiaries with 2 or more chronic conditions
Doctors could have regular interaction with their patient panel on a routine basis without a negative impact on their existing practice?
Providers could more efficiently operate their in-office practices, ensuring office visits are necessary and productive, allowing them more oversight of the general health of their patients.
Providers could be made aware of declining patient health status seamlessly, and afforded the opportunity to address these underlying causes remotely?
Doctors would be alerted to declining patient health conditions before they resulted in urgent Emergency Department or hospital admissions (or readmissions). Lifestyle, diet and medication adjustments could be made while the patient is at home.
A physician could maximize and greatly organize the non face-to-face care they are already providing to their patients, such as medication management, care coordination and care planning while being reimbursed by payers?
Practice revenue would increase, patient care planning would be more carefully followed, patient health would increase and costs to the overall health care system would decrease as a result of more comprehensive, coordinated and planned care.
Patients could maintain a two-way communication with their physician or his clinical staff, every moment, of every day, providing a feedback loop on a continuous basis?
A patient’s quality of life would improve. Their health questions, concerns and fears would be answered. Their health would be proactively assessed rather than reactively addressed as a result of illness.
A patient had a structured, comprehensive and readily available care plan that he or she could regular review, allowing for lifestyle adjustments such as dietary and exercise, clear and concise self-management of medication directions and clear contact information for clinical staff to address any issues immediately?
The patient would form a team with the physician, his clinical staff and clinical support team with the common goal of improving the patient’s health status by way of routine review of the care plan and patient’s compliance.
A provider could get help navigating issues related to chronic care management such as implementing an efficient process, educating patients about the benefits of proactive care management, addressing compliance concerns and IT related challenges?
A comprehensive solution can be structured for physicians and providers to help them achieve the goal of a cash-flow positive, patient centric care management program.