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Overview
ThoroughCare's Principal Care Management program is managed within the Chronic Care Management program. Patients are automatically sorted and billed into the correct program based on the number of documented chronic conditions.
Note: As of August 2024, Principal Care Management patients now populate to their own PCM-specific Dashboard and Worklist instead of being filtered through the CCM Dashboard and Worklist. These areas will populate patients based on their CCM Enrollment and association with the PCM patient flag.
PCM Care Management
ThoroughCare patients with one chronic condition will be managed through the Principal Care Management program, which exists within the Chronic Care Management program. Patients will be automatically placed into the PCM program any time they have a singular chronic condition documented in their chart that is associated with CCM.
Enrollment
PCM enrollment maintains the same workflow as CCM enrollment. A user will go to a patient's Care Management tab, locate the CCM program option, and click 'Enroll'.
A CCM Enrollment modal will pop-up where the user can set the patient's enrollment status to 'Active' and capture their consent to both the CCM and PCM programs.
Note: If a PCM patient was enrolled in CCM before August 13th, 2024, users will receive an additional consent pop-up each time they enter the patient's CCM screen until the modal is filled out and saved. This additional consent is to capture explicit consent to the PCM program and does not affect any other aspect of the patient's documented care or billing.
Documentation
PCM also shares the same Initial and Monthly workflow and documentation options as CCM. The only notable difference can be seen in the Monthly Time Log Goals. PCM has a default goal of 30 minutes compared to CCM's 20 minute default.
PCM Patient Flag
Patients will be automatically sorted into the appropriate program based on their number of chronic conditions. If a patient has 2 or more documented conditions or 0 conditions, they will be considered a CCM patient and populate to the CCM Dashboard and Worklist.
If a patient has only 1 chronic condition listed in their Conditions table with an associated CCM label, that patient will be considered a PCM patient and will automatically receive a 'PCM' patient flag. This flag will populate alongside any other patient flags in the patient's Patient View - 'Flags' field, as well as any program worklist's 'Flags' column.
Principal Care Management Dashboard
To access the Principal Care Management Dashboard, a user will click on the 'Dashboard' option in the left panel of their ThoroughCare screen and locate it amongst the other available program dashboards.
This dashboard provides an always up-to-date view of a practice's PCM patient population by separating the total patient count into the following buckets:
Patients Enrolled: The total number of actively enrolled CCM patients who are associated with the PCM patient flag.
60+ Mins: The number of patients from the total 'Patients Enrolled' who have 60 or more minutes of logged time under the CCM program.
30-59 Mins: The number of patients from the total 'Patients Enrolled' who have 30 to 59 minutes of logged time under the CCM program.
1-29 Mins: The number of patients from the total 'Patients Enrolled' who have 1 to 29 minutes of logged time under the CCM program.
0 Mins: The number of patients from the total 'Patients Enrolled' who have not had any time logged under the CCM program.
Inactive: The total number of patients who have been inactivated from the CCM program who are associated with the PCM patient flag.
Not Enrolled: The total number of patients who have never been enrolled in the CCM program but are marked as eligible for CCM in their 'Patient Info' screen.
If a practice is enabled to bill for provider time, the dashboard also provides additional detailed counts based on time logged by or on behalf of providers. To expand the dashboard and access the additional buckets, a user will mark the 'Show provider time' checkbox located at the top right of the table. Once marked a new table will populate underneath the first.
This table pulls from the same 'Patients Enrolled' bucket described above and separates that patient count into the following buckets:
60+ Mins: The number of 'Patients Enrolled' who have 60 or minutes logged that were performed by a provider.
30-59 Mins: The number of 'Patients Enrolled' who have 30 to 59 minutes logged that were performed by a provider.
1-29 Mins: The number of 'Patients Enrolled' who have 1 to 29 minutes logged that were performed by a provider.
0 Mins: The number of 'Patients Enrolled' who do not have any time logged that was performed by a provider.
Inactive: The total number of patients who have been inactivated from the CCM program who are associated with the PCM patient flag.
Not Enrolled: The total number of patients who have never been enrolled in the CCM program but are marked as eligible for CCM in their 'Patient Info' screen.
To view the actual list of patients associated with each count, a user can click on any bucket to automatically open a pre-filtered view of the PCM Worklist.
PCM Worklist
If a user wishes to see a comprehensive, filterable list of their PCM patients, they can go to the 'Programs' option in the left panel and select PCM. This worklist will populate patients based on their CCM enrollment status and the automated PCM patient flag.
This worklist contains the exact filters, column options, and batch functions as the CCM Worklist.
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