Continuum old - GenieMD

Providing one platform to support the CONTINUUM of care

The CONTINUUM of Care

Transforming the delivery of care. Each health and wellness consumer has a different journey, hence a different set of needs. The average Medicare patient with five chronic conditions see nine different doctors each year, they are only in front of their doctors for fifteen hours; to close the care gap we need to address what happens the other 8745 hours – as this is where one’s health is most influences.

The pandemic taught us that the integration of virtual services was viable; We also learned virtual services was much more than Telehealth (audio and/or video) capabilities. Most importantly the delivery of care model is not just about a brick-n-mortar model or just a virtual model – it’s about a continuous care model.

Virtual care is the ability to extend your clinical care services from your brick-n-mortar to the home; it is the fundamentals to providing a continuous care delivery model which has a direct correlation to advancing value-based care objectives; A virtual care solution offering needs to be modular and scalable coupled with a rich feature set supporting Telehealth, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM) and Chronic Care Management (CCM) and more. When you look at all the new billing codes to support these clinical services in the home, providers can reimagine their delivery of care model and frankly generate a great deal more in revenue. The tools, services and payment models are now in place to ease the transition from episodic care to value base care – without taking on a greater degree of risk.

If your virtual care solution doesn’t support all this TODAY – then stop spinning your wheels – GenieMD’s CONTINUUM virtual care solution can support your needs. GenieMD is experiencing explosive growth on this front – you don’t hear much about us because we white-label ever deployment – we believe our clients branding is more important than ours.

BTW: you don’t have to consume the entire platform day one, it’s a crawl, walk run adoption model that we promise won’t break the bank. Schedule a demo now – Clients rave about the simple yet robust feature set – be sure to also ask about:

Our protocol designer that allows YOU to design evidence-based protocols that map your unique delivery of care model.
Our clinical services to help with your clinical needs – including monitoring services.

Telehealth

Attract New & Retain Existing Patients, Increase Revenue

Using iVisit your patients can report their symptoms through evidence-based guidelines. Your entire available physician staff is notified of a new case and the first responder is assigned to the request if a preferred physician is not specified by the patient. From there, the physician can diagnose, treat, and prescribe from the convenience of their mobile device from anywhere, at any time. Most cases can be treated in less than 2 minutes. When video visits are desirable for care, iVisit provides Video Consultation along with: Appointment Scheduling, On Demand, Waiting Room and Call Back capabilities with a pre-visit patient interview which allows more efficient video encounters.

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Asynchronous Visits

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Video Visits

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Automated Follow Ups

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ePrescription

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Secure Text Messaging

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Provider Availability & Scheduling

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EMR Integration

Remote Patient Monitoring

Closing the Gaps in Care: Extending care from the brick-n-mortar to the home

A survey suggests 70% of those practices, adopting Remote Patient Monitoring (RPM) reports improvements in patient engagement, satisfaction and increased revenue associated with ability to create capacity for higher intensity office visits. Sixty percent of all respondents see RPM becoming a new standard of care over the next two years.

RPM involves the collection and analysis of patient physiologic data, via the use of medical device, for interaction that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition. The five primary Medicare RPM codes are CPT codes 99091, 99453, 99454, 99457, and 99458.

RPM services allows a provider to extend care into the home – providing a continuous care model. RPM, coupled with Telehealth, and Chronic Care Management (CCM) is a powerful platform to advance the tenants of value-based care.

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Remote Therapeutic monitoring

What is Remote Therapeutic Monitoring?

Remote therapeutic monitoring codes allow non-physiological data to be collected. This includes monitoring health statuses such as pain and medication adherence and response, as well as musculoskeletal and respiratory system statuses. The codes are still vague but imply a broader range of data points important to monitor patients’ health.

The current remote patient monitoring codes require that data be automatically transmitted by a connected device for the physician to access. Remote therapeutic monitoring codes propose that self-reported data be included under the proposed rule of non-physiological data inclusion. The proposed change is important because self-reported data is necessary to monitor metrics like pain levels and medication adherence. These metrics are not always captured through the current devices in place to monitor patients remotely.

What is the difference between Remote Therapeutic Monitoring (RTM) and Remote Physiologic Monitoring (RPM)?

CMS describes two major differences between RPM and RTM.

First is that providers that can’t bill for RPM may be able to bill for RTM. In the proposed rule, Medicare points out that the way the AMA designated the RTM codes as non-evaluation and management (E/M) does not allow Medicare to designate them as general supervision care management codes, hence the reason they are looking for comments about ways to “remedy” this disconnect.

Second concerns the nature of the data collected, more specifically therapeutic for RTM versus physiological for RPM. RTM can be used for non-physiological medical devices like those used to support medical adherence (e.g., smart pill reminder systems) and medication symptom/adverse reaction applications. Essentially, any information that a medical device — including software that fits the definition of a medical device — can collect that is not physiological can be collected and billed under RTM.

The RTM code descriptions are as follows:

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)

Chronic Care Management

What is a chronic disease?

A chronic disease, as defined by the U.S. National Center for Health Statistics, is a disease lasting three months or longer. About 40 million Americans are limited in their usual activities due to one or more chronic health conditions.

What is Chronic Care Management (CCM)?

CMS reimburses $42 per month for Chronic Care Management services for non-face-to-face care for patients with two or more chronic diseases. The goal of this program is to improve care and outcomes for patients with chronic conditions, reduce the overall costs associated with the care of these patients and reduce avoidable hospital admissions. The CCM programs gives providers financial incentives to develop care teams that can effectively deliver chronic disease management services.

Key Program Requirements:

Patient has 2 or more chronic conditions expected to last at least 12 months or place patient at risk of death, exacerbation, or functional decline
Provide a comprehensive physical exam or wellness visit to initiate the CCM service
20 minutes of non-face-to-face clinical staff time per month, delivered under direction of a qualified provider
An electronic care plan which must be available to the patient and other care providers
Patient signed consent for CCM services
Ensure 24/7 access to care management services
Only 1 provider per patient can bill CCM

Revenue Opportunity:

The estimated population that qualifies for CCM services is 35 million. The average individual primary care physician would have approximately 200 patients who qualify. At $42 per patient per month, this equates to $100,800 in annual revenue. The additional revenue opportunity is significant and pays for activities that their staff is already doing to some extent.

The CCM code descriptions are as follows:

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
Comprehensive care plan established, implemented, revised, or monitored Assumes 15 minutes of work by the billing practitioner per month.

Complex chronic care management services, with the following required elements:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
Establishment or substantial revision of a comprehensive care plan
Moderate or high complexity medical decision making
60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure). Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes additional to the first 60 minutes of complex CCM services during a calendar month.

Call Center Triage

Alternative Access Point – Increasing access to Care

The Clinical Call Center Triage platform allows payers and health systems to extend services and provide alternative care access points. GenieMD knows the goal of any health plan or health system is to ensure patients receive the most appropriate level of care at the right time. Our call center triage platform allows health systems and payers to provide services which avoid unnecessary emergency room and urgent care visits by speaking to a Registered Nurse when they need help. Our platform facilitates improved patient experience, reduces unnecessary ER visits, and captures office visit revenue.