Journal of General Internal Medicine

, Volume 32, Issue 12, pp 1349–1349 | Cite as

Capsule Commentary on O’Malley et al., Providers’ Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study

Capsule Commentary

This qualitative study by O’Malley et al. explores the current state of chronic care management (CCM) in a variety of practice settings.1 The investigators conducted semi-structured interviews of providers who bill the Centers for Medicare and Medicaid Services (CMS) for CCM, those who do not, and professional society representatives in order to elucidate the perceived facilitating factors, barriers, successes, and failures of the federal payment policy for the important disease management work done outside of office visits. Their findings reveal critical limitations in the CCM payment policy, even after the 2017 amendments.2

For context, we know that CCM, done right, can decrease hospitalization and ED visits over time, with an estimated $101-per-participant reduction in Medicare spending.3 We also know that proper implementation of CCM, like anything else, takes time and money. Reimbursement for CCM by CMS is a step in the right direction, but uptake in the early years of the policy is incredibly low, with fewer than 5% of all eligible providers billing CCM. This study sheds light on why.

The study findings are limited by the small number of non-billing providers interviewed, but the results highlight the limitations of the CCM policy itself. Documentation burdens and active billing (as opposed to per-member/per-month payments used in patient-centered medical home models) create barriers to entry for providers. Worse, patient eligibility restrictions and coinsurance payments are barriers for patients. We know from the 40-year old RAND health insurance experiment that patient cost sharing leads to decreased utilization of even highly effective services,4 and cost sharing was indeed highlighted as a barrier for those without supplemental coverage. One in seven Medicare beneficiaries have no supplemental coverage,5 and they are disproportionately black, poor, and disabled. Not only is the coinsurance ineffective at achieving the goal, but it contributes to health inequity.

Taken together, these findings suggest that further improvements in the CCM payment policy that reduce barriers to uptake and ensure best practices have the potential to reduce costly utilization, improve outcomes, and save money, the holy grail of healthcare value.

Notes

Compliance with Ethical Standards

Conflict of Interest

The author has no conflicts of interest with this article.

References

  1. 1.
    O’Malley AS, Sarwar R, Keith R, Balke P, Ma S, McCall N. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study. J Gen Intern Med. doi:10.1007/s11606-017-4134-7
  2. 2.
    Department of Health and Human Services, Centers for Medicare and Medicaid Services. 80170 Federal Register / Vol. 81, No. 220 / Tuesday, November 15, 2016 / Rules and Regulations. Available at: https://www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-26668.pdf. Accessed July 14, 2017.
  3. 3.
    Hsu J, Price M, Vogeli C, Brand R, Chernew M, Chaguturu S, Weil E, Ferris T. Bending The Spending Cure By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO Care Management Within A Pioneer ACO. Health Aff (Millwood). 2017 36(5):876-884.Google Scholar
  4. 4.
    Brook, Robert H., Emmett B. Keeler, Kathleen N. Lohr, Joseph P. Newhouse, John E. Ware, William H. Rogers, Allyson Ross Davies, Cathy D. Sherbourne, George A. Goldberg, Patricia Camp, Caren Kamberg, Arleen Leibowitz, Joan Keesey and David Reboussin. The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate. Santa Monica, CA: RAND Corporation, 2006. https://www.rand.org/pubs/research_briefs/RB9174.html. Accessed July 14, 2017.Google Scholar
  5. 5.
    Cubanski J, Swoope C, Boccuti C, Jacobson G, Casillas G, Griffin S, Neuman T. Kaiser Family Foundation’s Program on Medicare Policy. A Primer on Medicare: Key Facts About the Medicare Program and The People It Covers. Menlo Park, CA: Kaiser Family Foundation, 2015. http://files.kff.org/attachment/report-a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-covers. Accessed July 14, 2017.Google Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  1. 1.UCSF, Department of MedicineDivision of Hospital MedicineSan FranciscoUSA

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