What Is Chronic Care Management?
Many individuals struggle with chronic health conditions on a daily basis. While challenging, there are services available like chronic care management designed to help individuals better manage their conditions and overall health.
What Is Chronic Care Management?
Chronic care management (CCM) is a type of preventive measure for individuals who have chronic health conditions. It was originally started by the Center for Medicare and Medicaid Services (CMS) to benefit both patients and physicians.
This billable Medicare service ensures individuals have access to care coordination services outside of regular office visits. As a preventive service, chronic care management means it can also help prevent hospital or emergency room visits as well as reduce the chances of being readmitted after being released.
How Is CCM Different From Typical Care Management?
Both programs are designed to provide individuals with assistance and support. As its name suggests, chronic care management is designed specifically for individuals who have at least two chronic conditions. There are requirements regarding the length of time the condition is expected to last as well as how long the clinical time spent with the patient will be.
Through this program, providers will be able to record and note changes in the individual’s health. By keeping care plans and sharing patient health information with other providers, CCM helps manage changes in an individual’s health.
Typical care management can provide support to older adults who need ongoing assistance with managing their health and safety. These programs are especially beneficial during transitional periods, ranging from transitioning back home after a hospital stay or moving into a nursing home.
A client’s care manager essentially serves as their advocate, ensuring they have access to the specific services they need to live gracefully. While a typical care management program can include chronic care, it also includes a range of other services, such as:
- Client education
- Care research and planning
- Care coordination
- Medication management
- Hospital-to-home transition care
- Transportation to physician office visits
- Memory care
What Conditions Qualify for Chronic Care Management?
Chronic conditions are diseases and disorders that are long-lasting, not easily cured and can potentially get worse over time. Alzheimer’s disease is a common chronic condition that affects many older adults.
With this disease, individuals could experience difficulty focusing, remembering and communicating. Symptoms range from mood swings to physical problems like general discomfort and poor coordination. Some may experience delusions and hallucinations, or they might have a tendency to wander. These symptoms can make it difficult for individuals — and their family members — to continue caring for them alone.
Along with Alzheimer’s disease, CCM can help individuals with many other types of chronic conditions who may struggle with basic activities of daily living (ADLs), including:
- Autism spectrum disorders
- Arthritis
- Asthma
- Cancer
- Cardiovascular disease
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Diabetes
- Dementia
- Depression
- Heart failure
- Hepatitis (Viral B & C)
- HIV and AIDS
- Osteoarthritis
- Osteoporosis
- Rheumatoid arthritis
- Schizophrenia and other psychotic disorders
- Stroke
How to Know When CCM Is Right for Someone?
Chronic care management is provided outside of regular office visits to help individuals manage their health and follow their care plan.
To qualify for CCM, a person needs to have at least two chronic health conditions that will last for a minimum of 12 months or the rest of their life. The condition must place the patient at risk for functional decline, acute exacerbation or death.
To be eligible, individuals must also first have a face-to-face visit with a Medicare-qualified provider. This visit can be:
- An annual wellness visit
- A transitional care visit
- An initial preventive physical exam
- Another evaluation or management visit
After the initiating visit is complete, individuals must consent to the program, and then they will receive an individualized care plan. Clinical time spent with the patient can vary, but it must be a minimum of 20 minutes.
Find the Right Home Care for Seniors With Chronic Conditions
At Corewood Care, our aim is to improve the way care is managed. Older adults and their families throughout Washington, D.C., and Bethesda, Maryland, have access to our care management services as well as other types of home care and care coordination services.
Every client is unique, so we tailor our services to meet each person’s specific needs and goals. We specialize in an integrated care management and home care model, and our multidisciplinary team of professionals supports our clients and their families however they need us to. No matter what chronic condition individuals may be facing, our team is dedicated to improving health management by effectively cross-collaborating and mitigating potential health risks.
Want to learn more about our care management solutions and how we can help you thrive and live gracefully? Contact us today to schedule a free assessment.
