User Guide — athenaOne Care Management Services

athenaClinicals

athenahealth provides a Care Management (CM) service designed to help providers manage their chronic care eligible patients outside of traditional office visits to contribute to better health and care outcomes. A dedicated team of licensed nurse care managers and patient engagement specialists perform care management services on behalf of the practice, including patient acquisition, Chronic Care Management (CCM), and billing.

 

Qualified practices can either partner with athenahealth to use the athenaOne CM service or they can leverage care management functionality in athenaOne to implement CCM, on their own, for their Medicare patients.

 

If your practice serves patients with two or more chronic conditions, Medicare reimbursement rules for Chronic Care Management (CCM) allow you to be reimbursed for the non-face-to-face work that you perform to manage the care of these patients.

 

athenahealth provides a Care Management (CM) service designed to assist providers with the management of their chronic care eligible patients outside of traditional office visits. Acting as an extension of your practice, a team of patient engagement specialists and licensed nurse care managers and patient engagement specialists perform CM services on behalf of the practice, including patient engagement, chronic care management, and billing.

 

Your practice can either:

  • Sign up for the athenaOne CM service — Partner with athenahealth to have our CM service staff configure your CCM program and deliver care to patients on your behalf, or

  • Use existing CCM workflows — Leverage care management functionality in athenaOne to implement CCM, on your own, for your patients.

 

For more details on the CM service provided by athenahealth, including qualifications and resources, see Overview of the athenaOne CM service. For details on existing care management functionality in athenaOne, see CCM workflows in athenaOne.

 

 

If you're interested in partnering with athenahealth to use the athenaOne CM service, contact your Customer Support Manager to learn more.

 

 

The athenaOne CM service is an add-on service that is ideal for those practices that lack the time, resources, and expertise to implement CCM on their own.

 

Practices can still leverage existing athenaOne workflows to configure the CCM program and deliver care to eligible patients without additional support. You do not need to use the athenaOne CM service to use the care management functionality in athenaOne.

 

athenaOne has functionality to help practices implement CCM for their Medicare patients, including a care plan, and reports that track time spent on CCM per patient and surface patients that may be eligible for CCM based on claims data. For more details, see Resources.

 

 

Care management in athenaOne:

  • Care Management with athenaOne — Summary of the tools and resources available in athenaOne and the Success Community related to various care management programs.

  • Overview: Chronic Care Management — Overview and FAQ documents that focus on Chronic Care Management. Use this to understand the CCM workflow when utilizing the athenaClinicals Care Plan.

  • User Guide — Chronic Care Management (athenaClinicals) — Step-by-step procedures for configuring athenaOne for CCM and an overview of the CCM workflow.

 

Features and workflows:

 

athenahealth Population Health:

 

 

CMS recognizes CCM as a critical primary care service that contributes to better health and care outcomes for patients. CCM can lead to stronger patient satisfaction and engagement thanks to increased frequency and service to support the management of patient health.

 

Initially, CMS paid about $40 for CCM reimbursement, and the program resulted in cost savings of $74 per beneficiary, per month. To increase participation in the program, CMS has since increased the reimbursement to $64 for 20 minutes of clinical staff time for CCM per calendar month.

 

Despite the incentives, practices have been slow to adopt CCM due to:

  • Time — Providers lack the time to complete the many activities and actions required to set up and run the CCM program.

  • Resources — Practices don't have sufficient staff and/or can't hire dedicated staff to manage the program.

  • Expertise — There are extensive requirements from CMS on patient eligibility and program requirements around activities and documentation.

 

 

The athenaOne CM service helps practices capture new revenue streams with limited administrative work and improve patient outcomes. The service incorporates ongoing communication, care coordination, and structured documentation of patient health information.

 

Acting as an extension of the practice, a team of patient engagement specialists and nurse care managers provide patient and caregiver engagement, support for creating and maintaining health goals related to chronic conditions, resource coordination, and timely sharing and use of health information, outside of the regular encounters with providers.

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These services include:

  • Program development — We develop the CCM program for you, adhere to CMS guidelines and reimbursement rules, and hire experts with industry experience in patient acquisition, care management, and billing and coding. We meet with you to assess your practice workflows, review roles and responsibilities, align on patient outreach strategies, and plan for consistent future engagement.

  • Patient engagement — Patient engagement specialists call eligible patients on behalf of the practice to explain the program and what to expect, obtain and document consent for enrollment, and schedule initial appointments.

  • Care management — Your practice has dedicated licensed nurse care managers that are supervised by a lead RN. Care managers create comprehensive care plans for patients and hold regularly scheduled calls with patients to provide at least 20 minutes per month of clinical staff time.

  • Billing and coding — We prepare and submit all claims for CM services based on the prior month's billable patient activity. We handle all of the follow up to ensure your practice is paid for services.

 

For more detailed information on the service, see the service description: athenaOne Chronic Care Management Service.

 

 

The athenaOne CM service is intended for ambulatory practices that:

  • Use the athenaOne Base suite of services (athenaClinicals, athenaCollector, and athenaCommunicator)

  • Operate in the following states: Alabama, Florida, Georgia, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

 

If you're interested in partnering with athenahealth to use the CM service, contact your CSM to learn more.

 

 

athenaOne CM service:

  • athenaOne Chronic Care Management Service — Service description that describes the athenaOne Care Management service provided by athenahealth, including the division of responsibilities between you and athenahealth.

 

 

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