For Patients

At Synergrx we understand that having a chronic illness can feel overwhelming. With the expertise of our board-certified, clinical pharmacists, we can coordinate care with your physician and help you achieve the healthiest outcomes. In order to satisfy each individual patient’s needs, our pharmacists are available to answer your questions around the clock.

Patients: What is Chronic Care Management?

Chronic Care Management (CCM) is a Medicare program which provides its beneficiaries with two or more chronic conditions access to a care coordination program at little or no cost. A chronic condition is defined by Medicare as:

  • Expected to last at least 12 months
  • Places the patient at risk of functional decline, worsening of health, complications or death
  • Requires continuous management including establishing, implementing, revising and monitoring of a care plan

What are the benefits of Chronic Care Management?

CCM services allow for proactive collaboration between you and health professionals involved in your care. As part of this collaboration, our pharmacists will:

  • Develop a customized care plan with you
  • Coordinate care with your doctor, pharmacy, and other health care providers
  • Update your electronic health record
  • Address any medication related questions and concerns
  • Assist with prescription insurance authorizations and patient assistance programs
  • Monitor labs for safety and efficacy of treatment
  • Reconcile medications list
  • Provide tools to aid in adherence to medication therapy
  • Assist in care continuity
  • Assist with preventative health care including immunizations
  • Other benefits associated with CCM services for patients include:
  • Patient and caregiver education on medications and wellness
  • Convenience of access to board-certified pharmacists around the clock to ensure your questions are answered as they arise
  • Helps you stay out of the hospital by helping you manage your chronic conditions
  • Allows you to focus on your health and wellness

CCM services can be provided by pharmacists based on their extensive knowledge on chronic diseases and medications. Our clinical pharmacy staff will work directly with your primary care provider to provide these services and help you achieve your health goals.

I’m a patient caregiver, how will this help me?

Through Chronic Care Management services, we can help provide assistance with your concerns 24/7. By providing continuous support, we can help you feel confident in the care you are providing whenever a question arises. Common concerns that can be addressed by our pharmacy care team include:

  • Medication side effect management
  • Education on new medication therapy
  • Medication refill continuity
  • Medication adherence tools
  • Alternative medication administration options
  • Health preventative strategies

We understand the importance of staying informed in all things related to their care. Keeping that in mind, we can serve as a bridge of communication between you and the doctor and inform you of changes in treatment plans. Most importantly, because we work directly with the primary care provider, we will have a comprehensive understanding of the patient’s medical history. Thus, our pharmacy care team will be able to provide advice and intervene keeping the patient’s specific needs in mind. The direct collaboration allows you to focus more on you and your loved one by reducing some of the load associated with the responsibility of being a caregiver.

Frequently Asked Questions

Who should participate?

Anyone taking multiple medications with two or more chronic conditions can benefit from Chronic Care Management services. Our services can help you keep a healthy lifestyle by optimizing care and assisting with medications.

How do I enroll?

Written or verbal consent must be provided to formally initiate services. This can be completed in one of two ways: fill out the form provided below with your information or express your interest during your upcoming doctor’s visit to provide consent. You only need to enroll once into the program.

Who pays for these services?

Medicare and Medicaid provide payments for the services provided by your doctor and most beneficiaries pay little or no cost.

What is expected of me as a patient?

Before you can enroll, you must have completed an Annual Wellness Visit within one year prior to enrollment.

You must provide verbal or written consent to initiate services.

You must be open to discussing your health with the care team when contacted.

Will I have to change my medications?

Our board-certified pharmacy staff will make recommendations to your doctor regarding your current medication regimen. However, all changes will be discussed with you and your doctor taking into consideration your unique needs for final approval. The goal of the services is to ensure you are getting the best results possible from your medications.

Will I have to change pharmacies?

To provide the most accurate and thorough service, you should receive services from a single pharmacy provider. This reduces risk of safety concerns related to receiving care from multiple pharmacies including getting the wrong dose of medication, drug interactions that could increase risk of side effects or reduce how well your medications work while ensuring consistency in care. At Synergrx we work directly with your doctor to provide uninterrupted care and reduce miscommunication that can come as a result of receiving services from multiple providers. Thus, we highly recommend receiving all your services through our pharmacy though it is not required.

Will I have to change doctors?

No. However, Chronic Care Management services can only be provided by one doctor and thus, you cannot provide consent to multiple providers.

What if I change my mind?

You can request to stop Chronic Care Management at any time.

For Providers

Why Pharmacists?

Pharmacists play a vital role in the healthcare industry, particularly as the need for care for the aging population continues to grow. Medications play a significant role in treatment, with the World Health Organization estimating that medication nonadherence accounts for up to 50% of treatment failures and 25% of hospitalizations each year in the United States.

Clinical pharmacists, with their expertise in medication management, can identify and address gaps in patient care, including medication adherence and compliance, disease state management, and preventative measures such as immunizations and smoking cessation. They can also coordinate care for patients with chronic conditions and provide guidance on drug efficacy, safety, and interactions.

In addition, pharmacists play an important role in improving patient care by working in collaboration with physicians and other healthcare professionals to provide a comprehensive, holistic approach to treatment. By actively engaging with patients and addressing their specific needs, they can improve the quality of care and increase patient satisfaction.

In summary, by focusing on patient-centered care, pharmacists can improve health outcomes and reduce healthcare costs by helping patients stay on track with their medication and providing targeted, effective treatment. Their expertise and collaboration with other providers can improve patient experience and satisfaction.

CMS Quality Metrics

The Center for Medicare and Medicaid Services (CMS) has implemented quality metrics through the Merit-Based Incentive Payment System (MIPS) to tie payments to quality and cost-efficient care, with the goal of driving improvements in care processes and health outcomes, and reducing the overall cost of care. Health professionals and organizations with good quality metrics will receive financial incentives, while those with low ratings may face penalties.

Why Chronic Care Management?

Chronic Care Management (CCM) is an effective tool for impacting the MIPS performance, as it involves the provision of care management and coordination of services for patients with two or more chronic conditions. CCM enables patients to have access to a dedicated team of healthcare professionals who can help them stay on track for good health. Services provided under CCM include transition of care, medication reconciliation, a comprehensive care plan, patient support between office visits, coordination of care with other health professionals and pharmacies, assistance with insurance prior authorizations and patient assistance programs, and monitoring of adherence and health outcomes.

What are the benefits to physicians?

Implementing CCM can lead to a range of benefits. Studies have shown that CCM increases primary care physician visits by one appointment per year, while decreasing hospitalizations and emergency department visits. Having a dedicated staff for care between office visits also allows for early intervention in the event of noncompliance with treatment plans, which can negatively impact outcomes. Other benefits of CCM include improved coordination of care, enhanced patient experience and empowerment, strengthened patient-provider relationships, the ability to bill for between-visit care, and the identification of omissions in care. Additionally, it allow providers to focus on critical and high-reimbursement-related activities, seamless continuity of care to minimize errors, improve outcomes, and reduce costs.