(May 2025) – As of 2025, the Centers for Medicare & Medicaid Services will reimburse practices for offering their new program, Advanced Primary Care Management. Advanced Primary Care Management is a preventative care program for Medicare patients, offered by providers who serve as the patients' focal point of care.
ChartSpan, a care management organization and KHSC partner, has received hundreds of questions about the program. Here are a few of them–and for answers to more questions, you can view the full article here.
Advanced Primary Care Management Services
Who Is Eligible for APCM?
Providers can offer APCM to Medicare patients they provide primary care for. There are three levels of APCM:
- Level 1: For patients with one or fewer chronic conditions
- Level 2: For patients with two or more chronic conditions
- Level 3: For patients with two or more chronic conditions and Qualified Medicare Beneficiaries
What Does APCM include?
APCM must include multiple service elements:
- Consent: Explain the program to patients, ask patients for their consent to enrolll and record their consent
- Initiating visit: Required for patients who haven’t seen their provider within the past three years
- 24/7/365 access to care: phone or text line for health questions
- Ability to schedule successive appointments with the same care team
- Care in alternative ways, such as home visits or expanded hours
- Comprehensive care management: systematic assessment of medical and psychosocial needs, systems to provide preventative care, and medication reconciliation
- Patient-centered care plan: Available electronically and created in collaboration with patients
- Management of care transitions: Oversee transitions from the hospital, ER, or a skilled nursing facility to home and follow up with patients within seven days
- Community-based care coordination: Form relationships with other practitioners, home-and community-based services to assist patients
- Enhanced communication: Provide multiple patient communication methods, including secure messaging, email, online patient portal, or phone
- Population-level management: Ability to stratify patients into three levels of APCM and identify appropriate, targeted interventions
- Performance measurement: Will be evaluated based on quality measures
Advanced Primary Care Management Services for All Practices
Advanced Primary Care Management could improve outcomes for Medicare patients, helping them avoid unnecessary hospitalizations and enhance their quality of life. However, the program requires advanced stratification and quality reporting abilities, as well as in-depth, personalized care management. If you’d like to learn more about effective, compliant APCM, you can view our full article on APCM here. To discuss this further, contact Chris Miller at chris.miller@strategichealthcareadvisors.com or (816) 588-4650.