Care Management Blog

Chronic disease is one of the most significant challenges in Medicare today. Patients are living longer with conditions that require ongoing support and providers are balancing the realities of limited time, fragmented systems, and growing expectations in value-based care. Against this backdrop, CMS has released the ACCESS Model, short for Advancing Chronic Care with Effective, Scalable Solutions.

In the face of growing calls for value-based care, reduced reimbursement, and increasing costs, providers are launching care management programs to help counteract these pressures.

The Rural Health Transformation (RHT) Program, backed by $50 billion in federal funding, offers US states an opportunity to address healthcare for rural populations. This includes strategically investing in infrastructure and innovative models that deliver measurable, sustainable improvements.

According to an announcement from the Centers for Medicare & Medicaid Services (CMS), the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule includes suggested changes to the Medicare Shared Savings Program. The goal is to make timely improvements to program policies and operations.

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.”

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).

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.

Annual Wellness Visits (AWVs) have been shown to reduce healthcare expenses by 5.7% for Medicare beneficiaries. In addition to reducing future costs, AWVs provide an opportunity to assess a patient’s health risks and create a personalized prevention plan.

The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for its 2025 Medicare Physician Fee Schedule. It includes a significant change for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Many Medicare billing guides focus on reimbursement requirements but often lack clear steps on how to successfully and accurately bill Medicare for RPM services.