Mathematica Policy Research, 1100 First St., NE, 12th Floor, Washington, DC, 20002-4221, USA.
The Innovation Center (CMMI), Centers for Medicare & Medicaid Services (CMS), Baltimore, MD, USA.
J Gen Intern Med. 2017 Dec;32(12):1294-1300. doi: 10.1007/s11606-017-4134-7. Epub 2017 Jul 28.
Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits.
To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward.
Semi-structured telephone interviews from January to April 2016 with 71 respondents.
Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives.
Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices.
Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.
为患有多种慢性病的患者提供门诊以外的持续护理管理和协调支持一直不足。2015 年 1 月，医疗保险推出了慢性病护理管理（CCM）支付政策，为医疗保险受益人在门诊以外提供 CCM 活动的提供者报销费用。
探索提供 CCM 服务的实践经验、促进因素和挑战，以及今后的发展方向。
2016 年 1 月至 4 月期间对 71 名受访者进行了半结构化电话访谈。
60 名计费和非计费提供者以及对其实践的 CCM 服务有了解的实践工作人员，以及 11 名专业协会代表。
实践受访者指出，大多数患者对 CCM 服务表示积极看法。实践受访者还认为 CCM 服务有几个患者受益，包括提高治疗依从性、获得护理团队成员的机会、满意度、护理连续性和护理协调。CCM 提供的促进因素包括在实践中配备护理经理、以患者为中心的医疗之家认可、有制定护理计划的经验、患者对提供者的信任，以及补充保险以支付 CCM 共付额。大多数计费实践报告在获得患者对 CCM 的同意方面几乎没有问题，但提供者认为 CMS 可以通过向受益人宣传 CCM 的目标来更好地促进同意。专业协会代表和计费及非计费提供者报告的障碍包括 CCM 支付不足以支付人员配备、工作流程修改和管理复杂患者所需的前期投资。其他障碍包括与其他提供者进行健康信息交换的基础设施不足，以及记录和更新护理计划的电子健康记录功能有限。与较小的、独立的实践相比，拥有医院系统和大型医疗集团的实践在实施 CCM 方面面临更大的官僚主义。
要改善提供者对 CCM 的体验和接受程度，需要解决一些挑战，包括 CCM 建立的前期投资以及为更复杂的患者提供 CCM 所需的时间。
