According to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), chronic diseases are conditions that last 1 year or more and require ongoing medical attention. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States and are also leading drivers of the nation’s $4.1 trillion annual healthcare costs.[1] Since they are the primary cause of mortality and disability, they require timely and specialized treatment.
Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical primary care service that contributes to better patient health and care. It is a sort of digital healthcare service that assists healthcare providers in delivering educational information to their patients and the implementation of patient and illness-specific treatment alternatives and regimens.
Key players operating in the global chronic care management solutions market are:
- NextGen Healthcare (QSI Management, LLC)
- Philips Wellcentive
- TriZetto Healthcare (Cognizant)
- CSC, Chronic Care Management, Inc
- Citra Health Solutions
- Vivify Health, Inc
- CareSync[2]
Market Size and Segment
According to Precedence Research, the U.S. complex & chronic condition management market size was estimated at USD $3.2 billion in 2021. The market size is predicted to grow from around USD $2.7 billion in 2020 to USD $8.7 billion by 2027. That’s a CAGR of 18% from 2021 to 2027[3].
Impact of the Pandemic on the US Market
Covid-19 significantly changed the status quo for the healthcare industry in the US. Terms such as eHealth, telehealth, and telemedicine gained rapid traction.
The lockdown measures and the risk of getting infected compelled the US population to adopt telehealth services, especially those suffering from various chronic diseases and needing frequent consultations and monitoring.
Additionally, Remote Patient Monitoring (RPM) saw an increase in adaption after the Covid-19 outbreak. Moreover, the Department of Veterans Affairs intends to spend USD $1 billion to expand its roll-out of RPM[4].
U.S. Complex & Chronic Condition Management Market
According to the Precedence Research report on The US Complex & Chronic Condition Management Market 2020-2027:
1. Chronic Obstructive Pulmonary Disease (COPD) is expected to be the most opportunistic segment due to the rising prevalence of COPD among the US population. It is estimated that around 14.8 million adults in the US have been diagnosed with COPD in 2020.[5]
2. The Implementation services dominated the market with a 34.2% market share in 2020 due to:
- rapidly rising incidences of various chronic diseases.
- a growing geriatric population in the US, resulting in an increased volume of tests and clinical visits.
- a rise in the number of consumers on various telehealth platforms on account of ease & convenience in appointment fixation.
3. North America is expected to account for a prominent share of the market, attributed to the increase in demand for cost-effective disease management among patients and the rise in the prevalence of chronic diseases such as heart disease and asthma in the U.S. and Canada[6].
Common CCM Services
- CCM provides services that include Face-to-face Evaluation & Management (E/M) visits, an Annual Wellness Visit (AWV), or an Initial Preventive Physical Exam (IPPE) for new patients.
- It includes the structured recording of Patient Health Information (patient’s demographics, problems, medications, and medication allergies) using Certified Electronic Health Record (EHR) Technology.
- Patients & caregivers are provided with 24/7 access to physicians/qualified practitioners/ clinical staff for urgent needs and routine appointments.
- It includes the creation, revision, and monitoring of a Comprehensive Care Plan based on the patient’s needs and inventory of resources.
- Manages care transitions between health care providers, including referrals to other clinicians, follow-up after an emergency department visit, or after hospital discharges. It also includes the exchange & sharing of medical document(s) promptly with other practitioners.
CCM Service Practitioners
The following non-physician practitioners (NPPs) may bill CCM services:
- Certified Nurse Midwives (CNMs)
- Clinical Nurse Specialists (CNSs)
- Nurse Practitioners (NPs)
- Physician Assistants (PAs) [7]
Value-Based Care with CCM
- A CCM program provides continuity of care and regular interaction services that can be utilized to improve patient satisfaction and engagement to achieve better health outcomes and value-based success.
- According to a study by Mathematica Policy Research, CCM participation can lead to fewer hospitalizations and emergency room visits.
- CCM providers can maximize clinical efficiency by engaging and treating a high volume of patients remotely. A care manager can perform nearly all tasks required for CCM and engage with 100 to 250 patients per month.[8]
Reimbursements for CCM
CCM reimbursements help in generating substantial revenue for physician practices. Knowledge of CCM CPT codes ensures that physicians receive Medicare reimbursements on time and coordinate patient care efficiently.
This ensures the expansion of capacity into other areas or helps support the adoption of new technology to further increase efficiency. It also leads to cost-savings across departments, which ensures that the revenue cycle is protected.
Reimbursements from some of the more common CCM codes increased 40% to 60% in 2022.
Industry experts estimate that 40% of CCM patients will require 20 minutes of time, 40% will require 40 minutes of time, and 20% will require an hour or more, per month. Following the 40-40-20 rule forms an easier way to estimate the revenue potential for the practice.
[1] “About Chronic Diseases”, July 2022, National Center for Chronic Disease Prevention and Health Promotion, www.cdc.gov
[2] “Chronic Care Management Solutions Market 2018-2026”, Transparency Market Research, www.transparencymarketresearch.com
[3] “US Complex and Chronic Condition Management Market Size by 2027” January 2022, Precedence Research, www.globenewswire.com
[4] “New CCM Reimbursement Codes & Increased Revenue – 2022”, Healthmote, www.healthmote.com
[5] “US Complex and Chronic Condition Management Market Size… by 2027” January 2022, Precedence Research, www.globenewswire.com
[6] “Chronic Care Management Solutions Market 2018-2026”, Transparency Market Research, www.transparencymarketresearch.com
[7] “MLN909188 – Chronic care Management Services” September 2022, The Medicare Learning Network, www.cms.gov
[8] “Implementing Value-based Care with Chronic Care Management”, April 2022, Thorough Care, www.thoroughcare.net
