Educational Webinar: Optimizing Care Management Programs for Maximum Benefit

Conference Title: RemetricHealth: Optimizing Care Management Programs for Maximum Benefit Date: Wednesday, 25th February 2026 Operator: Hello, and thank you for joining us today. I'm excited to welcome you to today's Clinical Connections presentation, Optimizing Care Management Programs for Maximum Benefit, presented by RemetricHealth. Before we get started, I'd like to direct your attention to our disclaimer. And while you're reviewing that information, I will remind you that this presentation is being recorded. Within a day or two, you can expect to receive the link to rewatch the presentation. If you have a question, please feel free to enter it into the Q&A panel just to the left of your webinar window at any time, and we'll do our best to answer at the end of the presentation. I'm pleased to welcome our speaker today, Rebecca Russell. Rebecca Russell has spent more than 17 years in healthcare, with the last 13 dedicated to remote patient monitoring and chronic care management. She works with community health centers, physician groups, hospitals, and home health agencies to help improve quality metrics and improve patient lives. Rebecca finds the greatest reward in knowing that her work can give patients a better path forward and, in some cases, save lives. Rebecca, thank you so much for joining us today. Rebecca Russell: Thank you so much, Brandon. I appreciate it. I'm excited to be here. I always get excited about these types of events just because I have been in this for so long, learning about care management programs, and certainly not without plenty of trials and tribulations. But hopefully my goal today is just to impart as much helpful information as I can in terms of what these care management programs are all about and how you can truly be successful with them. When I say successful, I'm not just talking about adding as many patients as possible to the program or billing as many codes as possible. I'm talking about truly providing clinical value to patients today, living with chronic disease. Because when you implement these types of programs with knowledge, and you do it intentionally, it absolutely does improve care for patients. We've seen over, actually, the last number of years, especially this past year, CMS and the payers are increasingly adding support for care management programs. This past year, we'll talk about which was just some wonderful enhancements and overall additions to reimbursements for these care management programs. In order for us to keep seeing that, we want to make sure that we're able to continue to show the results. Show the clinical value of the programs, the outcomes, as well as the reduction of utilization and overall costs. So, without further ado, today we'll talk through some of the changes in 2026. A lot of really positive changes for all-around care management programs. We'll talk about some of the newer programs, in particular, APCM advanced primary care management services. And what that is all about, what that looks like in the day-to-day. And we'll also touch on some of the other care management services, as well as really the foundation that you need to have and how to implement these programs to really maximize benefit for your practice and your patients. Okay. Why does this matter, right? Why is this so important? Historically speaking, healthcare, especially primary care, was built around episodic visit-based care. Patients would be sick, they would go into the office, they would be treated. And a lot of times, they would go home, and they would feel better. But today it's much different. The majority of what we're treating today is chronic. It's longitudinal, and it's complex. Patients don't just go to the doctor's office and then go home, and they're better. They're still quite sick when they go home. And they need so much more. They need monitoring. They need reminders. They may need referrals. They need management. They may need a change of meds. And a lot of this is happening outside of that office visit. As I mentioned, CMS in the payers have been increasingly recognizing this reality, which is why they continue to support and invest in these type of programs that support care outside of the visit. Now, when I say that, I am not talking about instead of the visit. The visit is always going to be incredibly necessary. It's just that when a patient is in the office, and then they go home, it's making sure that that patient has the support at home so that they can follow the instructions, the care plan that the provider has set forth for them in the office. So these are programs that are all about supporting that visit. Okay. So the core problem. This slide is a little bit depressing, but I think it's important to look at, at the big picture. And so today, 90% of patients who are 65 years of age and older, the Medicare patient population, have at least one chronic condition. And many of those patients have many more. And the prevalence has been increasing. So in the last two decades, really, when they started looking at this data, the prevalence has increased by 7 to 8 million people every five years. And as chronic disease continues to rise, it drives healthcare costs and utilization. And so 90% of healthcare cost is driven by chronic disease. In 2024, there was $5.3 trillion spent in the United States on healthcare, and 90% of that was based on chronic disease. I think I was at a conference recently, and I shared those numbers, and nobody even flinched. Somebody said, "Yeah, up 7% from the year prior and 20% of our GDP. " And I was thinking about that. And I think one of the reasons is not that we're desensitized. It's more so that it's such a large number, $1 trillion. 5.3 trillion that it almost doesn't even feel real. And so, I think it's important to just step back for a second and understand what that actually means. Because when we have every $5, that is part of the US economy, one of those dollars is attributed to healthcare. And so when you have 20% going to a specific sector that can be problematic, especially if that sector is growing faster than the economy itself. And we all feel it. I think with insurance costs rising and premiums. This can lead to reduction in wage growth and just reduction in overall take-home pay cheques for average everyday families. And so as these costs rise, Medicare and the payers, they respond with tighter reimbursements, increased oversight. Expecting more from providers in terms of quality and outcomes. And so, then that pressure is passed to the providers. The providers have less margins. They have more patients, more responsibility, more complex chronic disease that they're dealing with. More so than ever before. And yet there's less providers. And we've had nursing shortages. So it becomes really challenging. And without a different approach, this becomes this vicious cycle. Why are practices turning towards care management? So if you are a primary care provider or a speciality provider, you probably or you work for one of those offices, you feel it already. The shrinking reimbursements, the additional expectations. And so, providers are looking for a way to better manage their patients and to drive reoccurring revenue. So that's where the care management services come in. And I stress the word correctly when they're implemented correctly with a solid foundation, and they're implemented intentionally, that is where you're seeing patients better managed. You're seeing a significant increase in overall patient engagement. And you're starting to see predictable reoccurring revenue generated. Okay. So I should mention UnitedHealthcare, just in case any of you have heard. Months back, UnitedHealthcare had come out and said that they weren't going to reimburse for remote patient monitoring anymore. They have since retracted their position on that. But I know that there was concerns in the industry around that. Are these types of programs going to go away? Are other insurance companies going to follow suit? I think it's important to just kind of take a look at this timeline for a second. And as of today, UnitedHealthcare is absolutely still paying and reimbursing for remote patient monitoring. And again, they've retracted their original statement. When we look at this timeline, one thing I think is really clear care management programs and reimbursement opportunities they're not going away. They've been expanding over the years and improving. So just to touch on these briefly for a second, in 2013, we saw transitional care management. So that's where patients were hospitalized. They were discharged from the hospital. And then there would be follow up with that patient after discharge. They would come into the office within seven days. In 2015, that's when chronic care management CCM became available. In 2007, we saw an extension of CCM with complex chronic care management, which is just very similar. But more time was required, and patients had more complex disease. We also saw behavioral health integration at that time in 2017. Then, a year later, we saw collaborative care management, which is an enhancement of the behavioral health integration for patients with anxiety and depression. And then, we saw in 2019, remote patient monitoring was first introduced. A year later, principal care management, which is very similar to CCM, but it's for patients with just one chronic disease. In 2022, we saw remote therapeutic monitoring. And I know there are still a lot of questions on RTM, so I will address those today. 2023 chronic pain management. And then in 2025, advanced primary care management became available, which I'm super excited to talk to you about that program today. And another huge win in 2025 was one Federally Qualified Health Centers were finally able to get reimbursed for remote patient monitoring, just like the rest of the world and build the CPT codes. And then this past year, I would say, out of all the years that I've been doing this, this year is really one of the most exciting because we saw such an enhancement to remote patient monitoring as well as remote therapeutic monitoring CPT reimbursement codes. There were codes added, but in addition to that, they significantly increased the rates across the board. And then we also saw an enhancement of the advanced primary care management services as well, where they added two add-on codes for behavioral health. So today, just in terms of key services that we'll talk through, I'll touch just really briefly on CCM because I think the majority of people understand what CCM is. If not, that's okay. We're going to touch on that. And also because it takes us into APCM. A lot of people right now, I think are asking, "Well, what's the difference between the two? Is APC and the new CCM? " So we'll talk through that. We'll touch again, just briefly, on remote therapeutic monitoring. I know there's usually a lot of questions there. And then we'll talk about remote patient monitoring as well. So, chronic care management. So this service is for patients who have two or more chronic conditions. In the most simplistic form, in terms of what CCM is, it is where you have a scheduled phone call with a patient once a month. And that phone call could be anywhere between 20 minutes to maybe an hour long, just depending on the patient and also the caregiver or the person providing the CCM services, I should say. And what they're reviewing is a care plan. So it's a very strict care plan. It talks about the patient's specific chronic conditions, the two or more that they have. And then based on that, there's prognosis, and there's goals. Cognitive function review. Are the patients symptomatic? Are their symptoms being managed? Have there been any interventions that we need to follow up with? Medication management is a really big part of CCM. When a patient is home, and they're on the telephone with their care nurse, it's so much easier for the patient to update us on what type of changes they may have had with their medications. They can look at the bottle compared to having to remember that type of thing when they're in the office. So I know that's one part of CCM that the providers really get a lot of value out of, because when the patient is in the office, they can easily see an updated list of their medications. And just overall care plan up-to-date information on that patient. They'll go over. Are they need of any social services, transportation, maybe food services? Do they have a caregiver? Do they need a caregiver? Those types of things. And so it's a pretty rigid, I would say, care plan where they're going over each and every one of these elements on a monthly basis with the patient. All right. So there are two different reimbursement codes for chronic care management CCM. 99490 is for the first 20 minutes of time that is spent. The reimbursement rate on 99490 is now $63, and then 99439 is for the second or/and third increment of 20 minutes of time. So if you spend a full 40 minutes of time, you can bill 99439 in conjunction with the first code 99490. 99439 is a $50 reimbursement as of the national rate of 2026. And then if you were to spend 60 minutes of time, you had a full hour conversation with the patient, you would bill 99490 one time and 99439 two times. That's the max. Okay. So that takes us into advanced primary care management. If you kind of take in this slide for a second, you can see that remote patient monitoring and remote therapeutic monitoring are still separate off to the side. And you can see that APCM really encompasses a number of these different care management services that we talked briefly about or that we mentioned. But the difference is you're only reaching out to the patient, or you're only responding to the patient reaching out, supporting that patient where they actually need support. Whether you've identified a gap in care or it's a follow-up, there's no need to follow a very strict, rigid care plan. It's based on really meeting the patient where they are and ensuring that you're providing that patient only what they actually need in a given month. There is no more time tracking minute counting. Again, no more rigid care plans or strict requirements. I think there are so many different care management programs today, which is a great thing. But on the other hand, each one of them has its own set of reimbursement codes, its own requirements, and sometimes it's really hard to remember what all of those are. And so even if you are providing care management services, maybe you're not billing for them because you're not sure you met the requirements. And those types of things. And so that's really where APCM comes in because it is no longer something again that is tracked by minutes. The way these codes are reimbursed is based on the number of chronic conditions a patient has. I'll show you what those look like in a second. But we'll first just talk through what CMS considers the requirements of APCM. It's important to note that these are capabilities that you simply need to offer. It doesn't mean that for every patient, every month, you're going to be going down a checklist and checking off each one of these boxes. That's not it at all. There's actually no minimum number requirement of activities in a given month. The first one is patient consent. We all are familiar with this. Patient needs to understand and consent to the program. That can be a verbal consent that you've talked to the patient over the phone, and they've given you their verbal consent. You need an initiating visit if it's a new patient; if the patient has been coming into the office regularly, you do not need an initiating visit. 24/7 access to care and medical records. So this is really for urgent needs. The patient needs to be able to call the practice. And even if you have an answering service on staff, they need to be able to notify or get ahold of either the provider or somebody that has access to that patient's medical records. Comprehensive care management. This is really what it's all about. This is what we're actually doing. We're managing the whole patient over time longitudinally. And we're only providing the patient with what they actually need in a given month. Quality and performance measurement and reporting. So this means how well or how you are tracking your patients and you're using that information to guide care for those patients. So if you're already participating in MIPs or you're part of an ACO or you have a value-based care program, most likely you're reporting quality metrics right now, as it is. An electronic comprehensive care plan. So electronic meeting, it needs to live in the EHR. All of these programs and documentation should really live in your EHR. It's not, like I said, a rigid care plan like chronic care management. It's not a form that you're checking the boxes. That's not what it is. It's a place in your EHR that is easily accessible. So when the provider or the nurse or whomever is looking at that patient's chart, they can easily see this information. And it provides the most up-to-date current clinical status of that patient. I know some of the EHRs right now are starting to come up with designated areas for APCM. So, as an example, in ECW, I know some people are using it under the enhanced Progress note section. In Athena, I've seen they actually have had this for a while. It's a care management box that you can drop into the patient's profile, and you can use that for anything that you'd like, just to update in terms of you know, what you're doing for that patient that's not physically in the office. What non-face-to-face time you're providing to that patient? I think a good way to think about APCM is you're thinking about that patient in a clinically meaningful way. When they're not physically present in front of you in the office, or they're not calling you with a problem, you're thinking about that patient. Then we have coordinated care transitions. So this is staying involved with the patient as they move between care settings. So a lot of people think of this as transitional care management. And it does include that. So if a patient is hospitalized, you can certainly reach out and provide that support and have them come into the office post-discharge. But it's actually so much more broad than just that. This could be a specialist referral or a follow-up after a specialist visit. It could be that the patient was just discharged from skilled nursing, or maybe a home healthcare was just initiated, or maybe there was some coordinating of behavioral healthcare. So again, it's really just coordinating any changes the patient may be experiencing in the healthcare settings and being able to support them in between those transitions. Home and community-based care. So this means that you are supporting the patient where they live. It doesn't mean home visits. It just means that the patient is they're living at home, and how is it that you can support them from their home? So it may be that the patient needs transportation services, and you've identified that. Or maybe you set them up with a pharmacy delivery service. It could be perhaps you set them up for wound care at home. Maybe you help them ensure that their oxygen is being delivered properly. It could certainly be remote patient monitoring. They are taking their vitals from home. So that's just a little bit about some of the elements that are included in the home and community-based care services. Population health management. This is one that can really help you understand which patients you need to follow up with based on what you have found, by running reports and data in the EHR to identify gaps in care or support that these patients may need. And so on a monthly basis. If you are able to run various reports, let's say you run a report for all of your patients who have hypertension. And you realize that, "Oh, there's 35,40 patients on this report that have hypertension and they haven't had a blood pressure check in the last 90 days. " And so then your care management nurse follows up with those patients, those 35 and gets them scheduled for a BP check or introduces remote patient monitoring for those patients. Other types of reports that you can utilize to identify gaps in care, as an example, are your patients scheduled for their annual wellness visits? Are there any cancer screenings that they're due for? Do they have their next PCP visit scheduled? Have there been any clinical changes? Maybe a patient's been recently put on a new medication. Maybe they have a new diagnosis. So all of these different reports that you're running are easily showing you that here's all my patients that most likely could really benefit from that care management nurse. That APCM nurse reaching out to that patient to either address or get them scheduled, or just provide whatever support it is that they actually need. I think it's also important to mention that for APCM, if you were to run these reports, and there are some patients that you have participating in APCM that maybe they don't show up on these reports. And you take a look at their profile or their chart, and you see that they've got their annual wellness visit scheduled. They've got their PCP scheduled. They're not behind on any of their screenings. No abnormal labs. Everything looks really good. That's okay. You can still document that you have looked at all of that information, assessed if the patient needed any support and that you will continue to monitor and follow up next month. And that is still providing that care to that patient, that APM service is still billable for you at that point, even if you didn't reach out and contact the patient and have a discussion. Why? Because you were thinking about that patient. And you were acting on that, and you were looking for ways that you could potentially help. But if there's nothing that really is meaningful, that makes sense for you to reach out; you don't have to do that just to be able to bill anymore. And so that's part of the beauty of APCM. You do have to really think through and make sure that you're doing your due diligence, of course. And make sure that you're always documenting as well. And then the last one, enhanced communication. This simply means that patients can reach you or people on your team in a way that is outside of just the phone call. So it could be through your patient portal. They ask a question, and they're able to receive an answer back through the portal. Again, it could be a remote monitoring program. Because the nurse is monitoring the patient and the vitals are going up, the nurse is escalating to the provider. So these are enhanced types of communications that you can have. After-hours calls could be part of that as well. All right. So these are the reimbursements for APCM as of 2026. And again, it's not based on time; it's based on the number of conditions. So there's three levels of APCM. Level one is for those patients who have less than or equal to one chronic condition. So yes, obviously patients who have one chronic condition qualify for this, but even if they don't have a chronic condition, but you feel that it's medically necessary for these patients to participate in this program, you can enroll them. Level one GEO[? ] 556 is a $16 per month reimbursement. Now, level two is for those who have two or more chronic conditions. That is billable at $53 per patient per month for the level two, two or more chronic conditions. And then level three is exactly the same as level two, except patients also have a qualified Medicare Beneficiary status. QMB is what it's called. So the patients have to have the same as level two, two or more chronic conditions and have that designation as a QMB. And what the QMB means is that they have Medicare, but they also have full secondary coverage as Medicaid. And it's not just a medi, medi patient. It's a little bit more specific. And they actually get that QMB designation. And it's based on income and things like that. And with level three, not only do you not have to charge that patient any co-insurance, you're actually not allowed. And the reason for that is because you're already getting the full allotment, the full allowable amount of reimbursement. So that code on level three is $117 per patient per month. And so standard Medicare across the board, they pay 80% of all Medicare services. And then there's that 20% left over. And that's the co-insurance for these types of services. And so, a lot of times patients will have a secondary insurance so that they don't have any out-of-pocket costs, co-pays, co-insurance. But with this specific designation, the Medicaid then is picking up the full remaining 20%. So you're getting the full amount of reimbursement. Again, the patient does not have to pay any co-insurance for that level three. And then lastly, just quickly, in terms of the reimbursements this year. They did add behavioral health management and collaborative care management to APCM as add-ons. So these behavioral health reimbursements, they still exist on their own outside of APCM. But now, if you have a patient on APCM and you're also providing these behavioral health services, you can also bill these codes on top of the APCM code that the patient is eligible for. So the behavioral health GEO 570 is reimbursable at $58 per patient per month. And then when we get into the collaborative care management, which does involve a psychiatric review from either a psychiatrist that works for the office or consult. The first the initiating visit for that is $162 every one time. And then, ongoing every month for those consultations is $146 in total reimbursement, which, again, you would be billing one level of APCM and then one of these codes on top of that. One of the big questions is, "Okay, I already have a chronic care management program. So what do I do? Do I transition all of my CCM patients to APCM? Does it make more sense? Is the APCM the new CCM? " And if you have an existing care management program CCM, I would say, no, don't take your patients off of the CCM program, but use them both as needed. And so you cannot bill CCM and APCM during the same month for the same patient, but if one month is appropriate and the next month APCM is more appropriate, then you bill CCM in that month and APCM in the following. And so, just to give you some examples of how this works, and I should also state that the patient does need, of course, to consent to APCM as well. But just to give you some examples, let's say your nurse has a CCM call scheduled with that patient, and the patient doesn't show up for their CCM call. And that's so unfortunate. And it happens a lot of times, I think in CCM, patients, something comes up, they get busy, maybe they forget, but the nurses blocked your calendar off for the next half an hour expecting to speak with that patient. And so that's unfortunate. So she didn't get to spend that 20 or 40 minutes of APCM time with the patient. They can't bill CCM. If the nurse has already prepped for that CCM meeting, they reviewed the patient chart. They've looked for areas where they could support that patient. Maybe the patient had a brief communication, and they scheduled an appointment for next week. Then maybe a PCM is absolutely appropriate for that particular patient that month. Another example would be, let's say you have patients on CCM, they're doing well, but the program is just growing stale maybe for some patients. Does the patient actually need a 20 to 60-minute phone call where you're going over the same criteria each and every month? Maybe they really do, right? But maybe they don't. Maybe it's just one thing that you want to focus on. Maybe it's something where right now they're having major transportation issues. And that's what you're going to focus on that month. So in that case, APCM would be more appropriate to bill. So it gives you flexibility. It gives you flexibility again to provide that patient with what they actually need in a given month. And it's also you're not doing anything in this case, just to be able to like, if you were to spend 19 minutes of patients with CCM, like, "Oh, I got to get that extra minute in because that's how I'm going to be able to be paid for the service. " That's not the case with APCM again, because it's not derived or billable based on minutes. Okay. Remote patient monitoring. So, remote patient monitoring again, it's separate from APCM. And it has to do with patients utilizing medical devices like a blood pressure monitor, a glucometer, a pulse oximeter, a weight scale. They're using those devices at home. Mostly for some of the most hypertension, diabetes, weight management, CHF, any type of heart condition, CKD, we see a lot of especially in nephrology. So patients that need that monitoring, they're utilizing a device at home. They use the device, the data is automatically and wirelessly being transferred to a HIPAA compliant web portal. Ideally the EHRs, the provider can review it when they're in the office. They can see their trends. And the benefit of these programs. Remote patient monitoring specifically is a couple of different things. Number one, yes, you catch things early. I always like to reiterate that this program is not intended to be an emergency service. That's not it at all. It's just so that as little things start to happen and the patient starts to exceed potentially thresholds that have been set for them based on their biometrics, the nurse can reach out and see what's going on. And if it is something where maybe they need a change in meds, then they don't need to wait to go to the doctor to get their meds changed, which might not be for a three-month period of time. The RPM nurse can talk to the doctor and say, "Hey, this is what's happening with this patient's vital. " And the doc might say, "Oh, come on in now, or let's change your meds. " And so you're catching things early before they get worse. That's the first big benefit. The second big benefit is if patients are using their device on a daily basis or a couple of times a week, and that information is being uploaded into the EHR in a nice, easy-to-read trend. And then the doctor has the patient in the office, and they haven't seen the patient, let's say, in three months. And three months ago they started them on a new med. They can easily look and see a trend of data to see how they're doing and make so much more informed clinical decisions just by looking really quickly at that trend of data. The last thing I would say for RPM is really just the engagement for the patients. This service, out of all of them, it's not necessarily like daily communicating with those patients, but the patients are typically using their device on a daily basis, and they know that their RPM nurse is monitoring it. So, they're thinking about it on a daily basis. They're thinking about their health. And then there is a lot of contact with the patient throughout the month. Patient forgets to use their device. They forget how to use the device. The nurse is reaching out to them, communicating with them, always educating them. And there's always a discussion at least once during the month, if not a lot more discussions throughout the month. So you can see that there's a lot of contact and communication going on with those patients. And even if there's not direct communication with the patient in a day, again, it's something where they know that their nurse is going to reach out if they're having any issues with their vitals. Okay. For time's sake, I'm not going to go through all of these slides and studies. They would be available if you'd like to take a look. But there's one that I did want to mention just because I think the engagement piece is so important. The first study that you're seeing here, this was a study completed in November of 2024, and it was looking at patients in a rural area. These patients had heart failure. And they were using remote patient monitoring with a blood pressure monitor. And they looked at four years before the patient was participating in RPM. And then they looked at four years after RPM was initiated, and they saw just drastic changes. They saw a 93% reduction in heart failure-related emergency visits. 83% reduction in heart failure hospitalizations. 50% reduction in cardiovascular hospitalizations. 73% reduction in unscheduled/urgent office visits. And then 519% increase in call and contact volume. That does not mean that it was a 519% increase in the patients calling the office and talking to the receptionist or the clinical team. That's not what that is. That is communication between the patient and their RPM nurse. As I was saying, there's a lot of communication that's happening with that patient. Sometimes on a daily basis, often on a weekly basis. Absolutely, on a monthly basis. And so it's just you can see, just like how big of an impact that can make. We can now go to the next slide. So again, lots of studies that just show the benefits in terms of reducing readmissions, reducing hospital admissions, overall cost of care improvement. Better satisfaction scores. And there's national support. And especially with the UnitedHealthcare announcement earlier this year, I think it's important to note, and this is supported and recognized by the most prestigious, well-known, well-respected institutions and organizations in the United States. All right. Now, I need to make this bigger. Okay. So regarding RPM reimbursements, the first code that you're seeing here, 99453, that is just for the setup for the patient. That code is now reimbursable at $22, and it's a one-time code. 99445, this code is brand new as of January 1st of this year. This code is providing you with reimbursement for supplying that device to the patient. So with RPM practices are purchasing, renting, leasing, whatever it is, devices, and the patients aren't paying for them. The practice is. And so that reimbursement then goes to the provider. The stipulation prior to this year, which was shown in this 99454 code, patients had to use the device at least 16 days out of every month. And that was tricky. Most of the patients most of the time did, but there was at least 20%, 25% of the patient population every month that just didn't meet that 16 days of use. And so if the patient only used their device 15 days, then you weren't able to get reimbursed for these codes. And that was really unfortunate, because even if the patients using it ten days out of the month, there's still so much clinical value to that. And so, what CMS did this year is they said, "Okay, well, let's add 99445. " They just swap these last two numbers, which makes it extra confusing. And it's the same rate, which right now the rate for 99445. This code or this one is exactly the same. It's $52. That is the national average CMS rate. But patients only need to use the device two times out of the month. So if your patient uses their device 2 to 15 days out of the month, you can build this code. This is a monthly code. If they use it 16 plus days, then you simply build this code, which has been available for a while now. So this was a really positive, impactful change that CMS made to RPM. This is also a new code that they added. And this is for time spent. So this is the nurse. If the nurse is only spending ten minutes on the RPM program, you can now build this code, which is $26 per patient per month. So any time spent between 10 and 19 minutes, you build this code, which is $26. Again, this one is new. It used to be only this one being the first 20 minutes of time, which is billable today at $52 per patient per month, again for the first 20 minutes of time. And then 99458 is for additional increments of 20 minutes, which today is billable at $42. Okay. All right. Let's touch on remote therapeutic monitoring. Just quickly, just because I know there's a lot of confusion, especially what's the difference between RPM and RTM, and what are these devices for RTM? And so we just talked about RPM. RPM is physiologic data. It is objective. You're using a device, and it tells you exactly what your weight is or exactly what your blood pressure is. RTM, on the other hand, is subjective. It's the way patients are feeling. It's how much pain they're in. The symptoms that they're experiencing, their medication usage. And so it's much different. And so what devices are out there that tell me how much pain I'm in or how I'm feeling? Well, it's typically an app. And so there is typically an app. The app should be designated as a medical device software. And that app is like a questionnaire, and it assesses their pain or whatever symptoms they're experiencing. A true device, as we think of a device the inhalers or the rescue medications that are tracking the number of puffs, that also counts for remote therapeutic monitoring as well. I think one of the problems with RTM, and it's changed over the years, but right now it's really only being used or available in the physical therapy and orthopedic space. For joint recovery, post-op rehab, back pain, those types of things, and then in the pulmonary respiratory therapy areas as well. And the reason for that is because that's what the device codes are derived from. So I know this looks like a ton of codes, but it's almost exactly the same as remote patient monitoring. The only difference is that there are two individual device codes for remote therapeutic monitoring. So this is your setup code. These two codes are either 2 to 15 days of usage or 16 to 30 days of usage for specifically a respiratory device. And then the other two are specific to musculoskeletal devices. And then you have your ten minutes of clinical time, your initial 20 minutes. And then you can build the last one up to two times for a total of 60 minutes. And the codes are structured the same as well in terms of reimbursement dollars. The setup is $22. Any of those codes is $52. The ten minutes of time is 26, and then $52 for the first 20 minutes, and 42 for the additional increments of 20 minutes. Okay. So, how to manage these programs? I think by this point it's probably pretty obvious that these care management programs take a great deal of work, of structure, of foundation. And I think most importantly, dedicated staff. We typically see organizations going in one of two directions: either they are building the program internally, they are hiring staff members specifically for a care management program. Maybe they just start out with CCM and 50 patients, and then they add and grow from there. The other option is partnering with an external care management service company that has a clinical team and has truly the experience and bandwidth to be able to provide those services as an extension of your own care team internally. I think ultimately, what success is not who provides these services but whether the program is truly has reliable, dedicated staff. I have seen these programs go 101 different ways over the years. And if you don't have somebody that is dedicated specifically for these programs and you're trying to sort of fit it in on somebody else's schedule who's doing other things, it doesn't work. It never gets off the ground. With RPM, you can't expect to give patients a blood pressure monitor, and they're just going to use it, and program's going to run itself. Unfortunately, it just doesn't work that way. As great as technology and the devices and the software and all that stuff is, you need that human touch for these programs to work. I will say also that the reimbursements that we just went through, the way they're structured, they absolutely support either hiring your own internal staff or working with a care management team. It's almost the same. It equals out to shakes, out to be very similar. And then there still should be enough room left over for a pretty significant overall return on investment and revenue generation. Okay. This is just a quick example of how these programs can work together and complement each other instead of competing with each other. It says one condition, but it could really be patients with numerous conditions. It should say at least one condition. So let's say you have a patient and they're enrolled in remote patient monitoring. And you know you're talking to the patient during the course of the month, and maybe you get alerted, the nurse gets alerted because let's say the blood pressure has exceeded beyond a specific threshold. So then the nurse reaches out to the patient and the patient says, "Oh, yeah, I've had my meds changed recently. " "Oh, okay. " So you've learned that their meds have changed. Wouldn't it be so great to then follow up with the patient in a couple of weeks, as well as with the provider, to see how they're doing with those meds at that time? So you're doing RPM, but at the same time, you have identified an area that you can also support that patient and follow up with them later. So you could potentially bill for RPM and APCM for those types of patients. Again, they have to consent to both programs. I actually went through these examples already when we were talking about patients on CCM. So I'll jump past this one and just want to make sure we're doing okay on time. We've got just a couple of slides left. So as we talked about, having that care management team in place it's the foundation that you need for these programs to be successful. One of the questions that we get a lot is, "Well, is going to take time out of my provider's day or my existing clinical team? " And the answer is a little bit. But just please hear me out just for a second. The care management team is running the day-to-day, right? They're doing all of the education, the outreach, the follow-up, the documentation, the reporting, all of that, interacting with the patients, all of that. And the providers and your existing care teams are not expected to track dashboards or manage data on a daily basis. That's not what this is all about. When it comes to really two things. Number one, enrolment, the most effective enrolment into one of these programs is when the patient is at the doctor's office in for their visit, and the doctor finishes what they're doing. And the doctor says, "Hey, I recommend our care management program for you. " What that is, is we're going to provide you with a blood pressure monitor that automatically sends the data up to our office. You don't have to write down your numbers anymore in your journal. Don't worry about that. We've got something better. And we're also going to provide you with a remote nurse that is going to be there to support you. And that way, the care and support that you receive when you're in our office, we now offer that into the home, or something along those lines. That is a patient that is going to be so much more likely to consent to the program when the care management team calls that patient to explain the program, and if they do want to participate, document consent. They're also going to be so much more engaged in the program. Their compliance to the program is going to be better because they know that their trusted provider, who maybe they've been seeing for years, recommends this and is on board with this program. And you compare that to, they don't hear it from their doctor, and they have some random person that maybe they've never met before, calling them, talking to them about a program that they've never heard of before. It's much more unlikely that the patient is even going to answer the phone, let alone not feel like it's some kind of scam in this day and age. So the enrolment piece, I think, is huge to have those providers support. And then lastly, the providers or the nurses, they should be reviewing the data in the chart when clinically Necessary. And when is that? When the patient is in the office for a visit, or if there's a med change or the patient calls with a problem, they have that data at their fingertips. But it is incredibly beneficial data. Because when they are in the visit, they have a list. Here's all the up-to-date meds. Here's what's going on with my patient. Oh, it looks like they had a referral. They saw this specialist. Their labs are right here. No abnormal results. It's all right there at their fingertips. So, yes, they have to oversee the program and review these things. But in reality, it makes their lives more efficient and more informed. I will also say too, that even though it is an investment of a little bit of time, it could just be seconds added on to the encounter. It's something that it is a small upfront investment now for an exchange for saved reactive hours of time later. Fewer uncontrolled patients, no more repeating the same conversation over and over to the patient because they're just not following your instructions. Much more engaged patients and ultimately less utilization, fewer hospitalizations. Those types of things. Eventually, the goal is that this doesn't feel like an add-on service or services. It just becomes part of the proactive care and the everyday workflow of the office. So for those of you who maybe you are the providers you're already there. You already understand. But if you're a quality director or a population health manager or something like that, sometime you've got 50 or 100 providers underneath you. Sometimes it's really difficult to get those providers on board and to buy into something new. And they are so stressed and so busy. So how do you do that? So obviously, you want to inform them about the program. If you are working with a partner that is an extension of your service, that is external, have them meet those nurses that are caring for their patients, that are providing the service, so that they know who they are and they don't have something in the back of their mind where they think it's a call center out [inaudible]. Like, let them introduce, let them see who it is that's working with their patients. So, introducing the care team. Also, really helpful for the provider is teeing up the patient referrals. So sometimes the providers aren't going to remember. Oh, is that patient in level one, level two? Are they appropriate for RPM or CCM? So if you can either pull a list or notate a flag the patient so that when the patient is in the office with the doctor they can see, "Oh, this patient is eligible for these services. " And then if they think it's appropriate, just talk to the patient about it. And they don't have to think about insurance or qualifications or anything like that. That makes it easier for them. Plus, it's a constant reminder that these services are available to them to offer to their patients because, if you have a big meeting and you talk about these programs for 15 minutes and everybody's on board, then they leave. They just forget about it. So keeping it front and center is really helpful. Also, reviewing the program performance regularly. We said that the program is going to improve outcomes. It's going to generate new revenue. Actually showing them, if appropriate, based on your organization, truly here's the reimbursements we received. Here's what we paid for the program. Here's our revenue generation. Here's our patient compliance to the program. Here's how much we've improved blood pressure over time. Things like that. Actually showing them the real results. Because if they just enroll a patient, then they never hear about it again. It's like they go into the abyss. What actually happened there? So you want to show them those results? And also patient surveys. After the patient's been on the program for six months or a year, send them out a survey, allow them to do some free text. And then show those responses to the providers in your team who you're trying to get on board to be an advocate of these programs, so they can truly see what their patients are saying. Okay. Payer expectations. And I know we're running low on time, so just make sure everything is well documented. Make sure there's clinical oversight of the program. Things change a lot. Making sure that whatever you're billing for, there's documentation in that EHR. I don't know if I did that right. This is showing you the financial impact. This is the return on investment. It is broken down based on one CCM program, one RPM program, or an RPM with CCM or APCM, two programs. So you can see and we're using an average of 40 minutes for RPM and CCM. That is our clinical average. If your average for these programs is only spending 20 minutes of time with the patient, then your reimbursement will be lower, but so will be your actual cost of the program. So, for CCM on a monthly basis, if you can build both CCM codes, you're generating about $113. Your cost for the program, again, whether you're hiring internally or you're utilizing a partner, it's going to be around $70 realistically and conservatively. So you're left with about $43 return on investment for one patient in a month. That generates about $516 per patient per year. RPM is a little bit higher of a return. 40 minutes of RPM time equates to $145. You're going to pay between the devices, the software, the staff. You're going to pay about $75 per patient per month. That leaves you with a margin of $70, and then 70 times 12 months in a year is $840 per patient per year. This is showing you an average of patients who are on two programs. So they took an average of RPM plus APCM and RPM plus CCM. And so the monthly revenue generation is about $260. You're going to pay about 145. You're going to be left with about $115, which in a year is $1,380 per patient. And then you can just time those numbers by 100 or 1000 or 5000, whatever it is, number of patients, and just start to really see. And this is truly taking into consideration this isn't just what you're getting reimbursed. This is taking into consideration your cost as well. I just want to say that Medicare, we talk about reimbursements, and there's a huge financial impact there. But that's not the only place that we're seeing financial impact. Clinically, it's huge. You're able to get your patients to become more compliant with their medications, their care plan follow-through, which I think sometimes is the hardest part of managing patients with chronic disease. From a quality perspective, you're going to be better on your blood pressure results, your diabetes results, your overall proactive care value-based incentives. So there are so many areas where these programs truly support the practice as well as the patient. I think at the end of the day, if we can really improve outcomes for patients and really change the impact of this vicious cycle that we saw in the beginning, everybody wins. The provider's office, the patient organizations like mine and the US healthcare system, truly, it will make a big impact. Okay, so I know we're right at time, so I will stop here, and I'll let Brandon jump in with any questions. I'm sorry. If you've put your questions in the chat, we will absolutely get to you. If we're ending this now, then we will get back to you, either myself or my team, by phone. Operator: Thank you so much, Rebecca. If you do have a question, please feel free to enter that into the window there to the left. I'm going to keep an eye there. Nothing's come in quite yet, but if anyone does have a question in this last couple of minutes or so, feel free to enter that in. I do want to thank everybody for your time today and remind you that you can see a full list of our upcoming events at mms.McKesson.com/learning-webinars. There you can register for a future webinar, share events with your colleagues, or sign up to receive regular updates on our webinar schedule. So we are just past the hour. If anyone does have a question for Rebecca or for anyone on our team, you can certainly log back into this presentation and enter that at any point. And Rebecca, thank you so much for your time today and expertise. This is really informative, very thorough. I really appreciate it. Rebecca Russell: Thank you so much, Brandon. Operator: Awesome. And thank you again to our audience for taking the time to join us today. And I hope everybody has a great afternoon.