At Gwinnett Drugs we understand that having a chronic illness can feel overwhelming. With the expertise of our board-certified pharmacists, we can coordinate care with your physician and help you achieve the healthiest outcomes. And, in order to satisfy each individual patient’s needs, our pharmacists are available to answer your questions around the clock.
Patients: What is Chronic Care Management?
Chronic Care Management (CCM) is a Medicare program which provides its beneficiaries with two or more chronic conditions access to a care coordination program at little or no cost. A chronic condition is defined by Medicare as:
- Expected to last at least 12 months
- Places the patient at risk of functional decline, worsening of health, complications or death
- Requires continuous management including establishing, implementing, revising and monitoring of a care plan
What are the benefits of Chronic Care Management?
CCM services allow for proactive collaboration between you and health professionals involved in your care. As part of this collaboration, our pharmacists will:
- Develop a customized care plan with you
- Coordinate care with your doctor, pharmacy, and other health care providers
- Update your electronic health record
- Address any medication related questions and concerns
- Assist with prescription insurance authorizations and patient assistance programs
- Monitor labs for safety and efficacy of treatment
- Reconcile medications list
- Provide tools to aid in adherence to medication therapy
- Assist in care continuity
- Assist with preventative health care including immunizations
- Other benefits associated with CCM services for patients include:
- Patient and caregiver education on medications and wellness
- Convenience of access to board-certified pharmacists around the clock to ensure your questions are answered as they arise
- Helps you stay out of the hospital by helping you manage your chronic conditions
- Allows you to focus on your health and wellness
CCM services can be provided by pharmacists based on their extensive knowledge on chronic diseases and medications. Our clinical pharmacy staff will work directly with your primary care provider to provide these services and help you achieve your health goals.
I’m a patient caregiver, how will this help me?
Through Chronic Care Management services, we can help provide assistance with your concerns 24/7. By providing continuous support, we can help you feel confident in the care you are providing whenever a question arises. Common concerns that can be addressed by our pharmacy care team include:
- Medication side effect management
- Education on new medication therapy
- Medication refill continuity
- Medication adherence tools
- Alternative medication administration options
- Health preventative strategies
We understand the importance of staying informed in all things related to their care. Keeping that in mind, we can serve as a bridge of communication between you and the doctor and inform you of changes in treatment plans. Most importantly, because we work directly with the primary care provider, we will have a comprehensive understanding of the patient’s medical history. Thus, our pharmacy care team will be able to provide advice and intervene keeping the patient’s specific needs in mind. The direct collaboration allows you to focus more on you and your loved one by reducing some of the load associated with the responsibility of being a caregiver.
Frequently Asked Questions
Who should participate?
Anyone taking multiple medications with two or more chronic conditions can benefit from Chronic Care Management services. Our services can help you keep a healthy lifestyle by optimizing care and assisting with medications.
How do I enroll?
Written or verbal consent must be provided to formally initiate services. This can be completed in one of two ways: fill out the form provided below with your information or express your interest during your upcoming doctor’s visit to provide consent. You only need to enroll once into the program.
Who pays for these services?
Medicare and Medicaid provide payments for the services provided by your doctor and most beneficiaries pay little or no cost.
What is expected of me as a patient?
Before you can enroll, you must have completed an Annual Wellness Visit within one year prior to enrollment.
You must provide verbal or written consent to initiate services.
You must be open to discussing your health with the care team when contacted.
Will I have to change my medications?
Our board-certified pharmacy staff will make recommendations to your doctor regarding your current medication regimen. However, all changes will be discussed with you and your doctor taking into consideration your unique needs for final approval. The goal of the services is to ensure you are getting the best results possible from your medications.
Will I have to change pharmacies?
To provide the most accurate and thorough service, you should receive services from a single pharmacy provider. This reduces risk of safety concerns related to receiving care from multiple pharmacies including getting the wrong dose of medication, drug interactions that could increase risk of side effects or reduce how well your medications work while ensuring consistency in care. At Gwinnett Drugs we work directly with your doctor to provide uninterrupted care and reduce miscommunication that can come as a result of receiving services from multiple providers. Thus, we highly recommend receiving all your services through our pharmacy though it is not required.
Will I have to change doctors?
No. However, Chronic Care Management services can only be provided by one doctor and thus, you cannot provide consent to multiple providers.
What if I change my mind?
You can request to stop Chronic Care Management at any time.
The 2011 Report to the U.S. Surgeon General “Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice” detailed the challenges facing the U.S healthcare industry: access, patient safety, quality and cost of care.
As the size of the geriatric population is projected to exceed 50 million, the need for health professionals to provide care is imminent. Medications are involved in 80% of all treatments and impact every aspect of the patient’s care. According to the World Health Organization, medication nonadherence accounts for up to 50% of treatment failures and up to 25% of hospitalizations each year in the United States. Adherence rates of 80% or more are needed for optimal therapeutic efficacy.
Clinical pharmacists can identify and address gaps in patient-self care including medication adherence and compliance, disease state management, and preventative measures such as immunizations and smoking cessation. Many patients with chronic conditions receive care from several providers leading to fragmented care. Pharmacists can coordinate care and provide clinical expertise relating to drug efficacy, safety, drug-drug interactions, disease-drug interactions and new clinical guideline recommendations. In providing a broader clinical picture as it relates to pharmacotherapy and assisting patients directly with medication related problems, pharmacists can improve both quality and safety measures impacting patient care.
A collaborative relationship with pharmacists, doctors and patients can improve patient care experience and provide optimal outcomes. And because chronic care management is extensive and focuses continuously on a relationship with the patient, it will increase patient loyalty, trust and satisfaction.
CMS Quality Metrics
As healthcare shifts from fee-for-service to value-based care, health professionals are now held accountable for patient outcomes. The Center for Medicare and Medicaid Services’ quality metrics impact reimbursement. The Merit-Based Incentive Payment System (MIPS) was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, and reduce cost of care. Professionals and organizations with good quality metrics receive financial rewards while financial penalties are imposed to those with low ratings.
Why Chronic Care Management?
Chronic care management (CCM) serves as a tool that directly impacts Merit-Based Incentive Payment System (MIPS). It is the provision of care management and coordination of services to patients with two or more chronic conditions. CCM will allow patients to gain a team of dedicated health care professionals who can help them stay on track for good health. Some of the services rendered include:
- Transitions of Care
- Medication Reconciliation
- Comprehensive Care Plan
- Patient support between office-visits
- Coordination of care with health professionals and pharmacies
- Assistance with insurance prior authorizations and patient assistance programs
- Monitoring of adherence and health outcomes
What are the benefits to physicians?
Research indicates CCM increases primary care physician visits by one appointment per year while decreasing hospitalizations and emergency department visits. Having a dedicated staff for care between office visits will allow for early intervention opportunities in the face of noncompliance to treatment plans that negatively impact outcomes. Other benefits associated with CCM include:
- Improved coordination of care
- Enhancement of patient experience and empowerment
- Strengthen patient-provider relationships
- Allow for billing for between-visit care
- Identify omissions in care
- Reduce preventable complications through education and intervention
- Allow providers to focus on critical and high reimbursement-related activities
- Seamless continuity of care to minimize errors, improve outcomes, and reduce costs