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Advanced Primary Care Management (APCM) gives primary care practices a more continuous, coordinated and patient-centered approach to managing patients beyond the traditional office visit.
At The Rize Group, we help practices turn APCM from a billing opportunity into an operational care-management program.
From patient identification and enrollment through care coordination, patient engagement, documentation, care plans and ongoing program management, we help build and support the infrastructure necessary to make APCM work inside your practice.
APCM is a monthly, non-time-based Medicare service designed to support ongoing primary care management based on the individual needs and complexity of the patient.
Unlike traditional time-based care-management programs, APCM is not centered around documenting a specific number of minutes each month.
Instead, the focus is on maintaining the capabilities necessary to provide comprehensive, coordinated and accessible primary care throughout the month.
APCM services for patients who do not meet the chronic-condition requirements of the higher APCM levels.
For patients with two or more qualifying chronic conditions that place the patient at significant risk of decline, exacerbation or other adverse outcomes.
For Qualified Medicare Beneficiaries (QMBs) who meet the chronic-condition requirements of G0557.
Successfully operating an APCM program requires more than identifying eligible patients.
It requires people, process, technology and execution.
The Rize Group works as an extension of your practice to support the operational infrastructure necessary to launch, manage and scale your APCM program.
Patient Population Identification
Identify patients within your existing population who may be appropriate for APCM.
Patient Education & Enrollment
Educate patients, obtain appropriate consent and establish them within the APCM workflow.
Comprehensive Care Plans
Support the development and ongoing maintenance of patient-centered care plans.
Patient Engagement & Outreach
Maintain consistent communication with patients based on their individual care-management needs.
Care Coordination
Coordinate with specialists, hospitals, pharmacies, caregivers and other members of the patient's healthcare team.
Transitions of Care Support
Support appropriate follow-up after hospitalizations, emergency department visits and other transitions in care.
Medication & Treatment Follow-Up
Assist with medication reconciliation, treatment-plan follow-up and patient education.
Preventive Care & Quality Opportunities
Identify care gaps, preventive-care needs and opportunities to improve quality performance.
EMR-Based Documentation
Work within your existing electronic medical record environment so care-management activities remain connected to the patient's chart.
Program Monitoring & Performance Management
Track enrollment, engagement and operational performance to identify opportunities for continued improvement.
A successful APCM program should not operate separately from the rest of your practice.
Our goal is to integrate APCM into the systems your organization already uses, including your:
Providers
Clinical Staff
Electronic Medical Record
Scheduling Workflows
Population Health Programs
Quality Initiatives
Revenue Cycle Team
The result is a program designed to function as part of your practice—not beside it.
Evaluate the patient population and identify potential APCM opportunities.
Explain the program, obtain consent and establish the patient within the APCM workflow.
Review the patient's needs and develop or update the comprehensive care plan.
Maintain ongoing patient engagement and coordinate care based on individual needs.
Capture relevant care-management activities and interactions within the patient's medical record.
Monitor program performance, patient engagement and opportunities for continued improvement.
Creating an APCM program is one thing.
Operating one consistently across hundreds or thousands of patients is another.
The Rize Group brings together the operational structure, trained personnel, technology-enabled workflows and healthcare-management experience necessary to help practices move from opportunity to execution.
You remain the patient's primary care provider.
We help build and support the infrastructure around you.
APCM can create meaningful opportunities to improve continuity of care, strengthen patient engagement, improve coordination and build a more proactive primary care model.
The opportunity is not simply to bill another service. The opportunity is to create a better system of care.
Whether you're evaluating APCM for the first time, preparing to launch or looking to strengthen an existing program, The Rize Group can help you build the people, processes and operational infrastructure necessary to move forward.
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