Implementing a Chronic Care Management (CCM) program is a significant decision for a healthcare organization. Selecting the right CCM vendor can be overwhelming and confusing given all the options for these programs. Making the right decision for your organization and your patients is vital, and key considerations should be carefully weighed.
Chronic Care Management Programs Simply Work
An effective Chronic Care Management program supports patients with chronic conditions through seamless coordinated care efforts designed to meet and manage their ongoing health issues. By implementing such a program, healthcare organizations will improve patient outcomes and satisfaction while also improving overall quality of care. This approach not only benefits patients but also empowers the health system’s existing providers to work more efficiently. Furthermore, the program will drive the achievement of value-based care initiatives, ultimately enhancing the financial performance of your healthcare organization.
Many factors should be considered when choosing a CCM vendor to help scale your program.
Experience Matters
Track Record:
- How experienced is the Chronic Care Management program provider?
- Have they scaled a CCM program successfully, or are they the new kid on the block?
- And more importantly, do they have the metrics to prove their success?
Look for vendors that have successfully scaled CCM programs well beyond the pilot phase within their client base. Many vendors will flash impressive client logo slides, but when you dig deeper you learn that a majority of those clients are small scale and/or pilot implementations. For example, if you want to scale your CCM program to 3,000 enrolled patients, make sure the vendor has reliable references where they have achieved this same scale.
And ask for the metrics and real-world customer stories that demonstrate their ongoing success. Key metrics like patient retention rate (% of enrolled patients that stay in the program) will illustrate that the vendor is providing a high-quality, personalized service that will increase engagement and that your patients will value. A vendor with a proven track record against these types of KPIs and a long list of satisfied client referrals indicates reliability and capability.
Success in Scaling CCM at Large Health System:
- Have they worked with large health systems in the past?
- Do they understand how to support and navigate the complexities of these organizations? For example, can they help you navigate internal billing and compliance concerns?
- Do they have experience with and understand how to coordinate with other care teams in your organization, i.e., SDOH, pharmacy, etc.?
Achieving scale in a Chronic Care Management program is challenging, especially as a large health system. You will want a vendor who understands how to address and solve these complexities before getting started.
Value-Based Care Knowledge:
- Does the vendor have experience with and thoroughly understand the nuances of the variety of value and risk-based payment models from CMS and other commercial Medicare Advantage payers?
In particular, you will want the vendor to be able to align engagement from the CCM nurse team with your (stratified) risk, cost and utilization data to maximize outcomes and financial performance in your value-based contracts.
Patient Recruitment and Onboarding:
- Does the vendor offer proven, dedicated in-house patient recruiting and program onboarding?
When conducted in-house, most patient recruiting efforts lead to a fraction of eligible patients being enrolled, due to the lack of an effective playbook for how to outreach and communicate to patients about remote care programs like CCM, RPM, etc.
And importantly, can the vendor get you up and running in less than six weeks?
Rapid launch of your Chronic Care Management program is crucial for achieving early success and demonstrating tangible benefits quickly, and vendors that do not document in your EMR and require integration with their external platform are unlikely to be able to implement quickly.
Staffing Considerations
Clinical Qualifications:
Quality of care is paramount in any Chronic Care Management program, and having skilled staffing will play a significant role in a CCM program’s success.
- Does the CCM vendor use RNs and LPNs in direct care, or do they rely on medical assistants and “medical coaches”?
You will want nurses operating at the top of their licensed skill level, even though CMS doesn’t technically require RNs and LPNs for a CCM program. RNs and LPNs offer a higher standard of care, and are more experienced with complex care management & communicating effectively with your providers.
The Care Model:
- What kind of care model does the Chronic Care Management vendor provide? Do they use a call center model?
- Do your patients and providers get assigned to the SAME dedicated nurse, or are they at the mercy of a round-robin approach?
Continuity of care builds trust and engagement, leading to better patient outcomes and satisfaction. This trust is essential for encouraging patients to open up about social determinants of health (SDoH) that might be hindering their health improvement. A consistent, dedicated nurse can more effectively uncover and address these crucial factors, ultimately leading to more comprehensive and effective care.
Technological Considerations
Integration:
- Does the Chronic Care Management program provider require complicated, time-consuming integration with your EHR?
- Or do they work within your EHR organically as a seamless extension of your team?
Provider workflows are sacred, and no CCM implementation will ever scale where the nurse team is not documenting in and communicating with providers directly within their workflows in your EHR.
Additionally, an EHR integration often requires the input of your organization’s technology teams, adding complexity, red tape, and extended delays for getting a program launched. However, if the CCM provider’s nurses work seamlessly within your existing EHR and clinical workflows, you can bypass all of this hassle. This approach eliminates the need for complex integrations, allowing for rapid implementation and cost efficiency. It’s a no-brainer: avoiding a complicated and expensive integration is vital for quick launch, provider engagement, and maximizing the benefits of your CCM program from day one.
Analytics and Reporting:
- Does the Chronic Care Management vendor offer analytics and key performance indicators (KPIs) to provide visibility into the program’s performance?
- Is the data useful in optimizing the program?
This capability is essential for continuous improvement and justifying the program’s success to key leadership stakeholders.
Financial Performance
Fees:
You chose to work with an outside vendor for Chronic Care Management instead of handling it in-house because of the value and de-risking aspect. This decision becomes even more advantageous when considering the financial model.
- Does the Chronic Care Management vendor charge upfront fees to get started?
Such costs can create financial risks for your health system, especially if your organization is on a tight budget. Instead, look for a vendor that offers zero up-front costs and participates in a revenue-share model based on your paid reimbursements. This approach transforms CCM implementation into a no-risk, all-reward decision.
Selecting the right CCM vendor is an important decision that can profoundly affect your healthcare organization’s ability to deliver high quality, coordinated care to patients with chronic conditions. Implementing the right CCM program can lead to several advantages, including increased patient enrollment, no additional staffing or technology investments, zero out-of-pocket costs, and greater billing and reimbursements.
By considering factors such as experience, staffing models, technology investment, and fee structures, you can make an informed choice on which CCM program most alignes with your organizational culture and goals. By taking the time needed to thoroughly evaluate potential CCM vendors, you will be in a better position to make the best decision in selecting a successful chronic care management program that works for your organization.
If you would like to implement a CCM program, outsourcing is a viable and recommended path.
Signallamp Health works as an extension of your providers, helping you to harness your physician-patient relationships to increase access to care, improve outcomes, and feed longitudinal patient engagement. We offer white glove, on-demand nursing capacity, dedicated only to your providers and patients and tailored to your workflows. Our unique remotely embedded nurse care model enables our nurses to become a truly integrated extension of your existing facility-base care team, all at no up-front cost to you. Our success is directly linked with your success.
Ready to improve patient care with a Chronic Care Management Company? Learn how Signallamp Health can help you Take Care Further™ with remotely embedded Chronic Care Management. Schedule a consultation with us.