PCM, CCM, EOM. The number of reimbursement and quality care program abbreviations can make your head spin. Every practice wants to know how to capture new reimbursements to maintain and further enhance quality care initiatives. Chronic and Principal Care Management (CCM and PCM) help practices get reimbursed for work they already do, with ~1/3 of billable care time coming from existing work. However, success in these programs requires a team approach across staff, physicians, and patients. With the right technology partner, practices can maximize reimbursement from these programs and optimize operations to run multiple reimbursement programs in parallel.

Canopy recently dove into this topic during a webinar with Jennifer Graham, Supportive Services Manager, Highlands Oncology Group, and Christeil Gota, Chief Executive Officer, Hawaii Cancer Care. The webinar was moderated by Chantel Hopper, Canopy’s Head of Marketing and Customer Success.

Although these practices vary in size, they have seen rapid returns from CCM and PCM, and Jennifer and Christeil shared the strategies that have helped to make the programs successful at their respective facilities.

1. Understanding That Now Is the Time for CCM/PCM

Panelists discussed that now, more than ever is the time to invest in reimbursement programs like CCM and PCM.

“This is work that we are already doing. We are already well-staffed to ensure patients have that feeling of high touch from the practice. However, the push came in July of last year when reimbursements were cut on the drug side, and our margins started eroding. Manufacturers were not lowering their prices, but Medicare was still paying less. We needed to engage with these programs to compensate for lost margins.”

—Christeil Gota, CEO, Hawaii Cancer Care

PCM and CCM are quality care programs for patients with chronic conditions and are based on evidence that proactive care for patients can improve long-term outcomes while cutting healthcare costs. There are some differences between the programs (you can check out our eBook here for more details). Still, a key differentiator is that PCM programs offer reimbursements for patients with a single condition, while CCM programs offer reimbursements for patients with multiple chronic conditions. Today, oncology practices can bill for both, yet administrative teams often need help to ensure that patients are appropriately enrolled, and monitored and that reimbursement opportunities are maximized.

Jennifer noted that at Highlands Oncology, the push began as the Oncology Care Model (OCM) ended, and CCM was the next logical step.

Key Challenges When Building a New Program

• Identifying and prioritizing patients for enrollment 
• Building a new patient education process (programs like CCM require patient consent) 
• Obtaining physician buy-in and program championing 
• Accurately capturing all care time spent on a patient
• Finding the right technology platform to support staff and maximize reimbursement

“CCM is a program that patients must consent to get billed; the staff has to be well-informed and champion the program. At first, patients would often say no during the consent process at sign-in. We had to shift resources to have a key person explain the program, answer questions, and send letters before the patient even came in.”

—Jennifer Graham, Supportive Services Manager, Highlands Oncology Group

2. Identifying and Enrolling Patients

At Highlands Oncology Group, Canopy was used for ePRO-Based Patient Monitoring, ticketing, and triage. The team identified eligible patients and prioritized those who needed considerable time dedicated to their care. Canopy is discussed with patients during the initial chemo-teach session. The team explains how ePRO-Based Patient Monitoring and CCM can benefit their long-term care plans.

At Hawaii Cancer Care, all patients are enrolled in a new overall care program, Empowered Healing. During that enrollment process, a nurse would work to register patients in PCM and the broader program with verbal consent. Christeil highlighted how physicians served a critical role during this enrollment period. “Physicians can convince patients to enroll by having honest conversations,” she said. “The financial burden of care really falls upon the patient and physicians; these programs can help mitigate rising costs. The doctors understand this intimately, and patients understand that their copays are increasing, especially for drugs. So, this is an honest, upfront conversation that they're having with the patients.”

The panelists noted that data integrity is critical to successful patient identification.

“One thing I heard as a common thread is that there is a focus on patients who need this type of attention the most—those enrolling in chemo. Identifying and prioritizing these patients requires a significant interaction between Canopy and the EMR—data integrity in the EMR and flowing to Canopy and vice versa.”

—Chantel Hopper, Head of Marketing and Customer Success, Canopy

Jennifer said, "Anything documented in Canopy automatically flows to the EMR. No double documentation is necessary. The EMR is pulled up for reference, but the documentation is mostly in Canopy to keep it consistent and ensure that time is accounted for.”

“Once adoption hit and our staff started documenting in Canopy, we captured that care time. It integrates well with our EMR,” said Christheil.

3. Technology Partnerships are Key to Optimizing CCM/PCM and Managing Multiple Programs

When looking for the right partner, both panelists said a platform with a timer! Jennifer said, “The care timer was vital! Any time staff works on something for a patient, that time must be counted across the organization - not just triage nurses but also the people helping with financial assistance.” 

Christeil shared that a timer was a primary consideration, but also looking toward future needs. Canopy had the time recording element we sought and a ticketing system and ePROs.

With Canopy Practices Can:

• Quickly identify patients who meet eligibility criteria through intelligent software to manage enrollment and consent efficiently.
• Capture all cross-functional time spent on billable patient care activities via robust, precise reports that streamline billing processes.
• Run multiple reimbursement programs in parallel and match patients with the quality program that’s right for them.

Today, Highlands Oncology Group has over 700 patients enrolled and receives a reimbursement of about $21,000 per month on billable care time using the Canopy Program Management solution. Hawaii Cancer Care was able to deploy PCM rapidly and enrolled 200 patients in just a few months, resulting in a 5x ROI, all without hiring additional staff.

Ready to see fast returns for your practice from quality reimbursement programs? Request a consultation to learn how our platform can help your practice maximize value.