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Chronic Care Management Solutions in the Health Industry

chronic care management

Chronic Care Management involves ongoing care, education, and oversight activities by healthcare professionals to help patients understand their condition, to modify their lifestyle to adapt to their status, and successfully live with it. Chronic diseases such as diabetes, high blood pressure, lupus, multiple sclerosis and sleep apnea require frequent follow-up, regular monitoring, and ongoing care. A lack of a proper well-defined system to take care of patients with various chronic diseases makes it difficult to take care of such patients.  

The size of the chronic care industry is uncertain and not well defined. The best guesses come from calculating the number of current Medicare patients with multiple chronic conditions. There are a large number of patients who need constant care and do not receive it. The industry is still in its infancy and is poised to grow larger. This is an excellent opportunity for immigrant patients who do not receive the necessary care due to lack of government recognition.

Challenges faced by Chronic Care Management industry

Almost 93 % of all spending on Medicare goes towards patients with multiple chronic conditions. Physicians are already overworked with managing the administrative and regulatory responsibilities of the day-to-day obligations of clinical documentation, revenue cycle management, and fulfilling the requirements of CMS and MACRA.  

Given these challenges, outsourcing chronic care management services can significantly simplify the care management of patients (and the reimbursement processes.) Given the CMC dictate of minimum 20-minute care coordination and management per patient per month, and the fact that most patients take more than this time; the total time requirements of institutions and hospitals tends to add up.  

This along with the administrative and documentation requirements adds up to additional staff time and increases investments both in staff and technology. Outsourcing Chronic Care Management (CCM) is a simple one-step solution to these challenges.

Benefits of Outsourcing Chronic Care Management

Revenue Generation 

With the initiative of Centers for Medicare and Medicaid Services that pays doctors for delivering non-face-to-face care to patients having two or more than two chronic conditions, additional revenue generation is one of the primary benefits of outsourcing. Revenue generation by outsourcing is possible for both large and smaller practices when outsourced to a reliable and professionally managed organization such as Allista.

Allista is a specialty healthcare organization that specializes in chronic care management of immigrant workers in US and Canada who have work-related injuries and face medical deportations.

Saving on Time

Implementing a chronic care management program is time intensive, and many healthcare providers lack sufficient staff bandwidth to provide ongoing care. Outsourcing to Allista can help save the time of the physician which can be better utilized for more intensive acute care cases.

Maximizing potential

Outsourcing chronic care allows doctors to give this facility to a greater number of patients by increasing his professional bandwidth and minimizing work at the same time.

The physician can prepare a healthcare plan for the patient and handover the care to Allista. Physicians at Allista then monitor patient progress and are responsible for follow up and ensuring compliance. The organization reports the patient’s progress to the doctor.

This aspect of chronic care is necessary for patients who are in the process of medical repatriation or may undergo repatriation in course. Outsourcing CCM to a professional institute such as Allista, which specializes in the care of migrant workers, ensures optimum health care for all persons, irrespective of their nationality and document status.

Compliance Considerations

Payments made under CCM will be under close monitoring of the Health and Human Services Office of Inspector General (OIG).  Physicians need to be aware of significant regulatory changes and adequately determine the eligibility of patients, providers, and services. Outsourcing takes these supervisory responsibilities off physicians.

Adopting a CCM program without adequately considering the requirements can potentially create a revenue risk and may increase the focus on post-payment reviews. Outsourcing organizations take care of remaining vigilant to regulatory changes and managing evidence of compliance. Compliance is a critical component of a successful CCM program and outsourcing to a professional organization ensures compliance while reducing strain on resources and increasing revenue generation.

Allista understands chronic care management aspects and ensures adherence to guidelines while optimizing healthcare for immigrants. Our facility caters to patients from all walks of life. In addition, our services are affordable, meaning that patients get easy access to high-quality health care. Through our partners, Hospital Americas and Hospital en Casa, patients are able to easily receive treatment in Guadalajara, Mexico.

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