Payment Models

There are several CMS (Centers for Medicare & Medicare Services) Models in which we work to help our integrative partners receive reimbursements. 
We have included the three main models in which we use to support healthier outcomes while providing optimal reimbursement for all providers.
Many commercial health plans are also offering value-based contracting opportunities similar to these CMS models.

We also help practices code better for higher reimbursements.

Chronic Care Management (CCM)

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic
Care Management (CCM) as a critical component of primary care that
contributes to better health and care for individuals.  The CCM service is extensive, including structured recording of patient health information, maintaining a comprehensive electronic care plan, managing transitions of care and other care management services, and coordinating and sharing
patient health information timely within and outside the practice. 

Bundled Payments for Care Improvement
(BPCI Advanced)

The Bundled Payments for Care Improvement (BPCI) initiative is comprised of four broadly defined models of care, which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare with shared savings for all.

Medicare Diabetes Prevention Program (MDPP)

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the completing the core sessions, less intensive follow-up meetings furnished monthly help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. The National DPP is based on the results of the Diabetes Prevention Program (DPP) study funded by the National Institutes of Health (NIH). The study found that lifestyle changes resulting in modest weight loss sharply reduced the development of type 2 diabetes in people at high risk for the disease.  This is the first time inwhich CMS is credentialling and reimbursing non-clinicans to deliver health services to Medicare beneficiaries. 

Not sure which model is right for your practice? No matter if you are a personal trainer, health coach, massage therapist, nutritionist, Naturopathic  doctor or other "integrative" practitioner, we'll help you find a model and payment structure to fit you and your patients needs.