When introduced in 2015, the Medicare Chronic Care Management Program seemed to be a win-win-win for patients with chronic health conditions. The goal is simple: improve patient outcomes while reducing the cost of treatment. Under the program, the services include regular calls from physicians to monitor their Medicare patients, as well as:
- Coordinating information and referrals between the entire medical team
- Refilling prescriptions
- Symptom management
- Patient health education
- Preventative health counseling
- Community resource referrals
- Interventions to reduce risk factors for falls
- Coordinating social support services
Patients who met the criteria for the program (i.e., had chronic conditions and were covered by Medicare and/or a Medicare Advantage plan) are able to receive these services and the physicians who participate are also compensated. The Centers for Medicare and Medicaid Services (CMS) view was that these calls would help reduce the number of Emergency Department and hospital visits and therefore lower overall healthcare spending. This is particularly relevant as federal statistics have shown that two thirds of Medicare enrollees have multiple chronic health conditions. The snag comes in with the number of enrollees in the program and doctors participating.
Where Patients and Physicians Stand
Based on federal research conducted in 2019, only 4% of eligible Medicare enrollees are participating in the Chronic Care Management Program which has been consistent through 2023. As of 2021, Medicare data reviewed by KFF Health News showed that 12,000 physicians had participated in the program. For those physicians who have, they received $62 per patient, per month. In 2021, data reflected 4,500 physicians having received a minimum of $100,000 each in Chronic Care Management Program revenue. In the program, Medicare pays for the development of a patient care plan, treatment coordination with specialists and regular calls with program enrollees.
For those doctors who have yet to participate, they say their practices are not equipped to make calls and regularly monitor patients. Typically, this is a role for a case manager. They did not feel that the additional income would make up for the effort and the upfront costs incurred to get up and running for the program. There is also the factor that most of their Medicare patients are not enrolled in the program. In 2022, Medicare increased its compensation which has been driving more physician participation and includes additional reimbursements for chronic care management.