The workflow at a medical practice is pretty standard. The patient checks in, they pay a co-pay, their insurance coverage is checked, they get triaged, they see a physician, theyâ€™re given instructions, they check out, and they leave. But what happens after they leave?
The workflow at a medical practice is pretty standard. The patient checks in, they pay a co-pay, their insurance coverage is checked, they get triaged, they see a physician, they’re given instructions, they check out, and they leave.
But what happens after they leave? And what about patients who have one or more chronic conditions?
“The desire for people to have their disease managed effectively really needs extra lift that what you can do in a 10-minute appointment,” says Travis Bond, CEO of CareSync, a leader in chronic care management. “These are things that have to be done outside the practice, but are initiated inside the practice.”
CareSync uses technology that extends beyond what a practice’s electronic medical records (EMRs) can do, and connects the family and the patient with other providers. In short, it guides practices that want to practice care outside of the four walls of their practice or their hospital, and allows them to utilize technology as the framework that helps with communication and care coordination.
“While there was always the desire for these programs to exist to coordinate the care of those who needed extra, now with MACRA and other initiatives coming, it’s more of a requirement,” Bond says.
Beyond the Basics
Bond explains that providing chronic care management means having a secondary practice workflow. Once the patient completes an office visit, does someone at the practice follow up? Or do you wait for the patient to reach out when they’re in need?
“With chronic care management, you really have a whole other flow,” Bond says. “A flow that now says, we will be the care leader with other physicians that see this patient as well. And we will put that information into one place that now everyone can share.”
That centralization of data into a platform that all can access does involve a process rework; a reworking of processes that recognizes that now you have to communicate with other providers. You have to leave patients with something that looks more like a care plan than just a prescription for a drug. You then have to coordinate the dissemination of that information. And, perhaps most important, you need to communicate this new style of caring with the patient.
“That’s really one of the biggest hurdles,” Bond explains. “Patients really are down at the very bottom of the learning curve when it comes to what is a non-face-to-face visit and what is care coordination. It’s an education point. That’s the only way to have a successful chronic care management program.”
Alan Hurty, MD, is a cardiologist with Willamette Heart and Family Wellness in McMinnville, Oregon. His practice uses the chronic care management services provided by CareSync because, “They do the work that we realistically cannot do ourselves.”
Hurty recalls a patient who he had on an antiarrhythmic for atrial arrhythmias.
“That’s a very specific class of medicines,” Hurty says. “A lot of physicians aren’t very comfortable prescribing and managing them. As cardiologists, we do a lot of that.”
The patient wound up in an emergency room during a trip to Arizona, and was given an antiarrhythmic that was clearly a contraindication in combination with his current treatment.
“That was picked up by CareSync, and I was notified, and within 24 hours I was aware of this,” Hurty recalls. “We contacted the patient and that was stopped. And that could have resulted in an extraordinarily severe consequence, such as death to the patient.”
Hurty explains that if he provided that level of care directly out of his office by hiring additional staff, his overhead would increase — a trend that has already been occurring.
“I used to be a very small cardiology practice, and now we have a lot of overhead,” he says. “As healthcare has changed, that’s somewhat been forced upon us, in a base of declining revenue. Those margins have gotten closer and closer. So, yeah, I see there’s a cost-benefit [to using chronic care extenders].”
There’s also a potential future cost, as Bond illustrates. He suggests that a physician starting a chronic care management program in 2016, getting about 500 patients to sign on, and demonstrating about half of the requirements under MIPS, would earn about $90,000 in 2017, and another $90,000 in 2018.
“It’s pretty significant,” he says. “What sort of now compounds that analysis is that you have MACRA basically saying that we are going to go from volume to value, and that there will be payment adjustments that will happen starting in 2019.”
In other words, if you’re not performing something that looks a lot like CareSync or chronic care management, if you’re not doing things that are demonstrating value, then you will be penalized.
“The carrot phase is here,” Bond says, “but the stick phase is coming.”