Leveraging CCM and RPM to Achieve the Quadruple AIM

by | Aug 13, 2020 | Blog

Chronic disease costs the US healthcare system $1.1 trillion a year in direct healthcare costs, with another $3.7 trillion in indirect costs like reduced productivity, early retirement, and premature death. [1] As our nation ages, that number is expected to double, which will bring an even greater burden on providers, payers, and the patients themselves. [2] With the existing provider shortage not expected to be resolved anytime soon, hospitals and health systems will be challenged to manage an increasingly sicker patient population with fewer resources.

In terms of mortality, chronic disease accounts for the majority of the top 10 leading causes of death. [3]

But the situation doesn’t have to be so grim. While we may not be able to prevent chronic illness, there are steps providers can take to reduce the pain—physically and financially—for all involved. Using chronic care management (CCM) combined with remote patient monitoring (RPM) can help providers take a more effective approach to reach the Quadruple Aim: reducing costs, improving outcomes, enhancing patient satisfaction and, recently added, improving provider wellbeing.

Reducing Costs

Patients with multiple chronic conditions—an increasingly larger percentage of the population—are the most likely to drive costs due to hospitalizations or emergency department visits. [4] CCM and RPM can reduce these through proactive management, and more effective assessment of patients with chronic disease. Yet only a small portion of the 35 million patients eligible for the program are enrolled. [5] This is largely because providers have seen it as a heavy lift, and one with little financial return.

But the Centers for Medicare and Medicaid Services have now issued its final proposed rules for services furnished under the Medicare Physician Fee Schedule for 2020, and it includes coverage for CCM, as well as provisions for RPM. Under the new rules, general supervision is allowed for RPM, meaning third-party clinical partners can now provide RPM services to practices similar to the general supervision rules associated with CCM. This helps relieve the heavy lift.

[1] https://www.fiercehealthcare.com/hospitals-health-systems/fitch-rain
[2] https://www.fiercehealthcare.com/hospitals-health-systems/fitch-rain
[3] http://managingcaresolutions.com/why-ccm/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973077/
[5] https://www.modernhealthcare.com/article/20151017/MAGAZINE/310179987/why-most-docs-skip-medicare-s-chronic-care-management-fee-and-how-some-are-making-it-work

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