How much is care management worth?

The Centers for Medicare & Medicaid Services' (CMS) proposal to begin paying for chronic care management in 2015 has led some to ask how much care management is worth. The CMS's proposal values it at approximately $42 for 30 days.

However, CMS’s Comprehensive Primary Care Initiative says it is reportedly worth between $8 and $40 per beneficiary per month (PBPM), averaging $20 PBPM during the first two years and $15 PBPM during the third and fourth years. Meanwhile, a Robert Graham Center presentation found that care management fees across public and private programs varied greatly, ranging from 60 cents to $444 per member per month (PMPM).

The fees are highly variable partly because no two fees are covering the same group of services. It is a matter of comparing not only apples and oranges but also pineapples and bananas.

One way to try to make sense of this fruit salad is to attempt to define what a care management fee should include. The AAFP recently took a stab at this by creating a policy on "Care Management Fees." The new policy lists seven elements it considers are core activities covered by a PMPM care management fee within the context of a patient-centered medical home:

1. Nonphysician staff time dedicated to care management
2. Patient education
3. Use of advanced technology to support care management
4. Physician time dedicated to care management
5. Medication management
6. Population risk stratification and management
7. Integrated, coordinated care across the health care system

The policy does not address how much the AAFP thinks these activities are worth, either individually or as a group. However, it does provide a starting place for trying to value care management in a systematic way.

So, how much do you think care management is worth?

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted on Aug 20, 2014 by David Twiddy