Chronic Care Management (CCM)

If you suffer from multiple chronic medical conditions, chronic care management (CCM) is one of the most important resources to know about.

CCM services are recognized by the Centers for Medicare & Medicaid Services (CMS) as essential in primary care, and these services are typically offered for at least one year through a comprehensive care plan.

This post will outline everything you need to know about chronic care management.

What Is Chronic Care Management?

Chronic care management (CCM) was introduced in 2015 as a service offered by the Centers for Medicare & Medicaid Services. The service is separately paid, which means it is not included in the standard medicare fee schedule.

The main idea behind CCM was to give health care professionals who treated patients with chronic conditions a way to care for their patients more effectively.

The umbrella of chronic care management covers several services that help patients get the care that they need for two or more chronic conditions. These services also help the patient's care team get proper compensation for their work.

CCM services can be administered by any of the following health care professionals:

• Physician Assistant (PA)
• Certified Nurse Midwife
• Clinical Nurse Specialist (CNS)
• Physician
• Nurse Practitioner (NP)

CCM services are divided into two categories: complex and non-complex.

With non-complex CCM, a patient who suffers from two or more chronic conditions has to give verbal or signed consent to receive treatment.

Complex CCM care involves the same services as non-complex CCM, but patients receive more clinical staff service time per month. In addition, this type of CCM care involves more complex medical decision-making.

What Does Chronic Care Management Do?

Chronic care management services help patients and care providers in several different ways. Below are the four main categories of CCM.

Comprehensive Care Planning

One of the main components of CCM is a patient receiving support from their care team in putting together a comprehensive plan for treatment.

After a plan is established for treatment, it will be implemented into the patient's life, then reviewed and revised, if necessary. The patient's care team will make sure that the treatment plan is as effective as possible, making changes to how the patient is treated if a better treatment strategy can be found.

Remote Assistance

All of the services offered through CCM are remote. This means that when you interact with your CCM provider, you won't be receiving face-to-face care.

Instead, you'll be able to communicate over the phone when you need assistance with medication, have questions about treatment, or run into other issues.

Medication Management Help

Another aspect of CCM is medication management. When you receive CCM services, your care team will keep track of all current medications that you are on, any allergies you have to specific medications, and any potential interactions between your medications and other treatments.

Care Coordination Services

Through CCM, you'll also have access to care coordination services. Your care team can help you schedule appointments as you continue treatment.

Meanwhile, your healthcare provider will interact with you in person, but your CCM care team will manage your electronic care plan, your medical records, and any other information that your doctor will need to provide thorough treatment.

Which Chronic Conditions Are Eligible?

You can qualify to receive CCM if you have two or more chronic conditions that are expected to last at least 12 months or more. All chronic conditions should be recognized by health care providers as putting you at a high risk of functional decline.

Below are some of the primary conditions that will qualify you to receive chronic care management services.

Diabetes

With diabetes, your blood glucose levels are too high, which can cause serious issues in the long run. The disease can lead to the development of kidney problems, nerve damage, and eye issues, as well as heart disease and stroke in some cases. Many diabetes patients require long-term care, just like most sufferers of chronic health conditions.

Depression

This mental illness can be chronic, and it affects about 17.3 million Americans. Since the condition can seriously hamper your ability to function in everyday life, you may qualify for CCM if your depression severely impacts your day-to-day life.

Glaucoma

Glaucoma affects your optic nerve, leading to partial or total blindness. This condition is often caused by a buildup of pressure in your eye, and it typically affects older adults.

Heart Failure

This chronic, progressive health condition involves your heart muscle not pumping blood as efficiently as it should. It often develops when your heart has been weakened by pre-existing conditions, and can be made worse from certain lifestyle choices like poor diet.

Hip Fracture/Pelvic Fracture

In older patients, a hip or pelvic fracture needs to be treated with surgery, medication, and long-term physical therapy.

In some cases, a CCM beneficiary will need help from their care team with all of the aspects of their recovery from a fracture as serious as this. That means that the patient's CCM provider will assist them in getting their medication, coordinating emergency department visits, and more.

Arthritis

This condition causes swelling, pain, and tenderness in at least one joint. It is often chronic, and involves being treated in a way that manages symptoms and tries to prevent additional damage from being done to the joint.

Asthma

This chronic condition can make it difficult for a patient to breathe, and requires long-term treatment. Many patients with asthma have coexisting health conditions as well that can make the asthma worse, such as allergies or COPD.

Cancer

Depending on the prognosis for your cancer, your care team may work to get you to a point where self-management of your symptoms is attainable. However, your treatment goals may look different if your cancer is not seen as potentially treatable.

If you are suffering from cancer with a significant risk of death, your care team will set you up with a treatment plan that factors in the possibility that you are terminally ill.

Alzheimer's Disease & Dementia

These conditions can seriously hinder cognitive functioning, often leaving a patient incapable of taking care of themselves. Alzheimer's and dementia are degenerative diseases, which means they progressively become more severe over time.

How Do I Find a Doctor to Perform CCM?

According to the CPT codes used for CCM services, some chronic care management services can be provided by a physician in-person.

To find out if your current healthcare provider offers chronic care management services, all you have to do is ask.

However, if your doctor is not in-network with Medicare, you will have to find an in-network treatment provider to provide you with in-person care.

How Do I Know If My CCM Is Covered?

If you are receiving Medicare or are covered by health insurance, there is a high chance that your chronic care management services will be at least partially covered. If you are receiving treatment that is not covered by insurance, the medical bills can be steep.

Fortunately, you will be informed about whether your treatment provider is in-network with your insurance before you start receiving CCM services.

Conclusion

For sufferers of chronic health conditions, CCM services can make a major impact on the overall treatment experience.

To learn more about CCM, visit the Centers for Medicare & Medicaid Services website for additional information.

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Sources:

What Is Depression? | Psychiatry

Find & compare health care providers | Medicare

Chronic Care Management Services | CMS