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Articles in Category: Performance Reimbursements

Quality-Based Compensation and Chronic Care Management

Quality-Based Compensation and Chronic Care Management

Strong patient relationships are important for better health and quality of care. Quality-based compensation has continued to evolve with quality-based care and performance metrics. Practices and health systems have aimed to find the balance between clinicians seeking to improve patient health and eliminating cost drivers, as well as risks. Population health management (PHM) can too often focus on measuring quality in terms of task-based care. In some instances, this can significantly diminish the clinicians’ ability to decipher difficult medical situations and impact their ability to build strong relationships patients who have complex chronic care needs.

Currently, many quality metrics assess a practice or health system’s ability to reliably deliver certain processes of care. As practices and health systems make the adjustments from fee for service to a focus on person-centered, and quality-based compensation models, Chronic Care Management (CCM) and Transitional Care Management (TCM)services add tremendous value and returns. CCM and TCM Care Managers can capture the data and provide outreach to patients that required additional outreach and care planning. This type of connection and communication with patients can boost quality benchmark performance.

Achieving Performance and Quality with Chronic Care Management

Achieving Performance and Quality with Chronic Care Management

As the prevalence and associated costs of chronic diseases continue to grow, healthcare stakeholders, including payers, are focusing on performance and population health program (PHM) measures of chronic conditions for reimbursements and value-based incentives

Provider groups taking on risk have initiated disease management (DM) programs for patients with common chronic diseases, and complex case management (CCM) programs for patients who experience critical or traumatic health events, or who have highly complex and high-acuity diagnoses. Core to both DM and CCM programs are requirements for care managers to address behavioral health problems or socioeconomic challenges. Effective care coordination programs have the capability to focus on building relationships with patients and primary care providers. This can allow provider groups and payers the ability to demonstrate improvement in preventive care and quality measures.

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