Chronic care management services are designed for individuals who live with two or more chronic conditions that put their health at risk and negatively impact their quality of life. These services are a foundational part of value-based care. CCM programs can reduce hospital readmission rates and improve adherence to medications while creating a new Medicare reimbursement opportunity for your organization.
While there are clear benefits to a CCM program, launching one internally can be incredibly challenging. Many healthcare leaders underestimate what the process involves and how much effort it takes to implement a program well. Here’s a realistic look at the costs of rolling out a chronic care management program in-house, as well as why you may want to bring in an external partner.
What Does an In-House CCM Program Require?
Chronic care management may appear straightforward. You must reach out to patients monthly, update their plans of care, and bill Medicare. In reality, a successful CCM program relies on dozens of moving parts and a strong infrastructure that includes:
- Secure patient communication technology
- EHR integration
- Clinical documentation
- Care coordinators and support staff
- Compliance monitoring
- Billing and reimbursement expertise
- Quality reporting
Building these components internally requires a substantial upfront investment. Many businesses implementing an internal chronic care management program run into the following challenges:
Technology Costs Add Up Quickly
The first roadblock you’ll encounter is technological. You’ll need to purchase or develop technology capable of supporting virtual engagement, then take stock of your current tools and identify gaps in your capabilities. You may need to add features like a patient communication platform, documentation tools, or care management software.
Integration alone can require months of planning and testing. Choosing a system that can readily integrate with your existing EHR is far more cost-effective and efficient.
Staffing Represents One of the Largest Expenses
Technology is only one part of the equation. You’ll also need trained staff who can consistently engage patients every month while meeting Medicare documentation requirements. Asking your existing staff to take on all of the new responsibilities of CCM is not realistic, which means you may need to hire additional:
- RNs
- LPNs
- Medical assistants
- Care coordinators
- Administrative support
- Billing specialists
Make sure you account for the costs associated with these new hires, such as recruiting, training, and onboarding.
Compliance Requires Ongoing Attention
Medicare imposes strict CCM reimbursement requirements for documentation and billing. Without established compliance processes, you will encounter high denial rates, which erode profit margins. Make sure that patients are properly enrolled and that your documentation processes meet CMS requirements.
Why Partnering With an Experienced CCM Provider Makes Sense
Instead of building a custom program from the ground up, many healthcare organizations partner with an established CCM provider. An experienced partner with a proven patient experience already has the infrastructure needed to set you up for success. They can deliver:
- Proven technology
- Established workflows
- Experienced staff
- Billing knowledge
- Compliance expertise
Instead of spending months building your processes from scratch, you can begin enrolling eligible patients much sooner.
Seamless EHR Integration
One of the biggest advantages of working with an experienced CCM partner like MetaPhy Health is streamlined EHR integration. Patient information can flow directly into your existing workflows, which saves time and reduces the need for redundant manual data entry. Comprehensive EHR integration gives clinical teams more time to stay focused on patient care.
Partner With MetaPhy Health
If you want to launch a chronic care management program without the hassles of the ground-up approach, MetaPhy Health can help. Our team provides the technology, experience, and support you need to launch a successful CCM program.
Learn about MetaPhy Health’s approach to CCM.
