Medicare Care Management Organization Demonstration Program
Chronic diseases are the leading causes of illness, disability, and death in the United States. They are also the leading drivers of our nation’s $4.5 trillion in annual health care costs.
A very small percentage of the total population constitutes over 30% of the overall cost ($1.35 trillion) being spent for those seriously ill patients (SIP).
Complete Care Management Services (CCMS) ACO LLC has built a unique care management solution in South Florida wherein partner hospitalists and PCPs identify and refer seriously ill patients, who would benefit from active care management, for transitional and chronic care management services available to them through the partner physician’s partnership with CCMS. Referred seriously ill patients receive transitional and care management services provided by their discharging hospitalist or PCP in conjunction with in-home chronic care management, medication reconciliation, remote monitoring, behavioral health, and other appropriate comprehensive care services provided by CCMS’s care management team of physicians, nurses, behavioral health therapists, clinical pharmacists, medical care coordinators, and other allied health professionals. The partner physician and CCMS care management team work together to track patient population care management benchmarks and outcome metrics via an individualized care plan. CCMS’s Hospital Readmission Reduction Program (“HRRP”) tracks hospital readmission rates of seriously ill patients discharged from the hospital within the last 30, 60, and 90 days. From 2023 through 2024, CCMS’s HRRP reduced its partner physicians’ readmission rate from Medicare’s average of 18% down to less than 4%. In a separate study, CCMS’s care management model significantly reduced any acute care admissions over a 29 month period with 72% of sampled patients not being admitted into hospitals.
CCMS now seeks an opportunity to demonstrate its care management model ability to produce billions in Medicare Program cost savings if adopted at scale through Care Management Organization (“CMO”) demonstration pilot program with the CMS Innovation Center. A CMO would partner with hospitalists and PCPs to coordinate seriously ill patients’ transitional care and ongoing care management needs by implementing a care management team of local physicians, nurses, behavioral health therapists, clinical pharmacists, medical care coordinators, and other allied health professionals that can provide primary-preventive medicine, chronic care management, medication reconciliation, remote monitoring, behavioral health, and other appropriate comprehensive care services in the patients’ home. Crucially, CMOs providing transitional care and care management services to seriously ill populations should be reimbursed on a capitation basis that pays a reduced monthly rate that covers the costs of maintaining a local comprehensive care management team and a yearly/quarterly incentive payment that is based on the CMO’s patient population care management benchmarks and outcome metrics. The keys to CCMS’s success in producing healthcare cost savings lie in CCMS’s meeting seriously ill patients where they come into contact with the healthcare system (in the hospital or PCP office) and proactively managing seriously ill patients’ heightened care needs where they are (in the patient’s home). CCMS believes it is best positioned to lead the way on effective care management implementation in the Medicare Program.
Proven chronic disease interventions can be cost-effective. “Cost-effectiveness” recognizes that the cost of the intervention is worthwhile in terms of longer life and better quality of life. Click the button above to learn more.