
https://www.signallamphealth.com/chronic-care-management-outsourcing-makes-sense/Chronic Care Management (CCM) is becoming an increasingly critical component in managing chronic conditions in the U.S. patient population. Chronic diseases such as hypertension, diabetes, heart, disease, and obesity currently affect millions of Americans and are costing the U.S. healthcare system billions of dollars.
Despite the importance of having an effective CCM program, many health systems struggle to implement such a program for a variety of reasons. This struggle results in less-than-optimal treatment outcomes and revenue enhancements.
But the need for effective chronic care patient management is becoming more obvious. According to the Centers for Disease Control and Prevention (CDC) Foundation, chronic diseases are responsible for seven out of 10 deaths in the U.S., and they contribute to 86 percent of the nation’s healthcare costs.
And those costs are rising.
The leadership at health systems are all too aware of these statistics, yet many health systems continue to face significant challenges in launching and maintaining an effective chronic care management program. Part of the problem is the complexity of CCM program requirements set forth by the Centers for Medicare and Medicaid Services (CMS) and the additional capacity & documentation burden placed on health systems to implement the program. These barriers leave the health system struggling to adapt to the requirements needed to launch and maintain an effective program.
Recruiting patients and increasing engagement
Two of the primary barriers to implementing and maintaining an effective CCM program are patient recruitment and engagement. Recruiting eligible patients is both labor and time-consuming. Identifying eligible patients, contacting them about the program, following up if they could not be reached, and overcoming objections to enrollment, even though they are qualified, requires a substantial time commitment for staff.

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In many cases, recruiting patients to an in-house CCM program can be a full-time job for a staff member to reach the high levels of enrollment that most health systems require to keep the program financially viable. This recruitment process is usually placed on clinical staff that already have more than a full-time job. This is one of the reasons that we typically see less than five percent of eligible patients enroll in their healthcare provider’s in-house CCM program, underscoring the difficulty that health systems have in achieving high levels of participation.
Maintaining patient engagement in a CCM program can be challenging due to factors such as patient churn, where patients frequently leave or disengage from their ongoing care, further complicating efforts for health systems to maintain a stable and consistent CCM patient population (and related reimbursements and financial incentives).
To effectively implement a successful in-house CCM program, care plans need to be created and customized for each patient. This is also something that can be a significant time commitment. Since CMS does not provide a standardized format for patient care plans, physicians, or more commonly their nursing staff, are often left to create their own, resulting in non-standardized and inconsistent patient treatment planning within the health system.
Outsourcing the CCM program can effectively address these barriers. By partnering with a specialized CCM service provider, health systems can leverage external expertise and resources that can be dedicated to patient recruitment, engagement, and follow up treatment planning. An effective outsourced CCM program employs dedicated teams to maintain consistent patient outreach and follow up, taking the burden off of staff, while significantly improving enrollment rates.
Overseeing and monitoring metrics
With an in-house CCM program, since most electronic medical record systems (EMRs) do not have robust capabilities for longitudinal care management, tracking and monitoring patient treatment and follow up can pose significant challenges for many health systems. Ensuring that patients adhere to their care plans and medication schedules requires ongoing effort and attention for both the patient and the clinical staff treating them. This is especially important when remotely monitoring patients for potential and escalating complications that could land them in the hospital.
Importantly, many health systems are not set up with the staff or technology to clearly create and follow the metrics that can demonstrate that their program is working. This lack of analytics can make it challenging for the health system to secure ongoing support and funding to keep their program fiscally sound.
CCM billing and reimbursements
Moreover, the complexities of CCM billing and documentation requirements can often lead to incomplete reimbursement for services provided. Outsourced CCM programs can help address this issue by ensuring that health systems meet the documentation and other compliance requirements necessary to bill for CCM services. By providing expertise in CCM-specific documentation and billing practices, these programs help health systems get fully reimbursed for the valuable care they provide. This not only improves the financial viability of the CCM program but also allows healthcare providers to focus more on patient care rather than administrative tasks.
The combination of robust analytics, proper documentation, and ensured compliance can significantly enhance the sustainability and effectiveness of a CCM program. It provides health systems with the data needed to demonstrate program value, secure ongoing support, and maintain fiscal soundness, while also maximizing reimbursement for the critical care services provided to chronic care patients.
Adding To Staff Responsibilities
The many obligations currently weighing on healthcare staff are a significant concern for the leadership of health systems. Implementing an in-house CCM program can add to those responsibilities. Staff may resist adopting a new in-house program if they think that it will add to their already strained workloads. An effective CCM program should reduce the weight on clinical staff, allowing them to focus on direct patient care, rather than being dragged down with paperwork and other administrative tasks.
A significant barrier to the implementation of an in-house CCM program is resistance from clinical staff to learn a new program or system. Physicians and nurses are already being asked to do so much for their patients with limited time and resources. So, the CCM program needs to help clinical staff do their jobs more easily, without becoming bogged down in more work. A good CCM program should help clinical staff do less so they can focus on the more important things, like patient care and treatment at the point of care.
It is important to remember that a lack of senior health system support, insufficient clinical staff, and an absence of training and resources can slow down the implementation of an in-house CCM program. Without the strong support from leadership, adequately trained staff, and the resources needed to launch such a program, implementation success could be compromised or outright fail.
An outsourced CCM program addresses these concerns by providing dedicated personnel who manage all aspects of the program and optimize it in an ongoing fashion. This reduces the workload on both clinical and administrative staff, while ensuring that the program is implemented with patient care and treatment as a focal point. Additionally, outsourced CCM providers often have the experience and expertise needed to manage the program more effectively, which alleviates the need for extensive in-house oversight.
Investing In Additional Technology
Technology can be a significant barrier to effectively implementing an in-house CCM program. EHRs are not designed to accommodate the operational needs of CCM, from nurses managing their call queues to administrators monitoring performance and holding nurse teams accountable to quality KPIs. Addressing this gap often requires investing in new technology or dramatically customizing existing EHRs, both of which can be costly and complex, often becoming cost prohibitive for many health systems. Additionally, current staff may struggle with learning and using new technology for patient tracking and monitoring.
Outsourced CCM programs offer a solution by tracking and reporting on critical patient care metrics without relying solely on the health system’s technology. This approach reduces the need for additional investments in new technology and staff training, allowing health systems to focus on patient care without the operational and financial burdens of technological upgrades. However, it’s crucial to note that while outsourced vendors may bring valuable technology to the table, it is still critical that their nurses document and communicate directly within the health system’s EMR workflows.
The seamless integration with existing EHR systems is vital for long-term program success. When outsourced nurses operate within the health system’s EHR, it prevents the creation of additional burdens for healthcare providers, who might otherwise become reluctant to support the program due to increased workload. By operating seamlessly in the health system’s EHR, an outsourced CCM program vendor doesn’t create any additional barriers to scaling the program. This integration ensures that all patient information remains centralized, accessible, and up-to-date, facilitating better coordination between the outsourced CCM team and the health system’s staff, ultimately leading to improved patient care and program sustainability.
Increasing Financial Stress
For health systems today, financial challenges are perhaps one of the biggest impediments to implementing an effective in-house CCM program. Given the limited budgets that many cash-strapped health systems are currently operating under, they find that they can face significant upfront costs for setting up an in-house CCM program before they can even start billing for their first CCM code. Given the financial pressures many health systems face, coupled with the long road to achieving sustainable enrollment numbers, the initial investment can be a significant hurdle to overcome.
Additionally, reimbursement rates for CCM services are often insufficient, with many providers in health systems experiencing billing below 10 percent of eligible Medicare revenue. Compliance and documentation challenges further complicate the financial aspects of an in-house CCM. Staff must spend valuable time and resources securing authorizations and keeping paperwork up to date.
By outsourcing, health systems can avoid many of the upfront costs associated with setting up an in-house CCM program. These programs often include streamlined billing processes, support for regulatory and compliance issues, support for documentation, and reimbursement-based revenue sharing, helping health systems manage their financial risks more effectively.
Implementing an effective in-house chronic care management program presents numerous challenges for health systems, including patient engagement and tracking, staffing, technology, and financial hurdles. Implementing an outsourced CCM program can offer a variety of viable solutions to these barriers, providing the system with specialized expertise, advanced technology, and cost-effective treatment management.
Overcoming these barriers with outsourced chronic care management
If you would like to implement a CCM program, outsourcing is a viable and recommended path.
Signallamp 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 Furtherâ„¢ with remotely embedded Chronic Care Management. Schedule a consultation with us.