2. What is CCM?
Effective January 1, 2015 CPT
99490
CMS reimburses providers approximately
$42/month to deliver 20+ minutes of non
face-to-face care coordination for
Medicare beneficiaries with 2 or more
chronic conditions.
3. CCM Requirements
2+ chronic conditions
expected to last at
least 12 months or
until the death of the
patient
Approximately
33 million
Medicare
beneficiaries
are eligible for CCM
Market Quantified
4. * Agency for Healthcare Research and Quality, 2010
Major Opportunity for Providers
There are over 209,000 practicing primary care physicians in the United
States. Each of them need to be prepared to transition to value based care.
Also targeting: Multi-Specialty Groups, ACOs, FQHCs & Health Systems
5. Benefits of CCM
1. Improve patient outcomes and quality of care
2. Pathway to value-based medicine (i.e. MACRA)
3. Revenue opportunity
6. (1) What’s in it for the Patients?
• Aggregation of all medical records
and health information in one place
and always accessible
• Expanded support system to include
family and 24/7 access to Clinical
Health Assistants
• Easy-to-use web and mobile apps to
access and share health information
• Proactive outreach to coordinate care
across all providers
• Confirm accuracy of medical records
• Medication reconciliation
7. (2) What’s in it for the Physician?
• Access to concise and comprehensive patient
summaries allows gaps in care to be managed
• Medication reconciliation and treatment
adherence
• Access to other doctors’ visits, labs, tests and
medication lists
• Comprehensive, compliant, billable Chronic Care
Management
•
• Create patient “stickiness” and provider loyalty
• Pathway to value based care
8. (3) New Revenue Opportunity for Providers
Annual number of unique patients
U.S. average per family medicine provider: 3279 1 3279
Percent of patients covered by Medicare
U.S. average 21.85%
21.85%
Annual number of unique Medicare patients 716
Percent with 2 or more chronic conditions
U.S. average 68.6% 2 68.6%
Annual number of unique CCM patients 491
CCM monthly payment
U.S. average: $42.253 $42.254
Estimated annual net revenue for family medicine physician $83,953
1 Per the MGMA Cost Survey for Single Specialty Practices: 2013 Report Based on 2012 Data specific to the specialty of family medicine.
Includes Medicare A/B and Medicare Advantage.
2 CMS.gov - County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.
3 Reimbursement amount from the CY 2017 Physician Fee Service.
4 Annual net revenue = $42.25 - $28.00 (CareSync standard full service fees)
9. CareSync Overview
• Proven Concept – CareSync is a leader in care coordination and
currently has with CCM programs with providers in 30 states.
CareSync technology and services are unique and designed to
scale.
• Experienced Team with Proven Track Record – The
CareSync team built the first browser-based EMR, sold it to
Eclipsys for $45M+ in 2008.
• Strong Financial Growth – We raised two rounds of funding
($23M, total) in the past 18 months and have grown to over 300
employees.
