Data integration and interoperability enable greater capabilities to capture and share patient information, supporting new models like value-based care management.

Primary care is the foundation of US healthcare. It’s reported that primary care is the “only” area in which providing more services—such as childhood vaccines and regular blood pressure screenings—is linked to better population health and more equitable outcomes.

So much of a health plan’s business and operational structure revolves around risk and revenue.

The need for tighter health plan-provider partnerships has never been greater.

Physicians and other qualified providers working within nursing and assisted living facilities can deliver covered care management services, according to The Centers for Medicare & Medicaid Services (CMS). So long as they meet all billing requirements, and the claim is submitted using a specific NPI number. These services include:

Combining Chronic Care Management with Remote Patient Monitoring can improve clinical outcomes, lower total cost of care, and enhance patient satisfaction.

UPDATE (1/8/2025): In its 2025 Final Rule, CMS changed the rules pertaining to HCPCS code G0511. Read here for the latest information. Since Medicare introduced care management programs in 2015, coverage has evolved to provide expanded opportunities for Rural Health Clinics and Federally Qualified Health Centers. Historically, however, new care management programs have been launched without initially including RHCs and FQHCs or with significant restrictions.

Quality is a foundational tenet of the US healthcare system. Performance measurement provides a standardized approach to prioritize specific clinical or operational outcomes.

There’s an expanding need for health plans to collaborate with physicians and launch large-scale Chronic Care Management (CCM) programs. As the adult population continues to age, 60% of adults and 40% of school-age children already have one or more chronic conditions.

Understanding the CPT billing codes for Transitional Care Management (TCM) will provide you with a better idea of what is expected, both by the patient and by Medicare.