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Posted on July 29, 2015 by West Corporation 


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How Chronic Care Management is Like Going to the Gym

For people with chronic health conditions like Diabetes, Alzheimer’s and Cardiovascular disease, taking care of your health and following your treatment plan can be a matter of life or death. But don’t feel like you are alone. Nearly half of all American adults — about 117 million people—suffer from one or more chronic health conditions and all of them struggle with the enduring health challenges.

Whether it’s adhering to your medications, monitoring your personal biometrics, or attending regular doctor visits, effectively managing chronic health conditions requires coordination and discipline. But it’s easy to slip. Here are a few of the common excuses: “I’m too busy”…”It’s not convenient”…”I try, but I lose interest.”

Sound familiar? It’s a lot like going to the gym. We all start with good intentions to work out regularly, but it’s easy to find an excuse to not go. We all know we need to exercise in order to lose weight, stay healthy and relieve stress, but to achieve those goals you’ve actually got to get up off of the couch and get active.

Personal trainers understand this basic human frailty when it comes to working out and staying healthy. As a result, a number of techniques are commonly used to keep folks engaged and actively working on their fitness goals. Finding a workout buddy, journaling your workouts, and setting goals and rewarding your accomplishments all work to motivate and activate.

Accountability is Key

These same strategies work in Chronic Care Management as well. And it all boils down to accountability. CMS recognizes the value of accountability and incentives. As our healthcare transitions to value based outcomes, the healthcare industry will benefit by utilizing many of the same strategies used in the weight management and fitness industry. The workout buddy becomes a Care Coordinator. Journaling workouts becomes journaling biometrics. Setting goals and monitoring progress becomes a Care Plan. And finally, the incentives and rewards become value based outcomes.

In this new model of healthcare, everyone wins, even physicians. CMS recently released the new CTP code 99490 that provides a financial incentive for physicians to take care of comorbidity patients outside of traditional office visits. The new code allows payment at an average of $40 per beneficiary per month for services performed for Medicare beneficiaries. The practice must implement an ongoing care plan and a clinical staff member must spend at least 20 minutes during a calendar month coordinating care and communicating with the patient.

Moving Forward

West Healthcare Practice has several tools and services available to help physicians and clinics take advantage of the new CMS reimbursement – like our technology enabled communications, automated notifications and case management tools, and supplemental services that make a difference. In whatever way you move forward, look for providers and partners with the right combination of capabilities, vision and experience that will help you employ meaningful strategies regarding Chronic Care Management and CPT 99490.


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