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Improving Chronic Care Management: Essential Role of Medications

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The chronic disease crisis in the United States was already on a rapid rise before 2020. Then COVID-19 hit, further fueling this already significant problem that is the leading driver of the nation's nearly $4 trillion in annual healthcare costs. A Medscape essay identifies some of the ways that the public health emergency is directly or indirectly contributing to chronic diseases, including respiratory distress caused by the virus, the reduced usage of and access to healthcare services, and increased exposure to suboptimal social determinants of health. As the Centers for Disease Control and Prevention (CDC) reports, six in 10 U.S. adults now have a chronic disease while four in 10 have two or more chronic diseases. Chronic diseases also represent 7 of the top 10 causes of death in the country.

As the number of individuals with chronic diseases has increased, so has the importance of chronic care management (CCM). The Centers for Medicare & Medicaid Services (CMS) defines CCM as follows, "Chronic care management is care coordination services done outside of the regular office visit for patients with multiple chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline."

A Verywell Health report highlights some of the benefits of chronic care management, and more specifically Medicare's CCM program:

  • People who participate in the program were 2.3% less likely to require emergency room or observation care in the hospital, according to one evaluation. The risk for inpatient hospitalization decreased by nearly 5%.
  • Hospitalizations related to congestive heart failure, dehydration, diabetes, and urinary tract infections were reduced.
  • The program saved Medicare about $75 per patient per month or nearly $900 per patient annually.
  • Patients reported increased satisfaction with their care.

10 Things to Know About Chronic Care Management and Medications

There are many factors that contribute to the success of chronic care management and a CCM program. One of the most significant is medications and medication management. Let's look at a 10 facts, statistics, and expert quotes that explain why medications play such an essential role in CCM.

1. Where there are chronic conditions, there are usually medications

One frequently cited report prepared by the Robert Wood Johnson Foundation notes that more than 90% of all prescriptions are filled by people with chronic conditions.

2. Medication adherence is essential for CCM success

A CDC Grand Rounds report notes the following: "Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions. Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased healthcare costs."

3. Patients with chronic diseases struggle with adherence

A National Community Pharmacists Association survey of American adults 40 and older who had been prescribed ongoing medication for a chronic condition found that about 28% of patients failed to refill a prescription in time. The survey also showed that 57% of patients missed a dose, 22% took a lower dose, and 14% stopped taking their medication. A Mayo Clinic Proceedings article notes that approximately 50% of patients with chronic illness do not take medications as prescribed.

4. The ramifications of medication nonadherence are significant for patients with chronic conditions

Bruce Bender, co-director of the Center for Health Promotion at National Jewish Health in Denver, was frank about the impact of medication nonadherence on patients when he told The New York Times, "When people don't take the medications prescribed for them, emergency department visits and hospitalizations increase and more people die."

As an article in The Permanente Journal notes, medication nonadherence for patients with chronic diseases "… is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year."

5. There are numerous reasons patients don't take their medications

The Permanente Journal article lists more than a dozen potential barriers to medication adherence. Among them: complexity of treatment, side effects, cost, poor practitioner-patient relationship, depression, and low educational level. The American Medical Association has its own list of reasons patients don't take their medications, with the article noting, "Medication nonadherence — when patients don’t take their medications as prescribed — is unfortunately fairly common, especially among patients with chronic disease."

6. Medications are a way for practitioners to identify eligible patients for CCM

CMS, in its Medicare Learning Network chronic care management booklet, indicates that a patient's medication regimen can serve as an identifier for CCM patient eligibility. The booklet notes, "Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (such as number of illnesses, number of medications, or repeat admissions or emergency department visits) or the profile of typical patients in the CPT prefatory language."

7. Electronic documentation of medications is required

Organizations providing chronic care management services must have the ability to record information including a patient's medications and medication allergies using certified electronic health record (EHR) technology.

8. Medication management is typically included in the CCM comprehensive care plan

One of the core requirements needed to bill for chronic care management is the development of a comprehensive care plan. As CMS notes, a comprehensive care plan for CCM is, "A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment, and an inventory of resources (a comprehensive plan of care for all health issues, with particular focus on the chronic conditions being managed)."

The comprehensive care plan is expected to include a number of elements, including medication management. As an American Society of Health-System Pharmacists FAQ on CCM indicates, medication management should include the list of current medications and allergies, reconciliation with review of adherence and potential interactions, and oversight of patient self-management). Other elements that should be part of the comprehensive care plan include measurable treatment goals, planned interventions and identification of the individuals responsible for each intervention, symptom management, and expected outcome and prognosis.

9. Medication-related services count toward CCM time requirements

To bill for chronic care management under CPT 99490, clinical staff, under the direction of a physician or other qualified healthcare professional, are expected to spend at least 20 minutes providing CCM services for patients. Types of services that count towards this 20-minute requirement include the performing of medication reconciliation, medications review, and helping the patient manage their own medications (i.e., self-management).

10. Chronic care management can greatly help with medication management and adherence

Chronic care management can deliver a slew of benefits in areas including medication management and medication adherence. Consider the following:

  • A study published in the Journal of the American Pharmacists Association found that pharmacist-provided CCM services can generate sources of revenue and that "pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation."
  • A study, published in The Journal of General Internal Medicine, using semi-structured interviews with Medicare beneficiaries who had two or more CCM claims submitted by an eligible provider included comments from several patients. One patient participant noted the value of a provider knowing their medications while another patient expressed appreciation for regular communication with a provider that helped with medication adherence.
  • The CMS Connected Care Toolkit notes, "By offering CCM services and billing for them under Medicare, eligible patients are provided with help from a member of the team who is dedicated to overseeing their care, a person that they regularly interact with and know. That team member can help them plan for better health and stay on track with treatments, medication, referrals, and appointments through regular check-ins and reminders."

Chronic Care Management and Medication Management: Critical Processes That Go Hand in Hand

Medication management is an integral element of chronic care management. For CCM to deliver on its full promise and potential, the medication management element, which should include medication reconciliation, medication review with patients, and patient support concerning medication adherence, must be treated as a priority.

At Cureatr, we partner with healthcare organizations to help them greatly improve their chronic care management and medication management programs, delivering clinical, financial, and operational improvements. To learn about how we do this for organizations nationwide, contact us today.

Whitepaper: Medication Management Challenges and Opportunities for Payers and Providers


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