Caradigm Care Management

Medicare Chronic Care Management Revenue

Caradigm Care Management enables providers to achieve Chronic Care Management (CCM) revenue to help fund ongoing investment in value based care. Since January 1, 2015, Medicare has paid separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

As healthcare organizations seek to earn Centers for Medicare & Medicaid Services (CMS) reimbursements for CCM they will need new solutions to support and scale care management efforts. Caradigm Care Management enables a multi-disciplinary care team to provide coordinated care for high-risk and rising-risk patient populations while working at "top of license". It employs evidence-based assessments that auto-generate care plans and recommend mitigations, facilitate medication review and help care managers plan their day and prioritize tasks. The efficiencies gained can help providers scale their care coordination initiatives so they can enroll more patients and optimize their return on investment. Investment in a solution supports the generation of new revenue through CCM, which helps fund overall investment in population health.

 

CCM revenue example based on a provider practice with 3000 patients, 50% that are Medicare and two-thirds of those with 2+ chronic conditions and are willing to participate in CCM:

Eligible and Participating Medicare

Patients with 2+ Chronic Conditions


1000 Patients

Potential Revenue Per

Member Per Month


$40

Potential Annual

Revenue


$480,000

 

For organizations in need of CCM solutions and services, Caradigm has partners that pair our solutions with additional CCM services.

Caradigm Care Management supports CCM by providing:

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  • Tracking and reporting of time spent per month for core care management processes
  • Automated assessments using evidence-based guidelines
  • Electronic plans of care that can be shared with the broader care team
  • Automated, event-based tasking and role-based tasking
  • Self-Management Action Plans (SMAPs, i.e. patient plan of care) that can be shared with patients

 

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CCM Services Revenue Calculator

Calculate your potential CCM revenue based on your eligible patient population:

Total number of patients

Percentage of patients covered by Medicare1

Estimated number of Medicare patients

0

Percentage of Medicare patients with 2+ chronic conditions2

68.6 %

Estimated Number of eligible CCM patients

0

CCM monthly payment3

$41.44

Estimated potential annual CCM revenue

$0

1MGMA Cost Survey for Single Specialty Practices: 2013 Report Based on 2012 Data specific to the specialty of family medicine.

2CMS.gov - County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.

3Reimbursement amount for CPT 99490 from the CY 2015 Physician Fee Service Final Rule, October 31, 2014, averaged across 89 localities.

The financial metrics provided by the calculator are for estimating purposes only. These estimates are not a guarantee of results. Caradigm does not make any representations or warranties of any kind on the information provided. We also disclaim any liability or responsibility for the accuracy, correctness or completeness of the calculation provided nor its applicability to your individual circumstances. Nothing contained in the calculator is intended to constitute professional, legal or financial advice. The calculator is only for use in the United States.

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