In 2015, the Centers for Medicare & Medicaid Services (CMS) issued a new billing code to allow eligible professionals to be reimbursed for chronic care management (CCM) activities. The fee is designed to support primary care through financial investment in care management services. Under the program, eligible professionals can bill CMS and participating patients for coordination and care management activities conducted by telephone or online rather than in person. Eligible professionals are required to obtain patient consent and review the terms of participation, including co-pays, prior to billing for CCM services.
In partnership with Mathematica Policy Research, Insight is evaluating the effects of CCM fees on primary care delivery.
This evaluation has three primary aims:
- Assessing the uptake and diffusion of CCM fees from January 2015 to December 2016.
- Exploring provider and beneficiary experiences with CCM services and fees.
- Examining the impact of the introduction of CCM fees on existing payment reform models being tested by the Center for Medicare & Medicaid Innovation.
To support CMS’ understanding of beneficiary experiences with CCM services, Insight conducted semistructured telephone interviews with 48 Medicare beneficiaries for whom eligible professionals billed CCM fees. The interviews gathered information about beneficiaries’ experiences of receiving CCM services, their reasons for agreeing to participate, and their intentions to continue or discontinue receiving the services. The interviews also explored beneficiaries’ responses to the introduction of a co-pay for care management services and whether their decisions to participate were influenced by the cost of the co-pay or having secondary insurance to cover the co-pay.
Data Collection; Semistructured Interviews; Interview Protocol Design and Development; Report Development and Presentation
Insight developed a semistructured patient interview protocol; an advance letter for the interview; transcripts for completed interviews; a coding scheme co-developed with Mathematica; and a written summary of the findings and themes, complete with summary tables, for CMS. Insight is also preparing a paper summarizing the results for publication.