Care Management program explained

What is Care Management, aka Chronic Care Management (CCM)? Houston Metro Urology’s Care Management program, or Chronic Care Management (CCM), is a Medicare program that encourages providers and their clinical staff to provide additional care to patients with single or multiple chronic conditions in between their regularly scheduled appointments. The goal of the program is to enable early detection and intervention before small complications become big problems leading to unnecessary emergency room visits, hospitalizations and functional decline.

Who is eligible to participate in the Care Management program?

Any Medicare beneficiary with single or multiple chronic conditions who has been seen by the billing provider within the past 12 months.

What is a “chronic condition?”

Chronic conditions, as defined by the Center for Medicare Services (CMS), are conditions expected to last at least 12 months that place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. Common Urologic Chronic Conditions include OAB, BPH, Prostate Cancer, Bladder Cancer, Renal Cancer, and Ureter Cancer, amongst others. Coupled with common chronic conditions such as Arthritis, Asthma, Diabetes, Hypertension, Hypercholesterolemia, Atrial Fibrillation, Chronic Pain, etc. Most of Houston Metro Urology’s Medicare population will qualify for this program.

What qualifies as Care Management?

Most clinic activity performed outside the visit setting is Care Management. Commonly performed activities include phone calls, text messages, chart reviews, lab reviews, referral coordination, refilling medication, etc.

Why is Houston Metro Urology participating in Care Management?

Houston Metro Urology expects this proactive care to drive improved quality by keeping frequent contact with our at-risk patients. Care Management makes it possible for us to provide more proactive care to our neediest patients, helping them manage their conditions on their own and ensuring the best patient outcomes over time.

Who will be managing this program?

Houston Metro Urology has built a team of qualified Care Managers to engage and manage our patients’ between-visit needs. This team will focus on the administrative and non-complex patient requests to our clinics. What are the patients’ benefits? Through this program, patients will benefit from Increased communication with HMU’s Care Managers, ensuring all their between-visit needs are met in a timely and effective manner. The end result is that patients receive increased contact from HMU, driving early interventions, increasing adherence and compliance, and improving patient outcomes.