CMS increases reimbursements for chronic care management, further highlighting the value of better care between doctors’ visits

By Thomas Ferry
Engooden Health President and CEO

The Centers for Medicare & Medicaid Services (CMS) recently released its final 2022 Physician Fee Schedule, which includes increased reimbursements for chronic care management (CCM). At Engooden, we see this change as a signal that CMS recognizes the value that CCM services have as a driver for better patient outcomes, reduced healthcare costs, and increased quality of life for the millions of Americans living with chronic conditions. We believe this change can have an impact on healthcare programs that span the spectrum of fee-for-service and risk-based programs.

In our view, the CCM reimbursement increase creates a stronger incentive for providers to put in place programs that help manage patient care between doctors’ visits, particularly patients in the rising-risk population. Rising-risk patients are those who may have multiple chronic conditions but are unaware, unwilling, or unable to access the care they need to prevent them from falling into the highest-risk population. High-risk and “healthy” patients also benefit from CCM services but capturing and addressing the needs of rising-risk patients can prevent a catastrophic health event that would push a patient into a higher-risk category.

According to The American Hospital Association, only 20% of overall health is determined by clinical care. We truly believe the path to better healthcare for all is what takes place in between clinical care appointments. Chronic care management services between provider visits create a more complete picture of an individual's health, including socioeconomic factors and health behaviors that often go undetected and have a major influence on their overall health. Without any insight into these factors, it’s impossible to work toward better, more consistent person-centered primary care.

History of chronic care management
CMS began recognizing chronic care management as a “critical component” of primary care to achieve overall better health for people managing chronic conditions in 2015, when it first included CCM reimbursements in its physician fee schedule.

The reimbursement for chronic care management services is based on at least 20 minutes of clinical staff time dedicated to each of those patients per month. For patients to qualify, they must have two or more chronic conditions. These conditions include, but are not limited to: cancer, cardiovascular disease, Chronic Obstructive Pulmonary Disease, depression, diabetes, and hypertension. In addition, each patient must have a comprehensive care plan.

Chronic care management at Engooden
At Engooden, we believe the increased reimbursements for CCM create more momentum for providers to offer a connective care model between office visits, validating our core belief that the path to better care, improved health and quality of life, and decreased healthcare costs is through intervention, education and coaching.

We built our company on this fundamental tenet and we strive for these outcomes every day. But we’re different than many organizations that offer CCM services for several reasons:

  • We are the only company dedicated to offering payers and providers tech-enabled, personalized services for patients in the rising-risk category, many of whom have two or more chronic conditions they’re either managing in the home or they need help navigating care to keep them out of the highest-risk population. This unique segment is often difficult to reach.
  • We go beyond traditional CCM requirements, helping providers initiate or enhance value-based care programs. With Engooden services, payers and providers can gain more insight and information about both clinical and non-clinical factors that may negatively impact a patient’s health and drive them toward a higher-risk category.
  • For those managing chronic conditions and those who are in the vulnerable rising-risk population, we positively alter their health trajectory by improving their quality of life, empowering their own involvement in their care, and keeping those rising-risk patients out of the highest-risk population.

Our care team & technology
We achieve these differentiators through our care team and our technology.

Engooden care navigators are highly trained, caring, and empathetic individuals who help patients manage their own health in between physicians’ visits. Patients trust our care navigators, often sharing more and different kinds of information than they do during a doctor’s visit or with a family member, including barriers to care. Our patient success stories demonstrate the care and trust patients develop with our care navigators. Engooden care navigators help patients navigate a complicated healthcare system, including scheduling appointments and refilling prescriptions so patients can receive care they need for their best health outcomes.

We offer patent-pending, proprietary technology that continuously analyzes EHR records for patients who qualify for CCM, identifying more chronic conditions than any other solution.

Our technology-driven actionable insights automatically alert our care navigators to impending clinical concerns regarding members within their patient population and surface potential critical care gaps allowing them to intervene with the right patients at the right time.

We have a trillion-dollar healthcare problem in the U.S. and focusing solely on clinical care is not the answer. Attaching comprehensive CCM programs to primary care to proactively manage patients between visits is the only way to truly make value-based care work. Engooden provides the right amount of technology and services to make providers more successful and patients healthier. We can help you stay informed about and manage patients when they’re not in your office. Contact us today to learn more.

To see how Engooden can help your organization manage qualifying CCM patients and identify more patients with rising risk, drop us a line.