The healthcare system has been largely a situation whereby you are trying to read a map and you are in a language that you do not understand, particularly when it comes to matters of health that are more than a one and done sort of business. Whenever you find yourself sitting in a doctors office and you hear the word Chronic Care Management (CCM) thrown around, you may have questioned yourself whether it is yet another dose of medical jargon or something that could possibly make your life a little easier.
In simple terms, CCM is a program designed for people managing ongoing health issues, but many still aren’t sure what conditions qualify for chronic care management or whether they meet the criteria. It provides individuals with one or more long-term conditions added support through coordinated care, scheduling help, and medication management.
But the biggest question most people ask is: Is it really that I qualify for this? It looks awesome on paper, and the criteria can be somewhat gatekeeped when taking into consideration insurance codes and clinical terminology. To address the air-clearing-up issue, you might want to disaggregate what makes you eligible in Chronic Care Management.
The “Two-Condition” Rule
What needs to be known, first and foremost, is that Chronic Care Management is not typically something that someone dealing with a single nagging problem should get into; rather, it directly targets individuals that are dealing with two or more chronic conditions that they are currently dealing with. These must be considered chronic, meaning that in the eyes of Medicare and most insurance companies, they must at least last more than 12 months or essentially, through the rest of your life.
The rationale behind this is quite simple; when you have a single condition, it becomes manageable because you can afford a regular check-up every few months but when you start adding conditions, such as having to check your blood sugar levels while having a temperamental heart, the complexity of your care doubles and the additional support offered by a CCM team becomes an absolute life-saver in your life.
Heart Health
It should not come as a big surprise that some of the most frequent reasons why people join Chronic Care Management are heart related, and that is due to the fact that the heart influences literally every other activity that your body has to perform.
- Hypertension (High Blood Pressure): This is the one that creeps in and even though a pill may limit the figures, the situation only goes on with another and only with constant supervision.
- Congestive Heart Failure (CHF): This is also heavy but you must monitor the amount of fluids you consume, the weight you are, and the quantity of salt so this may need several specialists who need to be on the same page.
Metabolic and Respiratory Struggles
Beyond the heart, there are conditions that affect how your body processes energy or how you breathe, and these are notorious for playing “tug-of-war” with each other.
Diabetes (Type 1 and Type 2)
Diabetes is perhaps the poster child for Chronic Care Management because it is so incredibly hands-on; you’re checking glucose, worrying about foot health, managing eye exams, and trying to balance your diet, all while hoping your kidneys are holding up their end of the bargain.
When you add a second condition into the mix, like high cholesterol or arthritis, the mental load of managing it all can become overwhelming, which is why having a CCM coordinator to help track your labs and refill your strips is such a relief.
COPD and Asthma
When you think that you are breathing through a straw, you understand that chronic problems with your lungs such as COPD (Chronic Obstructive Pulmonary Disease) or severe Asthma are not just annoying every so often but they determine how far you walk, where you go, and how much energy you have left to give you family.
These are conditions that should be included in CCM as they tend to trigger what can be referred to as a flare-up, which lands people in a hospital and the entire reason why the program should exist is to identify those changes in breathing early enough so you may remain at home in your own bed and not at the hospital ward.
Mental Health and Neurological Conditions
It’s a very common discourse that people think of physical health as being autonomous of our heads, but the healthcare sector is finally coming to an agreement that mental illnesses are equally chronic and challenging as the physical ones.
- Depression and Anxiety: Long-term acquaintances in this category make you think about how to take all your other medicines, have difficulty sleeping, and may have any energy left to attend your appointments.
- Dementia and Alzheimer’s: These are especially tricky to consider since in many cases, a specific caregiver will be expected to participate in the CCM process, the patient must be secure and in accordance with the plan even when the memory is gone.
- Arthritis: Be it Osteoarthritis or Rheumatoid, long-term pain and lack of mobility that arthritis can give you means that it could be difficult to maintain other health objectives, like working your heart or going to the pharmacy.
Why Does “Qualifying” Actually Matter?
Maybe you are thinking, okay I already have two of these, and why should I care about being an enrollee in a program? The fact of the matter is that the modern medical system is reactive – you are sick, you go to the doctor and they mend you and you go. The concept of Chronic Care Management turns the table around and is proactive.
When you qualify and enroll, you get a personalized care plan that is updated regularly, and you usually get 24/7 access to a care provider who knows your history. You don’t have to explain your whole life story to a stranger every time you have a question; you have a team that already knows you’re allergic to that one medication and that you struggle with transportation on Tuesdays. It’s about building a safety net so that “managing your health” doesn’t become your only hobby.
The Bottom Line
If you’re living with two or more long-term health issues, whether it’s the “big ones” like Cancer and Heart Disease or the “daily grinds” like Diabetes and High Blood Pressure, you likely qualify for this extra layer of support. It’s about using the resources at your disposal to ensure that you spend more time living your life and less time worrying about prescriptions, not about giving up or claiming you can’t handle things.
Talking casually with your primary care physician is the best approach to find out for sure. Say to them, “Hey, do I have two chronic conditions that would make me a good fit for CCM?”Most doctors are thrilled when patients take this initiative because it makes their job easier too!
