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Patient Experiences with Chronic Care Management Services and Fees: a Qualitative Study

  • Claire Wilson
  • Ann S. O’Malley
  • Carla Bozzolo
  • Nancy McCall
  • Sai Ma
Original Research

Abstract

Background

As of 2015, the Centers for Medicare & Medicaid Services (CMS) pays for chronic care management (CCM) services for Medicare beneficiaries with two or more chronic conditions. CMS requires eligible providers to first obtain patients’ verbal (and, prior to 2017, written) consent, to ensure that patients who participate in CCM services understand their rights and agree to any applicable cost sharing. CCM providers must also enhance patients’ access to continuous and coordinated care, including ongoing care management.

Objective

To understand patients’ perceptions of the consent process, their reasons for choosing to participate, and their experiences receiving CCM services.

Design

Qualitative study using semi-structured interviews with Medicare beneficiaries who had two or more CCM claims submitted by an eligible provider. Beneficiaries were selected from a sampling frame of Medicare claims submitted between January and September 2015.

Key Results

Most patients reported no concerns about being asked to participate in CCM. The majority of patients had secondary insurance (or Medicaid) that covered any coinsurance for CCM and therefore could not say with certainty whether they would participate if they had to pay for CCM services out-of-pocket. Reasons for participating included having insurance that covered the copay and peace of mind about having access to the CCM team. Patients reported multiple benefits of participating in CCM services, including better access to their primary care team, improved continuity of care, and improved care coordination. Most patients reported no downside to participating in CCM services, although some felt they were relatively healthy and questioned whether they needed CCM services.

Conclusions

These findings on patients’ experiences participating in CCM services during the first 9 months of the policy’s implementation can help providers and policymakers understand their perceived benefits and unintended consequences. Our findings also have implications for providers when approaching patients about CCM services.

KEY WORDS

care management chronic conditions patient experiences qualitative research care coordination 

Notes

Funding

This work was supported by the Department of Health and Human Services, CMS, under contract HHSM-500-2014-00034I, Task Order No. HHSM-500-T0003.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4750_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Claire Wilson
    • 1
  • Ann S. O’Malley
    • 2
  • Carla Bozzolo
    • 1
  • Nancy McCall
    • 2
  • Sai Ma
    • 3
  1. 1.Insight Policy ResearchArlingtonUSA
  2. 2.Mathematica Policy ResearchWashington DCUSA
  3. 3.Centers for Medicare & Medicaid ServicesBaltimoreUSA

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