Chronic Care Management

Last year, Medicare began reimbursement for Chronic Care Management (CCM) services. These payments cover non face-to-face care coordination support and 24/7 access to a Comprehensive Care Plan for Medicare patients with 2 or more chronic conditions.  CCM addresses one of the common complaints about fee-for-service care: failure to pay for non-acute care coordination between office visits. This translates to the potential generation of $130,000 in incremental revenue for a primary care physician with 250 CCM eligible and enrolled Medicare patients.

Progressive Healthcare implements CCM for a wide range of provider entities, including regional health systems, hospital-owned physician organizations, and independent physician practices. Beginning with our comprehensive, customized assessment for clients that are interested in learning more about CCM, Progressive Healthcare helps clients improve patient care and profits through our CCM Service and Consulting offerings:

CCM Services:

  • Outsourced CCM services via a qualified call center and certified staff. We handle the operational logistics of providing this service and generating incremental margin for the practice.

  • Proprietary software platform:

    • Turnkey Comprehensive Care Plan generation and secure portal, accessible 24/7 to patients and authorized members of a patient's care team

    • Automated time tracking tool to ensure billing accuracy and compliance

    • Custom patient engagement surveys

    • EHR interface options include API and HL7

    • Integration with Transitional Care Management (TCM) and Annual Wellness Visit (AWV) Modules

  • Staffing support models include full or hybrid labor outsourcing

  • Centralized scheduling service and appointment reminders

Consulting:

  • Operational assessments for CCM and related services, plus implementation support

  • Reimbursement analysis, business planning, and compensation modifications

  • Regular updates on related CMS rules and billable care management service trends

  • Integration in an MSSP environment (e.g., maximizing MSSP quality scores, achieving 5-star status for Medicare Advantage plans, generating Pharmacy dispensing revenues)