McKesson Business Performance Services (McKesson) has contracted with Sanctus Healthcare, a California practice management firm supporting independent private practice physicians with the delivery of chronic care management services. Medicare began reimbursing for chronic care management earlier this year. The initiative is designed to strengthen the continuity of care for chronically ill patients while providing a low-risk bridge for physicians seeking to transition from fee-for-service to value-based reimbursement.
Based in San Juan Capistrano, California, Sanctus Health Care, LLC manages Pacific Private Practice Network, a 212-doctor, multi-specialty independent physician network (IPN) located in Orange County. The company chose McKesson to assist with chronic care management on the strength of McKesson’s track record supporting value-based care arrangements nationwide, according to Michael Rovzar, MD, managing partner of Sanctus Health Care.
“Sanctus is pleased to partner with McKesson to offer chronic care management services to its independent physicians,” Rovzar said. “This new service will provide a value-added benefit for both the physicians and their patients, and contribute to better care and potentially improved health for individuals, as well as reduced spending.”
Disease management services rely on closer physician oversight to improve care integration and enhance patient engagement. Goals include mitigating the effects of the chronic disease, preventing complications, improving the patient’s quality of life and reducing costs.
In 2010, chronic diseases were responsible for seven out of the top 10 causes of death in the U.S. and 86% of all healthcare spending, according to the Centers for Disease Control (CDC). In an effort to mitigate these effects, the Centers for Medicare & Medicaid Services (CMS) began reimbursing for non-face-to-face chronic care coordination services on Jan. 1, 2015, under the 99490 code of the Medicare Physician Fee Schedule (PFS).
The services are available to any Medicare beneficiary with two or more chronic conditions that are expected to last at least 12 months or until the death of the patient, according to CMS. The conditions must place the patient at significant risk of death, acute exacerbation/decompensation or functional decline. In addition, the patient must consent in writing to having the management services provided.
Practitioners who can bill for the new code include physicians, certified nurse midwives, clinical nurse specialists, nurse practitioners and physician assistants, according to CMS. In providing the services, the eligible practitioner must:
- Provide at least 20 minutes of clinical staff time per patient per calendar month.
- Record the patient’s demographics, problems, medications, and medication allergies and create structured clinical summary records using certified EHR technology.
- Develop a patient-centered care plan available electronically to anyone providing chronic care management services.
- Ensure that patients have 24/7 access to care management services and continuity of care across designated providers.
- Provide specific care management service including, but not limited to, systematic assessment of the patient’s medical, functional and psychosocial needs, system-based approaches to ensuring timely receipt of all recommended preventative care services and oversight of patient self-management of medications.
McKesson’s responsibilities in assisting Sanctus physicians will include identifying patients who are eligible for the service, communicating with patients and coordinating physician appointments, and providing clinical staff to conduct comprehensive assessments, medication reconciliations, care plan development/monitoring and care transition monitoring. McKesson will also staff care management call centers, handle patient mailings and prepare detailed monthly itemizations of chronic care management services for use by physicians in billing CMS.
Dr. Rovzar said approximately 5,000 patients served by Pacific Private Practice Network physicians are eligible for chronic care management services.
Pat Leonard, president of McKesson Business Performance Services, said new chronic care management services represent a major opportunity to control costs and improve care for the chronically ill. At the same time, he said, the service presents physicians with a new revenue opportunity and a relatively low-risk avenue for pursuing value-based reimbursement.
“It’s long been recognized that better management of chronic disease represents perhaps the best way to both reduce expenditures and improve care,” Leonard said. “McKesson is excited about being involved in this critically important area and we look forward to working with Sanctus, not only in chronic care management, but also in other ways to bolster value-based care.”
About Sanctus HealthCare, LLC
San Juan Capistrano-based Sanctus HealthCare LLC is a practice management company that provides a range of services to 212 independent physicians in Orange County, Calif. Pacific Private Practice Network, Inc is a 212 physician network of physicians dedicated to creating a sustainable environment for the private practice of medicine. The company is based in San Juan Capistrano, California. For more information, visit: www.gotomyp3n.com/home.aspx
About McKesson Corporation
McKesson Corporation, currently ranked 11th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visitwww.mckesson.com.
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