If you’re one of the millions of Americans managing multiple medications and conditions, you know it can be hard to juggle everything related to your health care needs. There can be confusion about medications prescribed by different medical specialists, medical tests can be unintentionally repeated, and you can be given conflicting medical advice.
Unfortunately, multiple chronic conditions is a prevalent issue in the U.S. One study showed chronic diseases are common among those over 65 with 85% having one chronic condition, while 60% have at least two.
Thankfully, for Medicare beneficiaries who have two or more chronic conditions, they have access to chronic care management (CCM) services.
This program is designed to help coordinate and streamline your medical care by helping to avoid these issues. It aims to close any communication gaps in care and give patients support to help them manage their health needs.
“Someone with a qualifying chronic condition — such as heart disease, arthritis, diabetes or chronic obstructive pulmonary disease (COPD) — should consider the CCM program. They can receive more specialized care for their chronic illnesses and will benefit from a care management team to help navigate their needs,” says Erin Nevins, president of EP Nevins Insurance Agency in Greenville, New York.
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What Is Chronic Care Management?
CCM services provide ongoing care coordination and support for beneficiaries with two or more chronic health conditions expected to last at least 12 months or until death.
The goal of CCM is to improve health outcomes, reduce hospitalizations and improve quality of life through structured and continuous care coordination.
“What happens when people get more complex medically is it becomes harder to fit everything in the course of a 15- or 20-minute doctor visit. Oftentimes there needs to be care and follow-up that’s given between visits and that’s really where chronic care management fits nicely. It allows for that connection and support between visits,” says Dr. Jay Lee, medical director at Integrated Health Partners of Southern California in San Diego and a board member of the American Academy of Family Physicians.
Because not all doctors who participate in Medicare also participate in CCM, it’s important to check with your doctor first.
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How Does Chronic Care Management Work?
In order to qualify for this program, you must meet the following requirements:
— Have Medicare Part B
— Two or more chronic conditions that may last at least 12 months or up until death, risk of death, worsening of the disease or loss of function
Once you have determined if your provider participates and you have gone over the details of the program with them, you will be asked to give your consent in writing for them to be able to bill for the CCM program.
You’ll then work with your doctor to develop a comprehensive care plan. Be ready with a list of all of your providers, current medications and any other pertinent information. The more details you can give your provider the better they can help you.
After your initial in-person visit, you will be monitored monthly without needing to come into the office for every visit. Anytime you have a question or concern, you have access to a provider.
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Key Benefits of the CCM Program
The CCM program has many benefits for seniors, especially those who are overwhelmed with keeping up or coordinating their medical needs. Benefits of the program include:
— Better care coordination. Your doctors, specialists and other health care providers work together to manage your conditions. This reduces gaps in care and avoids duplicate tests or conflicting treatments.
— 24/7 access to health care support. You can contact a health care provider 24/7 to ask questions or address urgent concerns.
— Medication management. Your provider will coordinate your care with pharmacies, refilling prescriptions and help prevent harmful drug interactions and unnecessary prescriptions.
— Monthly check-ins and ongoing support. A dedicated care team checks in regularly (phone, online or in-person) to monitor your health. This encourages early detection of issues before they become serious.
— Personalized care plan. A customized health plan is created tailored to your health needs, focusing on your goals, medications and treatments. This gives you a roadmap to follow, which will help you stay on track with managing your conditions.
— Reduces hospital visits and complications. Knowing you have care support 24/7 can help reduce unnecessary hospital visits. Patients can reach out to their care team before a condition worsens, instead of waiting until they need an ER visit.
“The health care system is very fragmented and can be difficult to navigate. It helps to have someone in your corner, which is what the CCM provides. Having this reduces the barriers and challenges that patients may have to (health) care,” Lee says.
Cost of CCM
For beneficiaries, the costs associated with CCM will vary depending on Medicare coverage.
Generally, CCM services are covered by Medicare Part B, which means beneficiaries are responsible for their deductibles and coinsurance. Supplemental insurance, such as Medigap or Medicaid, may help cover the monthly costs.
You can also participate in the CCM program if you have a Medicare Advantage (Part C) plan, but benefits depend on your specific plan’s coverage. Most Medicare Advantage plans offer similar chronic care management services, but they may have different rules, costs and providers than original Medicare, so it’s important to check with your plan.
“By having better management of chronic conditions, the CCM program may reduce overall health care costs for patients, by reducing doctor visits, unnecessary medication charges and hospital stays, as well as other expensive health care related expenditures,” Nevin says.
To get further information about your potential out-of-pocket expenses for CCM services, consult with your health care provider or contact Medicare directly.
Bottom Line
Effective care coordination is essential for maintaining good health, but gaps in communication between health care providers can compromise the care you receive as a patient.
Conflicting medical advice, unnecessary medications and extra expenses from duplicate tests or hospital visits can quickly overwhelm the millions of Americans living with two or more chronic conditions.
Medicare’s CCM services are designed to minimize these challenges by providing consistent, coordinated care under the guidance of a single provider, offering 24/7 support and additional services to help keep you and your health in good shape.
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What Is Medicare’s Chronic Care Management Program? originally appeared on usnews.com
