What is Care Management?
Care Management is an initiative started by the Center for Medicare and Medicaid Services (CMS) to encourage medical practices to identify patients with one or more chronic or high-risk conditions, in order to proactively manage their care between office visits.
Urology Austin providers recognize the value this program brings to our patients in maintaining overall health. This program provides eligible patients with a dedicated Care Coordinator to work with them and their provider in developing a comprehensive, individualized plan of care. We believe that consistent and timely communication between the patient, their Urology Austin provider and their care team allows the Care Coordinator to follow through on all of the patient’s needs.
Who is eligible for this program?
You are eligible for the Care Management program if you have Medicare Part B or a Medicare Replacement Plan and have one or more qualifying health conditions. For patients who choose to participate, most sign up for a monthly call. However, you can choose your call schedule – once a month, bi-monthly, every third month, or every six months. Your schedule can be easily adjusted based on your needs or any changes in your health.
What are some of the benefits?
- This program provides you with a dedicated Care Coordinator to work with you and your provider in developing a comprehensive, individualized plan of care.
- Your personal Care Coordinator will focus on creating better care coordination to improve outcomes and reduce unnecessary ER visits, hospital visits or readmission to a hospital after release.
- Care Coordinators assess your current condition, answer questions about your treatment plan, review all medications and assist with pharmacy coordination.
- Care Coordinators schedule appointments, communicate with your Primary Care Provider (PCP) and other specialists, work toward quality-of-life goals and connect you with support services, as needed.
- Any consultations you’ve had with specialists will be reviewed by your care team. Your Care Coordinator will arrange any additional consultations, diagnostic work-ups, or follow-up appointments necessary as advised by your provider.
What are chronic and high-risk conditions?
The Centers for Disease Control and Prevention defines a chronic condition as any condition that has been ongoing for more than one year and requires prolonged medical care. Chronic conditions are also defined as those that limit the patient’s ability to perform basic activities of daily living (ADLs). Activities of daily living include eating (feeding themselves), bathing, dressing, toileting (the ability to independently use the toilet and perform personal hygiene), transferring (the ability to independently get in and out of a bed or chair), and the ability to maintain continence (bladder and bowel control).
The Center for Medicare and Medicaid Services has identified the list below as chronic or high-risk conditions. Along with these medical conditions, Urologic chronic conditions include Benign Prostatic Hyperplasia (BPH), overactive bladder (OAB), recurrent urinary tract infection, bladder cancer, renal cancer, prostate cancer, ureter cancer and renal pelvis cancer.
CMS list of chronic and high-risk conditions (including but not limited to):
- Alzheimer’s disease/Dementia
- Atrial fibrillation
- Autism Spectrum Disorders
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Heart failure
- Hepatitis (Viral B & C)
- Hyperlipidemia (high cholesterol)
- Hypertension (high blood pressure)
- Ischemic heart disease (coronary artery disease) – reduced blood flow due to plaque build-up in the arteries
- Schizophrenia and other psychotic disorders
This program is covered under your Medicare benefits and could be covered in full if you have secondary insurance. Full coverage depends on your secondary insurance carrier or Medicare Replacement Plan Coverage. Like all other healthcare services, Care Management is subject to your annual insurance deductible, coinsurance, and copay. Depending on your specific benefits there may be a minimal fee associated with the program.
Call (512) 828-6228 to learn more and to enroll in our Care Management program.