A Little Known New Medicare Benefit-  Chronic Care Management – is Saving Medicare Money

The Center for Medicare and Medicaid Innovation (CMMI) recently released a report showing that its newer Chronic Care Management (CCM) program is associated with lower growth in Medicare costs, an improved ability to connect patients with community-based resources, and is lowering hospital admissions.

A New Medicare Benefit to Support Chronic Care

Launched by Medicare in 2015 but little used to date, the CCM benefit was devised to help provide enhanced support “in-between doctor visits” for people with two or more chronic conditions. The program focuses on facilitating goal-directed, person-centered care planning, assisting with transitions of care (such as when a patient is discharged from the hospital to home), and providing help with medication management.  Medicare requires beneficiaries provide consent to enroll in the CCM program.   Upon enrollment, patients are assigned to a care coordinator.  The care coordinator works alongside the patient’s physician to assist in care planning, helps to identify risks that may lead to hospitalization (such as falls), provides help with medication refills, and helps to coordinate care with specialists and pharmacies.  The program creates framework for systematic care management, and aims to provide community-based support to patients with chronic illnesses who are at risk of using hospital or emergency department care.  Medicare pays physicians approximately $43 for each month in which they document at least 20 minutes of time spent performing these activities, with higher payment amounts available for more time and complexity.

Study Shows Program is Decreasing Hospitalizations and Costs

The recent study shows the program appears to be working.  Overall, the CCM program reduced costs by $74 per beneficiary per month (PBPM) over the 18 month time frame studied.  Savings increased to $95 PBPM when patients who received only one month of CCM were excluded.  Patients in the CCM program had lower hospital, emergency department and nursing home costs. Receipt of CCM services was also associated with a reduced likelihood of hospital admission for people with diabetes, congestive heart failure, urinary tract infection, and pneumonia.  The CCM program was also associated with increased access to advance care planning (10% among CCM participants versus 1% in the general Medicare population). The study authors concluded that “CCM is having a positive effect on lowering the growth in Medicare expenditures on those that received CCM services.”

ACO Model Has Not (Yet) Been Successful in Reducing Overall Costs

Comparatively, the Accountable Care Organization (ACO) is a hallmark value-based care Medicare initiative that aims to incentivize providers to keep patients healthy and lower costs.  Overall, the Congressional Budget Office predicted that ACOs would save Medicare $1.7 Billion in net savings between 2013 and 2016.  However, the ACO program actually increased spending by $384 Million during that time, likely in part due to the fact that most ACOs have been upside risk only.   In fact, in the first three years of the ACO program, only one-third of the 428 participating ACOs reduced Medicare spending enough to share in savings.   A recent Office of Inspector General report showed that the ACO model’s top performing subset saved Medicare $673 per beneficiary during the initial three years of ACO performance – a savings of $19 PBPM. The savings was mainly attributed to reductions in hospital and nursing home costs, similar findings of the CCM report.

The CCM & ACO Models: David vs. Goliath

It is no surprise that a key to reducing Medicare costs is to keep more chronically ill people at home, and out of hospitals and nursing homes.  It does come as somewhat of a surprise, however, that the CCM model – while focused on similar goals of care quality and cost savings as the ACO model – had such a significant impact in its first 18 months of existence.  There is typically a stark contrast in the structure of a CCM program versus an ACO –  a “David vs. Goliath” story –   CCM is typically provided and administered by the patient’s doctor and a care coordinator.  On the other hand, ACO’s typically include large groups of physicians, hospitals, nursing homes and others stakeholders, typically have a dedicated care management support division and have a considerable organizational hierarchy, including an ACO President.  The typical CCM program structure is typically a much smaller, grassroots effort, which mainly involves a very small group of people doing care planning with a patient.  The findings of the CCM study show that high quality, care management that saves Medicare money does not have to be provided by a complex, large organizational hierarchy that includes hundreds of stakeholders.  As long as the patient, the patient’s doctor, and a care coordinator are focused on the right things, a grassroots program can work just as well – and perhaps better – than the complex ACO model.  Being focused on correctly resourcing chronically ill Medicare beneficiaries with community-resources based via robust care planning– that includes regular follow up with the primary care physician, and, when appropriate, other home-based care such as home healthcare – just plain works.  ACO’s should embrace CCM as a low cost, effective way to scale their care management efforts – while reducing total medical expenditures.  Providing high quality, cost saving care to people with multiple chronic conditions “in-between” their physiciWilliam Mills, M.D.an visits works – and it does not have to be that hard.

Author: William Mills, M.D.

William Mills is President and Chief Executive Officer of Chronic Care Management, Inc., a leading provider of care management technology and services that is currently supporting patients with “in-between episode” care management in twenty-seven states.  Dr. Mills is a board-certified physician who provides care to the elderly. Previously, Dr. Mills served in a variety of roles for Kindred Healthcare, the largest diversified post-acute care provider in the U.S., including President, Kindred House Calls, Chief Medical Officer for Care Management and Kindred at Home, and Senior Medical Advisor.  Dr. Mills also founded a leading home-based medical care group (Western Reserve Senior Care) and a hospice company (HopeBridge Hospice) and served as President of both organizations from founding until each company was acquired.  Dr. Mills is an experienced medical director, having served in this role for medical practices, home health agencies, hospice organizations, nursing facilities, and assisted livings, as well as an experienced acute care hospitalist. Mills received his baccalaureate degree in chemistry and biology from University of Rochester, a medical degree at Case Western Reserve, and completed residency and fellowship at Case/MetroHealth.