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Advanced Primary Care Management (APCM) is a new Medicare program that lets medical providers bill for between-visit work. Done well, APCM can improve patient outcomes while compensating healthcare organizations for pursuing value-based initiatives. However, APCM isn’t a good fit for every practice. Here are 5 things to consider to determine if APCM is right for you.
Let’s start at the beginning. What do you hope APCM will do for you?
There are any number of reasons to launch a new program, from improving continuity of care to stabilizing cash flow. Done right, APCM can check multiple boxes. However, it’s important to define what success looks like for your organization before launching any new program.
Begin by assessing your current healthcare delivery model. Are there gaps in care coordination, patient engagement, or preventive health?
APCM was designed to close those gaps by encouraging providers to extend between-visit care to all Medicare patients, not just those with the most complex conditions. Phamily research supports this. Our data shows that between-visit care can close an average of 6.5 care gaps per patient, resulting in improved healthcare outcomes and a lower total cost of care (TCoC).
In announcing the new rule in the Physician Fee Schedule, CMS noted that, “A strong foundational primary care system is fundamental to improving health outcomes, lowering mortality, and reducing health disparities.”
But APCM doesn’t just deliver better outcomes for patients. It also supports the medical practices providing it.
APCM benefits practices willing to go the extra mile and assume responsibility for providing a high-quality primary care service. Healthcare groups can use APCM to increase revenue without significantly increasing their workload. That makes it ideal for organizations seeking new service lines to diversify their income.
Whatever your goals for APCM, setting measurable objectives can help you build a successful program. Consider goals from both a patient and practice perspective to create a program that drives the most benefit for all. Then use your objectives as a guide to keep your program on track. We’ve included a few examples to get you started.
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APCM compensates medical practices for between-visit care. Chances are, your clinical and front office staff are spending hours each month on these tasks already. With APCM, triaging calls, refilling medications, and updating charts all become billable activities.
However, to be successful at APCM, a practice must have the right tools and processes in place to operationalize all those ad-hoc activities into a working care management program.
Traditionally, between-visit care has been limited to phone calls that go unanswered more often than not. Rather than making the practice more efficient, they actually increase the volume of inbound calls and follow-up work as patients call back. A single care manager might be able to support 50 patients that way, making the process costly and difficult to scale.
To succeed at APCM, practices need to operationalize these activities and embrace new technologies to communicate effectively with patients.
Remember, many patients will have a cost-sharing responsibility for APCM. To keep them enrolled in the program, you need to engage them effectively. One way to do this is to work with patients toward their healthcare goals and set up check-ins to help keep them on track. Learn more about creating patient value in your APCM program.
Part of communicating effectively with patients is providing the right level of care for their needs. Cohorting patients by risk factors makes it faster and easier for practices to provide the right level of care. CMS recognizes and reinforces this by making risk stratification a prerequisite for APCM. Additionally, billing for APCM is spread across 3 codes depending on a patient’s medical needs and Qualified Medicare Beneficiary (QMB) status.
To launch an effective APCM program, practices must be able to analyze and stratify patients. This can often be achieved through your EHR or a PHM system. Stratification will help you identify patients with similar needs, not only for billing purposes but also to support care management planning and results tracking.
Managing your patient population and finding the best ways to communicate effectively with them are just two of the practice capabilities you need to succeed at APCM. There are also other factors to consider, such as performance measurement and care coordination.
To help ensure the right standard of care, CMS has outlined 10 requirements all practices must meet before they can invoice Medicare. These 10 care management activities and practice-level capabilities collectively framework what a successful APCM program looks like.
We’ve put together a handy checklist to help you prepare for APCM. Download your copy now to evaluate your practice’s readiness, and learn how to go beyond the guidelines to deliver exceptional care.
TOOLKIT
Get ready to meet all 10 APCM requirements as outlined by CMS with this easy to follow checklist.
You don’t just need the right tools and policies in place. You also need the right people.
Staffing a Connected Care program can be challenging. Hiring, training, and retaining care managers requires an upfront investment in time and resources. Some organizations overcome these challenges by reassigning staff who are already providing between-visit care. Others outsource care management services to external contractors.
CMS guidelines for APCM state that auxiliary personnel can provide APCM services, providing they:
However you staff your APCM program, all care managers must be clear on their roles and responsibilities. This includes ensuring they maintain the same high-quality, consistent care as your APCM program scales.
Whoever’s leading your APCM initiative, it’s important to bring all stakeholders on board. Ensure that each person in your organization understands the program and feels empowered to make it a success.
As we mentioned earlier, many patients will have a cost-sharing component to APCM. Copay amounts may vary depending on their plan and any supplemental insurance they have. To enroll as many patients as possible, it’s important that they understand the value of between-visit care.
Be clear about the benefits to them, including tangible ways APCM can improve their medical outcomes.
Even for patients who don’t have conditions that need close management, APCM can help maintain their health as they age. Segmenting your patient population can help you find the right message for each group.
After your APCM program goes live, it’s important to track performance to understand where you can improve. Here, you should refer to your original goals. That should make it easier to identify the metrics that will be the most informative as you evaluate progress.
Some metrics you might consider including:
Performance assessments aren’t only for your benefit, they’re also important for Medicare compliance. Practices delivering APCM are scored on cost and population health outcomes, and must monitor 4 quality measures from a set list. This requirement helps practices measure the effectiveness of their APCM program.
In our decade of building Connected Care programs at scale, we’ve learned that program success is a virtuous cycle. It works for Chronic Care Management (CCM), and it will work for APCM too!
By creating trusted relationships between care managers and patients, engagement, satisfaction, and quality of care all go up. And that in turn reinforces the trusted relationship. Performance metrics like net promoter scores and healthcare outcomes will quickly show you if you’re on the right track.
Rolling out a new healthcare service line can feel daunting, but you’re not alone. At Phamily, we’ve had a decade’s experience providing best-in-class Connected Care at scale, and we’re here to help. We can also provide a customized pro forma, showing the impact that APCM could have on your practice.
Just reach out, and one of our team will be happy to help you evaluate APCM for your organization.
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