Rats! I missed today’s
#KareoChat - a weekly chat on healthcare and related topics hosted by Kareo. This week's topics were about Chronic Care
Management and the chat was hosted by @CareSync. Specifically regarding the new Chronic Care Management Program that
CMS implemented on January 1st of this year. Whenever I miss a chat,
I go check out the transcript at Symplur.
Since this was a topic near and dear to my heart, I decided I’d go the
extra mile and create a “formatted transcript.”
So… the following is today’s #KareoChat transcript formatted
by topic. Note that this is not an exact
science so some tweets may be associated with the wrong topic. And perhaps
attributed to the wrong person. In any
case, I’m not charging for this.
Welcome to #KareoChat w/ our host @caresync! Today we'll discuss #ChronicCareManagement. Now, who's here?! #RollCall
Acct
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Tweet
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gokareo
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30 mins until #KareoChat with our host, @caresync! We'll discuss
#CCM with these questions: https://t.co/dYyNQwZjSG
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careyync
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So excited to be hosting our first #kareochat today! Thanks for
having us, @GoKareo
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stuckonsw
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How is #ccm defined for this chat? is it the tech like @caresync
or just #ccm in general (sorry for the question)
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gokareo
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Q1: What have been the biggest changes we’ve seen during this
first year of #CCM?
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caresync
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Usable data is key!
https://t.co/ZRIX1xLlUf
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caresync
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A focus on "between visit" care - a new way of
thinking for providers and their staff.
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jennhistalk
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Have seen some vendors see it as opportunity to relaunch
products for #CCM - MDs seem genuinely
interested but a bit gun shy
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actasifsite
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On the implementation side, several of my mother's physicians
have send VERY confusing letters that took a while to sort out
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caresync
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Also - a general provider anxiety around broadening the scope of
care to settings outside the exam room.
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jennhistalk
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Good point - opens up big doors for digital health - wearable’s,
at-home monitoring, etc. (assuming MDs can use the data)
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yogileana
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Biggest challenge is technology and requirements I think
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johnsungkim
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Biggest fear is the unknown. What can they throw at doctors
next??
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jennhistalk
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Chronic Care Management --> RT @yogileana: Biggest challenge is
technology and requirements I think
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jennhistalk
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Exactly - I imagine they're just now breathing sighs of #ICD10
relief. Now, on to the next govt program ... MU, #CCM
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leachatham
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Some interest in the potential but hesitance due to the
complexity
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gokareo
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That sounds about right :) I remember it be absurdly high
haha https://t.co/j2Ic9U5MtS
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jennhistalk
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Yes, would love to interview MD who's incorporated
patient-generated data into their practice/workflow. New Holy Grail?
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drtom_kareo
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obstacles 1) 8 dollar co pay, 2) ROI - low reimbursement 3)
process and staff requirements are disruptive
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johnsungkim
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Right! As well, I've read the codes and rules 5x - it's still
not totally clear to me.
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gokareo
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Q2: What are the obstacles that keep providers from #CCM?
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johnsungkim
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Been waiting for someone to ask that! :)
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caresync
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Ohhh the obstacles! Many fear it's just too much work for the
reimbursement.
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johnsungkim
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It's a combination of fess, lack of technology + patient panel
analytics and the question of who is going to actually manage?
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caresync
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Also, they really want proof that they're actually going to be
reimbursed. Thus 2015 is year of super-early-adopters.
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amberglende
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The Medicare # in FL is ~83%!
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johnsungkim
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Can the patient copay be waived by the physician and staff?
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caresync
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Exactly! a FT employee can only provide services to 250-270 CCM
patients compliantly,
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gokareo
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The patient education is ALWAYS evolving here.
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caresync
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There are a LOT of these, @JennHIStalk, some great, some
opportunistic.
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johnsungkim
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And what the heck does "24/7 accessibility" mean? Do
docs have to sleep next to their phones now?
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drtom_kareo
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Not really, the patient has to be asked for the payment.
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shereesepubhlth
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Neither CMS nor prof. organizations have furnished adequate ed.
to providers regarding CCM billing rules. Yeah, I said it!
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gokareo
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The boilerplate messaging available is NOT human-speak. We've invested
a lot into educating the seniors.
https://t.co/3j6iFMW3gJ
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leachatham
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Hopefully the early adopters will share their experiences and
help others see it can be done
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caresync
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Must be available to address urgent chronic needs - doesn't need
to be the actual doc. We are 24/7 as an outsource
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shereesepubhlth
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Real talk: How many providers want 2 adopt stringent
documentation rules when beneficiaries may not be willing 2 pay the 20% req.
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caresync
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So true - our docs have been incredibly helpful in educating others
checking out the program.
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shereesepubhlth
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It’s a familiar argument but I believe fear would be mitigated
by education, which is currently lacking.
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jennhistalk
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Obstacles keeping MDs from #CCM - time, knowledgeable staff,
tech, budget for all of the above
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yogileana
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But you ask them first... RT @ShereesePubHlth How many prov want
2 adopt stringent doc rules when pt may not be willing 2 pay
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jennhistalk
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Are you referring to the #CCM copay some patients have to pay
out of pocket? Still trying to understand that.
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shereesepubhlth
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CCM rules req. written consent from beneficiary acknowledging
resp. for 20% copayment for CCM." (PYA, 2015)
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amberglende
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Some are doing it already though MT @caresync: A1 a general
provider anxiety around broadening the scope of care
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caresync
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We'd love to get rid of the copay, it's been much less of a barrier
than anticipated. When patients understand.
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gokareo
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Q3: What would make #providers more likely to implement a #CCM
program?
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actasifsite
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>20% of patients have chronic conditions maybe??? #CCM
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caresync
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Similar to A2 - education around requirements, and confidence
that patients understand what they are getting.
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yogileana
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Better tools/education MT @GoKareo What would make #providers
more likely 2 implement
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brittanyrhyme
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We have had multiple iterations and many experts help us
simplify the language, Joe.
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caresync
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Closer to 70% 68% is the exact number if I am not mistaken!
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wilson_to
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Doesn't seem to be a lot of progress addressing A2 - need new
innovations in #payment #models, #technologies, #workflows
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jennhistalk
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Would MD participation be more if payers lent a helping hand?
Offered CCM "navigators" ?
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gokareo
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Some recent studies point to Resistance in CCM adoption and
enrollment, waiting to see how fess schedule is updated in 2016
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caresync
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I think there are things out there - care coordination is what
we've been doing well before reimbursed.
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shereesepubhlth
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There are a couple of metrics at play here" Ex. 43% of
eligible providers aren't aware of the CCM existence (Ross)
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dulcianhealth
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#FloCCM 7 Take the High-Road, prioritize your sickest patients.
Use compliance as the requirement floor.
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meddatainc
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Someone needs to! Vendors who are experts can consult/support
practices; so complicated for most on their own #CCM
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wilson_to
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I've seen it be the case for some CINs/ACOs - CCM navigators
have helped ease the transition and focus in #CCM
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johnsungkim
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Patients don't like to pay much if they already feel they're
paying "too much" for their insurance plans :)
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shereesepubhlth
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If some of the rules were removed by CMS, making it more
attractive to providers, CCM could still blow up
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gokareo
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Q4: What do #patients expect from #CCM?
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wilson_to
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Carrots and sticks aren't enough nowadays? Def seems like
education and rules keep remerging
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yogileana
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Do your patients know about #CCM?
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caresync
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Patients! Yes! The patient-centered code. They expect help
accomplishing THEIR goals for health.
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jennhistalk
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Is the average patient even aware of #CCM? What
value-proposition do MDs use with those who fit the profile?
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drtom_kareo
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Patients in my experience when asked about CCM service assume
they get responsive service and are not clear on CCM value add
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caresync
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Patients want the right info shared to right ppl at right time.
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jennhistalk
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MT @drtom_kareo: Patients, when asked about CCM service assume
they get responsive service and are not clear on CCM value add
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caresync
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Also - patients (people!) just want to make healthcare
easier…it's overwhelmingly hard for most.
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drtom_kareo
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CMS has not done a good job educating or marketing this value
add to members in 2015
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resultant
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IMO patients have low expectations as they have always had to be
the quarterback for their own care or have an advocate
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wilson_to
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Agreed - patient POV is around 'heal-on-demand' for relief more
than sustained #CCM - hence hard for #wellness etc.
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gokareo
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Wish I could join #kareochat but I'm running out the door. Sort
of taking you with me though... https://t.co/uiOl5GScMi
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shereesepubhlth
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It would stand to reason but ultimately, those who propose these
programs do very little to ensure their success
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johnsungkim
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Valid point. The good news is that people are talking about it a
lot more than January…
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caresync
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WOW! #KareoChat #GreatStat https://t.co/iXxQF1Tbfv
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travislbond
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Yep --> MT @Resultant: IMO patients have low expectations as
they've always had to be QB for their own care or have an advocate
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drtom_kareo
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I would like to know the dollars forecasted to be saved per pt
by medicare for CCM, maybe pass more on to provider
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jennhistalk
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So for govt #CCM incentive to work, vendors must take lead on
educating patients/physicians on the value add? Is that right?
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drtom_kareo
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No as the provider is asking for additional out of pocket, so
they are selling and this is a problem
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gokareo
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Tech barriers. Ability to provide full scope of service - it's
intimidating for most!
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esseeconsulting
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Yep! Hoping education really is a theme for CCM in 2016.
Patients and docs!
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powered_mb
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Aren't there some vendors that offer turn-key CCM services too
that did a rev share with the docs?
has anyone seen this yet?
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gokareo
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Q5: Has #CCM been what you expected when it was announced at the
beginning of 2015?
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yogileana
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we expected it to take off like a rocket... but it didn't -
technology barriers maybe
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shereesepubhlth
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Abso-freaking-lutely! #Consultants can greatly assist providers
w/ understanding & navigating CCM reqs
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caresync
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Referenced earlier, but the adoption numbers show early adopters
are proceeding cautiously.
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caresync
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We've also had #ICD10 as a mega distraction to #CCM.
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shereesepubhlth
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I expected earlier & more robust adoption but again there's
the provider frustration factor etc.,
https://t.co/ohRXxjRFbA
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caresync
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There are lots of questions around compliance, too. It's been
slow to get guidance.
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shereesepubhlth
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39% of providers say response from CMS on compliance issue is,
"long pause; no answer!" Its a definite concern slowing adoption
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jennhistalk
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We need another year to truly determine how initial #CCM
participants will fare - a year without competing govt timelines
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wilson_to
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Bad to say that 'slow adoption' should be expected? We've seen
these rates (or lower) across various initiatives.
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wilson_to
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THANK YOU @gokareo for inviting us - this was absolutely a blast
- we love talking to smart, innovative thinkers!
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jennhistalk
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How can CMS do a better job moving forward?
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drtom_kareo
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IMO remove copay, advise and market to members and improve
reimbursement rates
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shereesepubhlth
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It’s sort of joke when I talk to provider clients. I can hear
them thinking, "Here she comes w/ another program" No thank you.
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caresync
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Between visit care/monitoring CAN provide a ton of value. Just
has to be easier for the doc/patient to access.
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gokareo
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Can I assume there is data showing better outcomes? If so CCM should
be required w no copay -pts that dont coop shud pay co-pay
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gokareo
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Q6: If you could change/improve the program what would you do?
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caresync
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Broken record here… remove the copay - it confuses patients. Especially
when the bill comes and they've not seen doc.
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caresync
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Increase reimbursement for the docs - the scope of services is
wide and a lot of work!
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caresync
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Increase guidance around #CCM. Make it more appealing and not so
complicated!
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shereesepubhlth
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Relax the rules & throw money at the problem
#ProviderReimbursement
https://t.co/DNl1lDzM7G
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resultant
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LOL!!! RT @ShereesePubHlth: A6 Relax the rules & throw money
at the problem #ProviderReimbursement
https://t.co/y4lENFbky3
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The Sandbox – Stuff I wasn’t sure about
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drtom_kareo
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Fun fact only 100K CCM payment codes were processed in 2015 thus
far, not a business yet.
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leachatham
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I'm hoping 2016 is the year of being open to new opportunities
in healthcare overall!
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wilson_to
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Was on a panel this past week on #FutureMed - seems we've
(unknowingly) designed systems around acute care > chronic care
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gokareo
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We built 12 tips for a successful CCM implementation
#ChronicCareManagement hashtag: #FloCCM
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leachatham
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But chronic conditions are a growing issue - obesity and
diabetes are skyrocketing
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stuckonsw
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Melissa is working a patient engagement training
(@STIinnovations) that matches #ccm codes ;)
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jennhistalk
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Would be great to see #HIMSS16 sessions focus on this. Maybe
we'll see case/success studies presented
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johnsungkim
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A provider in the Peds Dept at @UCSF told me that childhood
obesity was expected to be 25%+ of kids!
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turbodean
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Wow this seems like a no brainer for docs that don't know how or
want to do on their own is tech
integration the prob?
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stuckonsw
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Yes " throwing money" @ a problem & ignoring the
process behind it always goes well
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shereesepubhlth
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But its CMS way 2 do business "Hey here's an incentive 2
perform the basic functions of your job"
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stuckonsw
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#CCM codes are (sort of) a way to sustain something...glad
#KareoChat highlighted the secret
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gokareo
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Thank you @GoKareo When is the next #KareoChat ?
https://t.co/VN78rpVSk7
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gokareo
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gokareo
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And that's a wrap! Thank
you all for joining and thank you @caresync for being an incredible host!
What a worthwhile discussion!
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If you'd like to get more of this type of information and information on other healthcare and healthcare information technology-related topics, consider following me on Twitter I'm known @Shimcode.
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