The term “care management” refers to activities performed by health care professionals with a goal of facilitating appropriate patient care across the health care system to increase patient satisfaction and self-management skills resulting in improved outcomes. Care management services are not consistently paid under traditional, fee-for-service payment models. At a high Level, care management could included patient and caregiver education; medication management and adherence support; risk stratification; population management; coordination of care; and care planning. (See AAFP policy on "Medical Home"
Care management fees are not intended to defray start-up costs associated with implementing a care management nor to provide payment to practices for improved outcomes and/or savings that result from their care management efforts. Such expenses and outcomes/savings should be compensated separately. Payers should clearly delineate what is in a care management fee paid to practices, and the fee should be commensurate with the services covered by it. Payers should not dictate how a practice uses the care management fees it receives.
Consistent with AAFP's policy on "Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States," the AAFP believes care management fees should be paid on a prospective basis. Care management is an ongoing service that necessistates predictable, prospective payment, such as a per patient per month amount, to ensure its continued provision, especially in rural and small, independent practices.
(2004) (January 2022 COD)