Common Barriers To A Successful Chronic Care Management Program

Chronic conditions are on the rise in the United States with citizens having one or more chronic diseases being 141 million in 2010 and expected to grow to 171 million by 2030. Every 1 in 2 Americans will be suffering from a chronic illness by 2030. Additionally, there’s a rapid increase in the number of Medicare beneficiaries and according to the Centers for Medicare and Medicaid Services, the total number of Medicare beneficiaries by 2030 will be 80 million; a significant increase from 55.3 million people in 2015. 

Managing chronically ill Medicare beneficiaries is an area CMS is constantly working to improve. Chronic conditions are particularly hard to manage as frequent physical evaluation is not a possibility for a majority of chronic patients. Regular clinic visits become even more difficult for chronically ill patients living in remote areas with little to no access to competent medical professionals in their neighborhoods. 

To enable this patient population to receive high-caliber medical care without having to leave their homes and offices, CMS has introduced a remote care delivery model called chronic care management (CCM). If you are a healthcare practice looking for ways to improve outcomes for chronic patients while also adding an extra stream of revenue, providing CCM services is the way to go. In this article, we will discuss what CCM is, how it can be effective and beneficial and what barriers practices face in implementing CCM programs. 

What is chronic care management (CCM)

Chronic care management is a care coordination and delivery program for facilitating seamless communication and coordination between chronic patients and providers outside of the conventional clinic settings. CCM uses the latest digital technologies to help patients and providers coordinate regarding patients’ conditions, symptoms as well as treatment recommendations and medications. For a patient to be eligible for a CCM program, they must have two or more chronic illnesses that are expected to last at least 12 months or till their death and put them at risk of serious aggravations and physical decline. 

CCM services are rendered remotely and every CCM enrollee receives at least 20 minutes or more of care delivery services every month. Healthcare providers in a CCM program work with patients to design their care plans as well as provide treatment recommendations as per the patients’ latest healthcare data. Patients have 24/7 emergency access to their healthcare providers without moving out from their place of comfort. Expert assistance is provided to every CCM enrollee to help them achieve their long and short-term health goals. 

Benefits of chronic care management 

CCM provides several benefits for both patients and providers. For patients, CCM enables them and their families to be relieved that a competent medical authority is remotely monitoring them and any signs of exacerbation will be pre-identified for instant intervention and risk prevention. Furthermore, CCM reduces costs for patients and enhances the quality of care. It also involves patients in their own health and well-being and compels them to self-manage their conditions. 

For providers, CCM provides an extra stream of revenue that they can add to their existing healthcare practice. It also helps them enhance patient outcomes and provide coordinated care for reducing wasteful spending. The glaring gap between patients and providers is adequately closed with CCM as providers get to connect with patients remotely and access their entire medical records with a touch of a button. Over 90% of physicians indicate that they wish they had help making patients adhere to their care plans. CCM can be the help physicians need for optimally treating MCC patients. 

Is chronic care management effective?

With 71% of the overall healthcare costs claimed by chronic illnesses, the need for effective chronic disease management is imminent. CCM is highly effective in managing patients suffering from multiple chronic conditions and reducing the risk of expensive aggravations. Furthermore, CCM can be profitable for providers with the Centers for Medicare and Medicaid Services offering an average of $40 per patient enrolled in a CCM program under CPT code 99490. 

It’s calculated that a healthcare practice can add an additional revenue of $139,104 per year by offering chronic care management services. CCM has proven to reduce expensive hospital admissions and readmissions thereby lowering the annual healthcare costs. 

Common barriers to a successful chronic care management program

1.Gaining patients – Getting the patients’ consent and convincing them to enroll in a CCM program is a major challenge most providers and practices face. 92% of patients are satisfied with the care they receive at their primary physician’s office. However, only 9% of physicians indicate their MCC patients receive ideal care. Practices should invest in creating outreach campaigns to market the benefits of the program to eligible patients and compel them to enroll. 

2.Accuracy in medical coding – Since the reimbursement codes and guidelines keep changing, practices need to stay abreast with the latest developments in the payment rules introduced by the CMS. Accurate coding and billing and managing documents is a hurdle practices face in executing a successful CCM program. 

3.Calculate the value of chronic care management – To demonstrate the value of the CCM program to patients, healthcare practices must first evaluate what unique benefits their CCM program can provide to MCC patients. Additionally, it’s also important to compare the estimated profits they are going to earn against the costs of managing documents for coding and billing as well as other overheads. Though CCM is a highly profitable program for practices, it can be difficult to see the benefits at the outset which is a major barrier healthcare practices face. 


If you are a healthcare practice looking to implement and operate a successful CCM program, working with a reliable CCM and RPM solutions provider can be your best bet. These full-service healthcare solutions provider helping healthcare practices initiate CCM programs for their Medicare patient population and earn valuable profits. By partnering with big-name healthcare organizations.