Principal Care Management (PCM) is a useful service for patients with one high-risk chronic condition — if you’re unfamiliar with the details of PCM, read our first article covering it here. The usefulness of PCM can extend into multiple sectors of health care, including the ability to help manage some conditions requiring specialty care. 

 

Who is PCM for? 

The service is intended for those with one “serious” chronic condition. If a patient has more than one chronic condition requiring regular monitoring due to high risk factors, Chronic Care Management (CCM) would be more suitable for them. “Serious” is defined as being applicable to one of the following¹: 

 

  • A complex chronic condition lasting 3 or more months, which is the primary focus of the intended care plan
  • The condition is severe enough to have the patient hospitalized or put them at increased risk of hospitalization 
  • A specific care plan needs to be developed or revised in relation to the disease

 

NOTE — PCM will become a billable service for Federally Qualified Health Centers (FQHCs) and Rural Health Clinic’s (RHCs) in 2021 per CMS’ proposed changes in the Medicare Physician Fee Schedule. PCM services can be billed using HCPCS code G0511, either separately or in conjunction with other billable codes². 

 

PCM and Specialty Care

These services can be used to treat a wide range of conditions that warrant specialty care³. Here are some conditions under each specialty, although this list is not exhaustive: 

Cardiology Neurology Gastroenterology
Heart Failure Alcoholic polyneuropathy Alcoholic Liver Disease
Coronary Heart Disease Alzheimer’s disease Alcohol-induced chronic pancreatitis
Post-myocardial infarction complications Degeneration of nervous system due to alcohol Celiac Disease
Ischemic cardiomyopathy Drug induced secondary parkinsonism Chron’s Disease
Pulmonary hypertension Epilepsy
Chronic pulmonary embolism Hereditary motor and sensory neuropathy
Atrioventricular block Huntington’s disease
Ventricular arrhythmia Multiple sclerosis
Atrial fibrillation Narcolepsy

 

Oncology Pulmonology Nephrology
Certain Types of Anemia Chronic Respiratory Failure Kidney Disease
Sickle Cell Disease Asthma End-Stage Renal Disease
Primary Malignant Neoplasms Pneumonitis

 

Virtual care services are a prime opportunity for patients only facing one chronic condition, as, in some cases, targeting one condition can prevent the onset of another. This keeps patients healthy, an imperative benchmark to continue building upon as the health environment advances toward value-based care. 

 

How We Can Help

Like CCM, PCM is allowed to be furnished via, and in conjunction with, other telehealth modalities, which increase the accessibility of this beneficial care service. Remote Patient Monitoring and Health Coaching are both utilized to empower patient adherence by giving additional support outside of a doctor’s office. But as stated before, the complex condition which a patient might face could very well be outside the scope of in-house primary care physicians. Certintell helps bridge this gap, by connecting providers and their patients with specialty care providers, all through telehealth. This eliminates the need to refer a patient to another clinic, which could be out of their way or be an added burden on already tight time constraints. 

 

Certintell’s medical director, with more than 35 years of experience, oversees internal APRNs and Health Coaches on hand to ensure seamless care coordination between our team, your team, and the specialty physician a part of the care team. We can connect patients via telehealth to physicians specializing in conditions including, but not limited to, Cardiology, Dermatology and Endocrinology to name just a few. These specialty services are fully integrated into your existing clinical workflows. The telehealth platform is fully 340B and HIPAA-compliant, so your clinic can maximize specialty savings for covered entities. 

 

SOURCES: 

¹ “Medicare Diabetes Prevention Program (MDPP) Expanded Model | CMS Innovation Center.” CMS.Gov, 1 Apr. 2018, innovation.cms.gov/innovation-models/medicare-diabetes-prevention-program.

² “CMS Proposes to Expand Principal Care Management to RHCs in 2021 |.” National Association of Rural Health Clinics, 6 Aug. 2020, www.narhc.org/News/28536/CMS-Proposes-to-Expand-Principal-Care-Management-to-RHCs-in-2021.

³ “Home :” Principal Care Management Services, 17 July 2020, principalcaremanagement.com.

 

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