What You Need to Know about Chronic Care Management

June 2, 2017

Reimbursement, initiation, and what pharmacists can do.

Chronic Care Management (CCM) is a way for pharmacists to become more involved in the treatment of patients with chronic diseases. But as with any other collaboration, many barriers and questions exist, such as how reimbursement will work, who is involved, or how to get started.

To help pharmacists, the APhA teamed up with Health Quality Innovators (HQI) and the Delmarva Foundation, two federally-designated Quality Improvement Network-Quality Improvement Organizations, to create a guide for navigating the world of CCM.

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“CCM and complex CCM represent an opportunity for pharmacists to leverage their medication expertise in the ongoing management and coordination of care for people with chronic diseases,” said Anne Burns, RPh, APhA’s Vice President of Professional Affairs in a press release. “Participation as clinical staff in CCM delivery also allows pharmacists to contribute to key quality metrics of interest to qualified health care providers.”

The guide, Chronic Care Management (CCM): An Overview for Pharmacists, begins by defining the “core activities” of CCM: “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; and transitional care management.” The guide then delves into the specifics of payment codes depending on service and amount of time. CCM involves at least 20 minutes of services while complex CCM involves more than 60 minutes of services. They require separate payment codes.

The guide also includes tips on possible pharmacist roles as well as pharmacist scopes-of-practice. Pharmacists are defined by CPT coding as clinical staff, “a person who works under the supervision of a physician or other qualified health-care professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service; but who does not individually report that professional service.” The pharmacist as a member of clinical staff can work with a qualified health-care professional (QHP) to collect structured data, maintain updates for care plan, manage care, and more.

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The guide also covered how to bill through EHR, patient enrollment, a business model for pharmacists, and more details that pharmacists need to know before attempting to work in this kind of model.

During comprehensive and transitional care management components of CCM,” the report concludes, “pharmacists also have the potential to influence key quality metrics of interest to QHPs.”

Read the full guide

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