More often than not, patient care is more than just a single prescription. Sometimes, a patient only needs a single order for azithromycin and methylprednisolone, and they’re on their way.
For others, however, their health issues aren’t so clear-cut. Some health journeys are bumpier than others due to chronic disease. Patients have these ailments for the long haul. This is where chronic care management comes in.
Chronic care management plays a vital role in your independent pharmacy. It honors that patient care goes beyond a single prescription or your independent pharmacy.
It is a long-term, sometimes lifelong endeavor. And just like so many aspects of pharmacy work, it’s more than worth your time. Here’s what you need to know about chronic care management.
What is Chronic Care Management?
ASHP defines chronic care management as the payment for chronic care services to Medicare patients “who have multiple significant chronic conditions that are expected to last at least 12 months, or until the death of the patient.”
In short, chronic care management is exactly what it sounds like: a program that treats patients with multiple chronic conditions as long as it’s necessary.
This is mainly a Medicare-centric program, which makes sense given that most Medicare patients are elderly.
To qualify for chronic care management, Medicare beneficiaries need to be diagnosed with two chronic conditions, such as blood pressure and diabetes.
Before you or your patient can go any further, their primary care physician must authorize their patient’s entry into the program.
Once your patient’s doctor has given consent (verbal or written) to continue with chronic care management, it’s time to see what the program truly consists of. Hint: it’s more than just filling a prescription.
The Scope of Chronic Care Management
As you likely know, chronic care management is an expansive and comprehensive method of patient care. It requires healthcare professionals from all industries to work together to help your patient.
Chronic care management plans often consist of a problem list, treatment goals, medication management, coordination of services, and periodic reviews of the care plan.
While it sounds like a lot — and it is — chronic care management is a tried and true way to ensure you and other healthcare professionals are rightly caring for your patients. What’s a little more paperwork?
How Your Pharmacy Software System Factors In
Independent pharmacists wear several different hats. What’s more, pharmacy work often runs at a breakneck pace. As such, you need a pharmacy software system to help you keep the hectic pace.
Your software should let you do the basics effortlessly well. It should also assist you in more complex tasks with the same amount of comfort and ease. Chronic care management is one of those complex tasks.
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Let’s look at the patient profile. Are you able to add comments or notes to help give more context to the patient’s health journey? Your pharmacy software system should let you add such comments, which will be helpful for the rest of your pharmacy staff.
Your pharmacy software system should provide a clear and concise layout of your patient’s fill history. You should also be able to filter out specific medications to see how consistently they take a certain prescription.
This will be especially helpful for the patient’s doctor to keep track of their chronic care management plan.
The key to successful chronic care management is having the independent pharmacist, doctor, and the patient themselves on the same page.
Your pharmacy software system should help make this process a little easier and more streamlined for all the parties involved. Pharmacy work is difficult on its own. Let your software do some of the heavy lifting.
Feel like your pharmacy software isn’t cutting it? Visit our Compare Software page to see how the industry’s top pharmacy software systems compare.
If you’re taking the plunge into a new pharmacy software system, visit our blog,What to Expect When Changing Pharmacy Software Systems.
How to Get Paid
Being an independent pharmacy owner also means being a small business owner, untethered by the corporate red tape of the large chains.
You get to put your own stamp on patient care. However, it’s a business at the end of the day. And independent pharmacies heavily rely on third-party reimbursements. Such is the case with chronic care management.
Chronic care management plans are a great way to boost your Medicare star rating, which further opens your financial door to greater profits.
The CMS Star Rating System is a complex one, and we’ve got you covered. Check out our blog about the rating system to prime your independent pharmacy for even greater success.
Chronic care management plans also open the door for clinical services and med sync services. They are invaluable assets to your independent pharmacy that will not only boost your profits but increases its ability to provide exceptional patient care.
When it comes to billing, it’s mainly up to you and the patient’s doctor as to what party gets how much. Some opt for a 50/50 split but every situation differs.
What matters most is you and the patient’s doctor are properly billing these services. Medicare is reliably complex and dense with submission claims, providing different submission codes for slightly different circumstances.
It may be tedious but it is necessary to ensure your pharmacy receives the proper reimbursement. Refer to the Chronic Care Management (CCM): An Overview for Pharmacists document for more information on billing.
Conclusion
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Chronic care management is an extremely important part of modern-day patient care. It is likely the center of your pharmacy’s attention if you work in an elderly community.
Even if you don’t work in an elderly community, chronic care management plays a vital role in your independent pharmacy’s profits, quality of patient care, and Medicare star rating.
Just like offering clinical services and a wide array of vaccines, chronic care management plans will help take your independent pharmacy’s quality to the next level. Greater profits, greater health, great ratings — what’s not to love?
