Is chronic care management the next healthcare frontier?

The exact size that the ongoing chronic care management industry may eventually reach is difficult to pin down with any great certainty. One rough way to estimate it is to take all of the current Medicare patients with multiple chronic conditions and multiply that by the approximately $40 monthly in consultations offered by the Centers for Medicare and Medicaid Services (CMS). As there are 36 million patients that fit into that category, that puts the possible size of the market at $1.4 billion per month, or $17.2 billion annually, according to HealthCare IT News. 

While this methodology is admittedly imprecise, the implications are valuable for providers to understand. Namely, that chronic care management, from both a services and technological standpoint, is in its relative infancy, and the market only stands to get larger. In fact, that figure could even get larger, provided that private payers institute similar guideline as the CMS. All told, the value of chronic care management could reach over $50 billion. This stands to not only help hospitals financially, but also patients medically. 

"Medicine has been more of a reactionary thing: You get sick, you go to the hospital," said Beth Hamacher, RN, patient care director at Emerald Physicians, told Cape Cod News. "We're really moving toward a model of wellness and prevention with this program."

Changes to be made
For the above figure to be reached, however, several factors need to be in place. CMS will need to release clear guidelines about what is covered by those $40 consultations, which are limited by 20 minutes each. In some cases, what is applicable will need to be expanded, as not every chronic condition is currently covered. As well, there are still great administrative difficulties associated with the process, and a great deal of paperwork associated with each visit. To provide chronic care management for 36 million – or more – people, that will have to be streamlined. 

On the physician side, the value of management will have to be reinforced on a regular basis. Providers will need an efficient way of deciding the best candidates for chronic care management, and have a system in place to determine exactly when a particular set of symptoms qualifies. Each member of a clinical team will have to be on the same page when it comes to follow-up and billing, and patients will need to fully buy into the process to see results. 

The value of chronic care management
For a provider, the immediate value of providing chronic care management is straightforward: a foothold in a market whose value could stretch into the billions. However, there are also benefits with respect to patient outcomes, which helps hospitals work more efficiently, cut costs and ultimately help more patients. 

One physician, Dr. Michael Gimnis, explained to Healthcare IT how an emphasis on chronic care management was able to help one of his patients. That man, who was diagnosed with colorectal and lung cancers, as well as anemia, had spent most of his life shuttling in and out of the hospital. He was going to more than half a dozen providers across different systems, which made getting cohesive information an uphill battle. 

"Since we've gotten him involved with [chronic care management], I'll send him to home health. He's been out of the hospital more than he's been in. Now, say that's an aggregate of my entire patient population. If we can lower that by 20 percent, that's a huge win because then we can use those resources for other things, like preventative care," Gimnis explained.

An opportunity for providers
As a nascent market, chronic care management opens up chances for providers to be ahead of the curve with regards to the technology necessary. Only 13 percent of participants in a recent study by Enli Health Intelligence and the consultancy Pershing, Yoakley and Associates had provided the necessary forms for reimbursement. Physicians have the opportunity to provide a relatively new service for their patients, and one that is in line with many of the technological advancements that are shaping the industry, such as orthopedic emr software and orthopedic coding. 

For those clinics, doing so requires a strong connection between various parts of the staff. In Gimnis' case, he relies on RNs to be an extension of his expertise. That way, his ability to provide proper care is no longer limited by his physical availability.