Chronic Care Innovations^™

In 2015 CMS, in an effort to decrease healthcare spending by focusing on the needs of patients with two or more chronic conditions, initiated the Chronic Care Management (CCM) program. This program reimburses medical practitioners for contacting patients once a month to meet these patients’ ongoing needs.

In 2017, a study by Mathematica Policy Research evaluated the diffusion and impact of the CCM services and found that Medicare saved $95 per beneficiary per month over an 18-month period. The challenge, however, has been that a CCM program is labor-intensive and can tax already limited office space. For physicians, helping these patients (predominantly geriatric) cope with multiple chronic conditions is also tricky due to the shortage of skilled frontline health workers. The solution to this problem is Chronic Care Innovations, Inc. (CCI). CCI is an outsourcing option for medical practitioners to provide chronic care services for their patients with chronic conditions.

“Utilizing only RNs, CCI provides unparalleled clinical excellence that enhances patients’ healthcare services and improves quality performance, while significantly increasing revenue generation for medical practices,” stated Donna Q. Brown, CEO of CCI. “Our unique chronic care program provides a clinically professional outreach for chronic care patients and elevates the overall coverage and level of care.”

CCI’s RNs are highly qualified in multiple areas of the care delivery spectrum and work as an extension of the physician’s practice without disrupting existing workflow. RNs provide knowledgeable handling of chronic conditions and escalation of critical or emergency cases when necessary. CCI’s RNs also help ensure that quality measures are being met, thereby supporting the improvement of overall practice metrics performance. Above all, CCI supports physicians in optimizing their time and resources to do what they do best. In essence, CCI provides more attention to patients, more revenue to the practice, at significant healthcare cost savings.

Highlighting the game-changing value of CCI’s approach is a success story where the company has partnered with Florida Community Health Centers, Inc., a large, federally qualified healthcare provider in Florida. Before the engagement, FCHC struggled to do roughly 800 CCM events in a year as most of their care coordinators and primary care providers were attending to multiple demanding administrative and clinical efforts. With the addition of CCI’s dedicated team of RNs, FCHC’s CCM program increased to close to 1,000 CCM events consistently per month.

Oteasa Townsend-Hardy, BHSA, MBA, LHRM, is the Senior Director of Quality Improvement, Compliance, and Communications at FCHC. She states, “CCI, as an integral part of our overall care management program, has played a crucial role in enhancing our quality measures. Most notably: our emergency room visits have decreased significantly and annual wellness visits have increased since the program began in early 2020. We have also realized a substantial increase in revenue due to our chronic care management program with CCI.”

Crafting similar success stories for physicians by enhancing the existing CCM care delivery model, CCI onboards RNs from across the country, thereby ensuring its ability to support medical practices throughout the U.S., “Our vision is to provide value to our practices and improve quality of life one life at a time.” With this vision, CCI is set to usher chronic care into a considerably healthier future.