Over a decade, the Centers for Medicare & Medicaid Services (CMS) tested various value-based innovation models focused on improving primary care. Models like CPC, CPC+, and Primary Care First demonstrated that “comprehensive primary care can lead to reductions in emergency department and hospital visits while better meeting patient needs.”

Ineffective transitions of care challenge providers Readmission rates have remained high despite the Hospital Readmission Reduction Program (HRRP). The average US all-cause readmission rate is 14.56%, and it ranges from 11.2% to 22.3% across states. Other value-based care programs, where reimbursement is tied to the quality of service, haven’t led to a significant change in readmissions, either.

Medicare’s new program, Advanced Primary Care Management (APCM), moves away from time-based tracking and focuses on reimbursement based on a patient’s risk level. The highest risk level is covered under CPT code GPCM3 and focused solely on any patient who is a Qualified Medicare Beneficiary (QMB).

The Centers for Medicare and Medicaid Services (CMS) updated the CPT codes for the Annual Wellness Visit (AWV). For 2025, there were no major changes to the AWV program rules and regulations in CMS’s Final Rule.

A recent AARP bulletin story by Dr. Howard Zucker asks, "Where have all the doctors gone?"

Health equity can play a vital role in enhancing and optimizing care delivery across populations.

Medicare Advantage (MA) plans are at a pivotal moment. First launched in 1997, these managed care alternatives for Medicare beneficiaries were designed to reduce costs and improve outcomes.

What is Remote Therapeutic Monitoring? The Centers for Medicare and Medicaid Services (CMS) introduced Remote Therapeutic Monitoring (RTM) in 2022. The program reimburses providers for the review and monitoring of non-physiological data collected through medical devices that meet FDA standards.

What is Behavioral Health Integration? Behavioral Health Integration (BHI) is a monthly program that helps Medicare beneficiaries address mental health concerns. Covered by Medicare Part B, providers should learn what CPT billing codes are used for BHI in order to optimize care delivery and avoid denied claims.