CSF2 - How CHCs Can Revolutionize Patient Experience and Outcomes for the Medicare Population Through Care Management

Session Description: The Centers for Medicare & Medicaid Services (CMS) has recognized care management as a critical component of primary care, contributing to better health and better care for patients and promoting health equity, as well as to reduced health care spending.

Care management has expanded rapidly over the 12 years since it was first introduced in Medicare. Today, FQHCs are authorized to provide eleven different types of care management services based on the Medicare patient's needs, ranging in emphasis from chronic medical conditions, to behavioral health needs, to addressing non-clinical factors of health. By providing Medicare care management, FQHCs can build on an opportunity to move past the volume-based per-visit Medicare FQHC PPS. Care management allows for a team-based approach to care, with primary care practitioners supervising a suite of services that reaches patients more effectively through outreach, tech, and the skill of a wide range of clinical team members. The monthly payment methodology used for most Medicare care management services is beneficial for FQHCs, and additionally, implementing care management makes FQHCs more attractive applicants for opportunities to participate in accountable care models and other payment/delivery system reform opportunities.

In this session, we will cover the nuts and bolts of Medicare care management. We will then discuss changes and opportunities in 2025, including Medicare's new advanced primary care management service and new code-based care management payment methodology. Finally, we will provide tips on operational issues, such as obtaining consent and assessing coinsurance for care management services, and guidance on using vendors.