Quality improvement program: Implementation of chronic care management services in an affordable care organization

Abstract

<p>Chronic diseases are the leading cause of death and disability in the United States each year.&nbsp; According to the Group Health Research Institute (2015), almost one-half of all Americans have one or more chronic health diseases.&nbsp; Two of the most common of these are type 2 diabetes mellitus and hypertension.&nbsp; Inadequate management of chronic diseases lead to poor patient outcomes and higher health care costs.&nbsp; In an effort to transform the current health care system, the Centers for Medicare and Medicaid (CMS) introduced a non-visit based payment reimbursement program for chronic care management services.&nbsp; Providers caring for Medicare beneficiaries with two or more chronic diseases that are expected to last at least 12 months can receive a monthly fee of $42 per beneficiary who participate in a chronic care management program, utilizing CPT code number 99490 (U.S. Department of Health and Human Services, 2015).&nbsp; The purpose of this practice change project was to create a pilot quality improvement program for the implementation of chronic care management services within an affordable care organization.&nbsp; Using a retrospective chart review, 100 charts from a rural primary care clinic were examined for improvement of blood pressure readings and HgB A1C levels of patients enrolled in this program.&nbsp; Medicare reimbursement for the patients enrolled in the chronic care management program was also examined for improvement.</p>