If you have Medicare, there’s a good chance you have two or more chronic conditions, among them arthritis, cancer, diabetes, heart disease or dementia.
Two-thirds of the 57 million Americans with Medicare have multiple chronic conditions, which increases the risk of death and functional limitations, decreases quality of life and leads to higher health care spending.
Managing chronic diseases can be difficult, to say the least. The patient often faces multiple visits to one or more doctors, must take multiple drugs at different times on different days, must make extra trips for tests. It can all be a bit overwhelming.
At Medicare we recognize the challenges of managing medical conditions, working with health care providers and trying to stay healthy. Two years ago we added a new benefit called Chronic Care Management, or CCM. This program provides additional payments to doctors and other providers to help individuals live with chronic disease.
For example, through the CCM benefit your primary-care doctor will help you keep track of your medical history, medications and all the different health care providers you see. You’ll receive a comprehensive care plan that outlines your treatments and goals. Additionally, you’ll have 24-hour-a-day, seven-day-a-week access to health care professionals for urgent needs from the comfort of your home.
To be eligible for CCM services, you must be enrolled in Medicare or in both Medicare and Medicaid. And you must have two or more chronic diseases expected to last at least 12 months and place you at significant risk of death, acute exacerbation / decompensation or functional decline.
Other examples of chronic conditions include, but are not limited to, asthma, atrial fibrillation, autism spectrum disorder, chronic kidney disease, chronic obstructive pulmonary disease, depression, heart failure, hepatitis, hypertension (high blood pressure), infectious diseases such as HIV/AIDS, ischemic heart disease, osteoporosis, schizophrenia and other psychotic disorders, and stroke.
Specific CCM services might include:
>> At least 20 minutes a month of chronic care management services.
>> Personalized assistance from a dedicated health care professional who will help create a care plan.
>> Coordination of care among your pharmacy, specialists, testing centers, hospitals and more.
>> Phone check-ins between visits.
>> 24/7 emergency access to a health care professional.
>> Expert assistance with setting and meeting health goals.
How much do CCM services cost? You’ll be responsible for the usual Medicare Part B cost-sharing and might have a deductible or coinsurance/copay. However, many people with Medicare have Medigap supplemental insurance that provides wraparound coverage of CCM cost-sharing.
Chronic Care Management means having a continuous relationship with a dedicated health care professional who knows you and your history, gives personal attention and helps you make the best choices for your health. CCM gives you and your loved ones the assistance you need to manage your chronic conditions so you can spend more time doing the things you enjoy.
Ask your doctor about Chronic Care Management and get the connected care you need.
Call, toll-free 800-MEDICARE or visit go.cms.gov/ccm.
Greg Dill is Medicare’s regional administrator for Hawaii, Arizona, California, Nevada and the Pacific territories.
