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Bridging to value with codes that promote care management.
Catherine S Hwang1, Ashok Reddy, Joshua M Liao
1Virginia Mason Medical Center, 925 Seneca St, H8-GME, Seattle, WA 98101.
The American Journal of Managed Care
|November 16, 2020
Summary
Transitional care management (TCM) and chronic care management (CCM) codes help organizations build care management skills. These codes support the shift from volume-based to value-based care delivery.
Area of Science:
- Healthcare Management
- Health Policy
- Value-Based Care
Background:
- Fee-for-service billing codes for Transitional Care Management (TCM) and Chronic Care Management (CCM) are crucial tools.
- These codes facilitate organizational development of essential care management capabilities.
- They serve as a bridge for transitioning from volume-driven to value-based healthcare models.
Purpose of the Study:
- To examine the role of TCM and CCM codes in developing care management infrastructure.
- To understand how these codes support the transition to value-based care.
- To identify implementation challenges and policy implications.
Main Methods:
- Analysis of the function and impact of TCM and CCM billing codes.
- Review of organizational strategies for adopting care management capabilities.
- Assessment of implementation barriers and policy support.
Main Results:
- TCM codes foster capabilities for managing hospital discharge transitions.
- CCM codes support longitudinal management of patients with multiple chronic conditions.
- Key challenges include achieving ROI in health IT and securing stakeholder engagement.
Conclusions:
- TCM and CCM codes offer a pathway for organizations to build competencies for value-based care.
- Policy support for these codes signals an encouraging environment for gradual transition.
- Overcoming implementation hurdles is vital for successful adoption and achieving desired outcomes.
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