How Advanced Primary Care Management (APCM) Reduces Costs and Improves Patient Outcomes

The health setting is changing fast, due to an increased customer demand for value-based healthcare.  CMS reveals that at least 40% of U.S. healthcare providers have now adopted it. Possibly the most promising of them is the Advanced Primary Care Management (APCM) program introduced by CMS. Intended to support the delivery of primary care, APCM replaces the time-based billing system with a system that focuses on reimbursement based on risk, incentivizing proactive, continuous, and coordinated care.

Enable Healthcare Inc. is dedicated to helping practices successfully make the shift to this new kind of model to realize the positive benefits with customized technology and support services. Find out more at APCM in Enable Healthcare.

What Is APCM (Advanced Primary Care Management)?

APCM is an initiative started in January 2025, where providers are notified of patients that need their attention and are paid on a CMS-initiated basis. It contrasts standard billing models of fee-per-service of chronic care services, such as Chronic Care Management (CCM), Principal Care Management (PCM), and Transitional Care Management (TCM), with streamlined payments of bundled payments per month.

The model introduces three risk-adjusted payment levels:

• G0511 (Level 1): Zero or one chronic condition – $15/month

• G0512 (Level 2): Two or more chronic conditions – $50/month

• G0513 (Level 3): Qualified Medicare Beneficiaries (QMBs) with two or more chronic conditions – $110/month

These payments are not associated with the time-based deliverable services but rather expertise in care and involvement with a patient, which reduces administrative overlap.

How APCM Reduces Costs and Bridges the Patient-Provider Gap

The main advantage of the APCM model is that the overall costs of healthcare could be decreased, whereas the relations between patients and providers could be enhanced and more regular.

• Lower Utilization of High-Cost Services: When the emphasis is placed on preventive and ongoing care, APCM minimizes emergency room visits, hospitalization, and unnecessary testing.

• Streamlined Coordination of Care: The monthly engagement supports primary care teams to recognize the challenges early and coordinate between specialists to reduce fragmented and duplicated care.  This can be achieved by HIPAA-compliant electronic communication, e.g., texting and direct messaging.

• Improved Resource Allocation: Providers can afford to spend more time and attention on their high-risk patients so that care delivery remains efficient with minimum waste, thus maximizing clinical value.

• Stronger Patient Relationships: The regular monthly follow-ups with APCM help in developing relations, encourage the patient to stick to the medical plan, and invite them to stay engaged in their health.

These enhancements enable practices to reduce the increasing cost of care and enhance quality and patient access.

How APCM Benefits Patients

APCM transforms the patient experience in several key ways:

• Improved Care Continuity: The follow-ups and patient care coordination are structured into monthly visits and create a proactive, comprehensive care plan.

• Enhanced Access to Services: The virtualized health experience will improve patient access to services by utilizing virtual check-ins, remote monitoring, and facilitating communication with care teams.

• Better Health Outcomes: Early interventions limit complications and hospital visits, and likewise bring about better clinical outcomes.

• Cost Savings for Vulnerable Populations: QMB patients (patients receiving Level 3 payments) have no cost-sharing, and thus, the payment structure improves affordability and access.

Benefits to Practices and Providers

To providers, Advanced Primary Care Management provides a sustainable and streamlined means of care delivery: 

• Stable Monthly Revenue: Predictable income through bundled payments helps practices manage finances and invest in care improvements.

• Reduced Administrative Burden: No time-tracking requirements, so clinicians and administration have more time.

• Simplified Billing: Billing is simplified through the use of three HCPCS codes that eliminate the complicated documentation and audit requirements. 

• Increased Efficiency: Developing more effective workflows and outcomes will help teams make better time and resource allocations towards patients with high risks or needs.

Enable Healthcare provides a specialized team, software platform, care plan templates, and rigorous documentation services in order to streamline the implementation process.

Bringing It All Together

The APCM model offers a forward-thinking framework that aligns the goals of all stakeholders:

• For Patients: Greater access to timely and personalized care, better health literacy, and fewer emergency room visits.

• For Providers: Less labor-intensive, greater productivity, and much more meaningful patient interactions.

• For the Healthcare System: Cost-containment driven by preventing hospitalization and acute care utilization, and by promoting equity and access. 

Practices have the capability of assuming control to change healthcare delivery and guarantee its sustainability through the integration of APCM. This model allows clinics and providers to provide even more proactive services, establish long-term relations with patients, and decrease dependency on high-cost treatments.

Enabling Healthcare believes that a successful transition to APCM is not only manageable but also scalable and can be achieved. Our fully integrated EMR, intelligent care coordination modules, and customizable reporting tools enable the practice to customize solutions based on its patient population. The benefits of improved outcomes and compliance, along with enhanced operational transparency and performance monitoring, are not the only ways practices can benefit from the practices.

Why Partner with Enable Healthcare

With the healthcare reimbursement environment undergoing significant change due to CMS, Enable Healthcare Inc. will have your practice on the cutting-edge of innovation. We bring:

• End-to-End APCM Support: We manage the entire APCM lifecycle, including initial onboarding and performance analytics.

• Integrated Technology: Our EMR and care coordination platform is customized to APCM success.

• Compliance and Consent Support: Enable Healthcare works to ensure documentation across all areas complies with CMS regulations and leaves the ownership of documentation with your practice.

• Scalability: We customize solutions to your needs, whether you are a solo provider or a multi-site group.

• Experience: Our experience of success in CCM, Remote Patient Monitoring (RPM), and value-based programs enforces our suitability as an APCM partner.

Practices working with EHI benefit from:

• Automated Patient Engagement Tools that stimulate retention and compliance.

• Real-Time Dashboards that enrich visibility and accountability.

• Revenue Optimization Features that guarantee that you are optimizing your CMS reimbursements.

Now is also the time to modernize care delivery and make a measurable impact on patient outcomes.

Contact Enable Healthcare

Have questions or ready to get started? We are here to assist you. The implementation of APCM can be a complicated process, but our staff members can assist you with every stage of the process of implementing APCM.

📞 Call us: 866-876-8272

📧 Email us: info@ehiehr.com

🌐 Visit us: www.ehiehr.com

Sources:

• CMS Advanced Primary Care Management Overview

• Enable Healthcare: Understanding APCM

• Enable Healthcare: APCM Services Overview