How to Qualify Your Patients for CCM Part 3

In part 1 & 2 of this series we defined the criteria for patients’ qualification for Chronic Care Management.  We’ve also identified three subsections of patient needs in Chronic Care Management.  In this installment, let’s look at one more Highest Risk category.  We’ll end with some notes about how staff hiring ties into this type of care, and how to get started.


The last identifying factor you can use is to identify the volume needed to hire additional part-time and full-time staff and prioritize the eligible patients.  Look at the total number of patients that qualify for Chronic Care Management in your practice.  Prioritize those patients based on how much staff time you have.  This is one of the biggest reasons why doctors see the importance of having Chronic Care Management program outsourced.  After they have identified the patients with two or more chronic care conditions, they see the volume and they realize what it is going to take for their current staff or additional staff to handle this level of care.  I would say this is definitely the most common way to start a Chronic Care Management program and that this is the way that most doctors go about it.


The requirements of having to hire additional staff are probably one of the biggest reasons why doctors outsource Chronic Care Management. With RTI you get the advantage of having our nurse take care of your patients’ needs without having to hire additional staff. 


Other Chronic Care Management vendors will tell you that this is a new revenue stream for your practice. While you will be making a profit when you use our Chronic Care Management program we suggest that you look at it a different way.  We look at Chronic Care Management as patient enrichment and we suggest that you do too.  This is something that is going to enrich the lives of your patients by increasing their level of care.  It is going to enrich the lives of your staff by decreasing their workload.  It is going to enrich your life because you’ve just added to your bottom line, increased your level of care, and lowered your workload and stress. 

We have reviewed the five most common ways that people can identify which patients are a priority for Chronic Care Management.  Again, the first criteria for Chronic Care Management are that the patient meets the identifying factors with the Part B Medicare patients with two or more chronic conditions expected to last 12 months or until the death of the patient.  But after they meet that qualification, these five categories are the most common areas of need that we utilize to prioritize who needs the program first.  

Your ultimate goal is to get every one of your patients that qualify for Chronic Care Management into that program.  This system we’ve described basically gives you an approach.  It gives you a method to start with.  You have to start somewhere when you realize that you have this giant subset of patients.  Some offices have a very large number of qualifying Chronic Care Management program patients.  It can be quite daunting to tackle that list when you have a list of 4000+ patients.  You don’t know where to start.  This gives you some basic approaches, some basic methods to utilize in order to identify who out of that patient subset is going to be your priority for enrollment.  First of all, you really do want your highest level priority patients enrolled first.  It is great when you can enroll other people, but when you are starting a program, it is important to focus on those with the greatest need.  These are the methods we have utilized successfully.

Please reach out if we can help get you on the road to offering this level of care to your patients.

Like what you read? If you're looking for help implementing Chronic Care Management at your practice, reach out to our team of experts!   

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