CMS Chronic Care Management service lowers costs, improves care

CMS’ Chronic Care Management (CCM) service is aimed at strengthening access to chronic care management services in primary care settings while reducing costs, and a report on the program prepared by Mathematica Policy Research for CMS indicates its doing just that. 

CMS introduced separately billable CCM services in 2015, and more than 684,000 beneficiaries have taken advantage of its benefits in the first two years of the program. Most participants were in poorer health than the standard Medicare fee-for-service beneficiary. On average, the majority of participants received four to 10 months of services through CCM, but about 19% took advantage of the service for just one month. During the first two years of the program, providers billed for $105.8 million in CCM services. CMS pays providers under the Medicare Physician Fee Schedule for these services.  

CCM allows providers to bill for care management services furnished outside of office visits for fee-for-service Medicare beneficiaries with two or more chronic conditions that put them at risk for decreased functionality or death. To bill for these services, eligible professionals must provide or supervise staff in providing a minimum of 20 minutes of clinical staff time for CCM services each month. Services provided under CCM include ensuring participants have a dedicated clinician, developing or adjusting care plans, managing medications, and communicating with other providers involved in the participants' care.  

The median number of patients a provider treated through the program was 10, although the average was 47, which indicates some providers furnished CCM services for many beneficiaries. More than half (68%) of those who billed for CCM services were primary care providers and 42% were solo practitioners.  

The report revealed that CCM services increased the use of community-based resources, including home health, primarily because the program allows providers and their staff to better connect participants with services at home and in their communities. The report also found that beneficiaries who participated in CCM early in the initiative were less healthy and more frail than those who received services later. CCM also helped reduce Medicare costs for beneficiaries who died during the CCM follow-up period, which suggests CCM participants receive better end-of-life care than non-participants.