Principal Care Management
Principal Care Management
According to the CDC, 6 in 10 people in America have one chronic disease.
Whereas CCM requires that the patient have at least two chronic diseases, Principal Care Management (PCM) focuses on early intervention for patients with a single-risk or complex chronic condition.
PCM is a Medicare program for managing isolated or high-risk chronic conditions, specifically those that put patients at risk of hospitalization, physical or cognitive declines, or death. This allows for more individualized care and the potential to reduce healthcare costs. The patient must meet the following criteria to qualify for PCM:
- The chronic condition must be expected to last between, at minimum, three months to life-long
- The condition being treated must pose a significant risk of death, acute exacerbation or decompensation, or cause a state of functional decline, and/or be linked to a recent hospitalization.
- Documented written or verbal patient consent
Our Difference
Like CCM, PCM is a care management program that can be combined with other Medicare programs such as remote patient monitoring, to provide comprehensive, wrap-around care. These programs work better together to provide unified patient-centric care.
When patients are enrolled in PCM programs, our solutions identify patient eligibility for other beneficial programs, like Remote Patient Monitoring (RPM) or Transitional Care Management (TCM).
Because our care management programs are non-exclusive to medical specialties, conjoining multiple programs into one cohesive patient experience is not only possible, but also recommended. The flexibility to implement multiple programs within one integrated system, with flexible staffing models, is unlike none other in the market.
Medicare Billable Codes
- 99426: PCM services for a single high-risk chronic condition – the initial 30 minutes of clinical staff time under the direction of a physician or other qualified health care professional, per calendar month
- 99427: PCM services for a single high-risk chronic condition – each additional 30 minutes of clinical staff time supervised by a physician or other qualified health care professional, per calendar month
- G0511: For Rural Health Clinics or Federally Qualified Health Centers (RHC or FQHC) only, 20 minutes or more of general care management provided by clinical staff. G0511 incorporates multiple codes to keep costs down, covering services for Principal Care Management and many others.
Principal Care Management Features + Benefits
Increase Patient Satisfaction
Offer patients focused attention and foster patient-caregiver relationships
Cost Savings & Elevated Revenue
Reduce avoidable procedures while increasing service line reimbursement
Care Coordination
Determine any patient needs that exist, coordinating care with community organizations
Engage & Encourage Self-Management
Guide patients to timely preventative care through telephone coaching and digital patient engagement
Reduced Hospital Visits
Measurable reductions in ER and hospital readmissions
Individualized Patient Care Plans
Evidence-based clinical goals and interventions, with task-based assessments
