Managing chronic conditions over the continuum of care has become more of a challenge as we continue to see the shift to value-based care reimbursement models. Providers must find ways to coordinate in a cost-effective way the management of these conditions while optimizing the revenue opportunities. Additionally, providers must meet the quality outcome metrics that has become a mainstream requirement of the
healthcare system. These types of models are a challenge for healthcare providers in a time where margins are smaller and often obsolete. There are reimbursable programs focused on population health that can support and grow revenue with a focused care team approach.
Examples of population health billable revenue streams are programs such as Chronic Care Management, Behavioral Health Integration and Remote Patient Monitoring. The Chronic Care Management program is focused on patient outreach for those that have at least one chronic diagnosis. The eligibility for these services has expanded over the past couple of years, which is creating more opportunity for these types of programs. Behavioral Health Integration is a similar program focused on those with a mental health diagnosis that uses a psychiatric collaborative care model approach with a primary care provider, psychiatric consultant, and care manager working directly with the patient. Another component of these types of reimbursable services is Remote Patient Monitoring. This is a monthly billable service to Medicare for both the monitoring and the Care Management services. All these programs require a Care Management team approach to managing chronic conditions in collaboration with the provider network at the facility or clinic level. By instituting these services, the facility is providing a service that can support revenue growth for 2021 and beyond. By frequently contacting patients, this impacts the overall care and allows for the patient to stay connected to the facility.
Staying connected and increasing capture of all needed services through the facility will also increase pull through revenue at a system level. These types of population health revenue streams have the potential for not only bringing in additional revenue but also for positively impacting the quality outcomes. Quality outcomes are becoming more important with additional payors expanding into basing portions of reimbursement on outcomes. It is important to review the potential for your facility to ensure you are not leaving revenue on the table. Having a team dedicated on executing your population health strategy is the key to success. If you are not currently maximizing your opportunity for these types of billable services, you can contact Trilogy Population Health for a complimentary evaluation of your revenue potential.
Brandy Hoell, MSN, RN, CCM
Partner, Population Health
Trilogy Health
brandy@trilogy-health.com
318-773-2948
