Beginning January 1, 2015, the Medicare Physician Fee Schedule (PFS) reimburses qualified providers for Chronic Care Management (CCM) services for Medicare beneficiaries with two or more chronic health conditions. Pharmacists can participate in CCM as clinical staff, with their services being billed incident to by a qualified provider. CCM services include five core activities:
- Recording structured data in the patient’s health record
- Maintaining a comprehensive care plan for each patient
- Providing 24/7 access to care
- Comprehensive care management
- Transitional care management.
The Centers for Medicare & Medicaid Services (CMS) estimates that approximately two-thirds of Medicare patients have two or more chronic conditions, and CCM aims to better coordinate the care these patients receive. Through CCM and complex CCM, CMS pays for non-face-to-face care coordination services furnished to Medicare beneficiaries who reside in the community setting that meet the following requirements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
- Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline; and
- Comprehensive care plan established, implemented, revised, or monitored.
CCM could be a powerful base payment mechanism for pharmacists and their prescriber partners who are collaborating on the care of a patient population. Additionally, CCM and complex CCM could provide the fee-for-service mechanism for pharmacists to be compensated for some of their services as pharmacists and physicians enter into emerging quality-based and risk-sharing payment structures.
APhA's CCM Resources
APhA collaborated with two Quality Improvement Organizations, Health Quality Innovators and Delmarva Foundation, to create Chronic Care Management (CCM): An Overview for Pharmacists. This guide describes the requirements for CCM and how pharmacists may play a role as clinical staff.
CCM in Practice. Learn about how Michelle Thomas, pharmacist at Chickahominy Family Physicians in Virginia, has integrated CCM into her pharmacy practice.
The CCM Patient Consent Checklist was created in collaboration with Telligen and can be used to help guide members of the CCM care team as they collect necessary information for patient consent to participate in CCM service.
What Can Chronic Care Management Do for You? - This webinar helps the whole care team learn what CCM is, how pharmacists can engage, and strategies for reimbursement/sustainability. Free CE is available for all clinicians.
Additional CCM Resources
CMS Guidance on Chronic Care Management Services
CMS FAQs on CCM
CMS Summary of CCM Changes for 2017
CMS Connected Care Initiative