Value-Based Care
The Value-Based Care Company That Runs the Care, Not Just the Dashboard
Most value-based care companies hand you analytics and a list of patients to call. HealthArc is the layer that makes the calls, takes the readings, closes the gaps and documents every minute — across nine CMS care-management programs that reimburse fee-for-service while you build toward risk.
HIPAA compliant
SOC 2 Type II
FDA-cleared devices
No long-term contracts
Care gaps closedBetween visits, not at year-end
Contract models supportedUpside & downside
MSSP & ACO REACHShared savings, quality, total cost of care
Medicare AdvantageStars, HEDIS, risk-adjustment accuracy
Bundled & episode paymentsIncluding the CMS TEAM model
Capitation & PMPMPrimary care capitation and full-risk panels
Commercial & Medicaid VBPPay-for-performance and quality withholds
9CMS programs, one platform
2,000+Providers served
100,000+Patients monitored
~30 daysTypical time to go live
The Real Problem
Value-Based Contracts Are Signed in the Boardroom and Lost in the Exam Room
Almost nobody fails at value-based care because they picked the wrong contract. They fail because the model asks for something fee-for-service never built: continuous contact with patients who are not currently in the building.
You are judged on 365 days and you see the patient on four
Total cost of care, readmissions and utilization accumulate every day of the performance year. A panel seen three or four times a year leaves roughly 360 days unobserved — and that is where the avoidable admissions happen.
Analytics tell you who to call. Nobody has time to call them.
Most value-based care platforms end at the worklist. The worklist is not the hard part — staffing the outreach, the follow-up, the medication reconciliation and the documentation is the hard part, and it is where programs quietly stop.
Care management is treated as overhead, so it never gets funded
Between-visit care usually shows up on the budget as cost with a payoff eighteen months out in a reconciliation report. That is a hard case to make internally — and it is exactly the assumption that CMS care-management codes overturn.
What We Actually Do
An Execution Layer, Not Another Reporting Layer
The distinction matters when you are choosing a value-based care partner. One kind of vendor tells your team what should happen. The other kind is accountable for it happening.
The usual model
Buy a platform, then find the staff
- Risk stratification you still have to action. A ranked list arrives; the outreach is yours to resource.
- Quarterly claims data. You learn about the admission six weeks after it happened.
- Care gaps surfaced at year-end, when there is no time left to close them.
- Documentation as a separate chore — reconstructed for the audit rather than captured as the work happens.
- A cost center waiting on a shared-savings reconciliation to justify itself.
The HealthArc model
Buy the work, and the codes help pay for it
- A clinical team that performs the outreach — enrollment, monthly contact, escalation and follow-up, under your protocols.
- Daily device and patient-reported data, so deterioration is caught in days rather than discovered in a claim.
- Gaps worked continuously across the year, with each touch logged against the patient record.
- Documentation generated by the workflow — time, thresholds, consent and transmissions time-stamped as they occur.
- Fee-for-service reimbursement today under nine CMS programs, while the same activity moves your value-based numbers.
The On-Ramp
Build Value-Based Capability That Pays for Itself on the Way
This is the part most value-based care companies leave out. Medicare already reimburses, on a fee-for-service basis, for nearly every activity that decides value-based performance — remote monitoring, chronic care coordination, post-discharge follow-up, medication review, behavioral health integration. Run those programs and you are being paid today to build the muscle you will need under risk tomorrow.
| CMS program | Value-based lever it moves | Billed under |
|---|---|---|
| Remote Patient Monitoring (RPM) | Early detection of deterioration; fewer avoidable admissions and ED visits | 99453994549945799458 |
| Chronic Care Management (CCM) | Coordination for multi-condition patients; care-gap and quality-measure closure | 99490994399948799489 |
| Advanced Primary Care Management (APCM) | Bundled monthly primary-care management — the closest thing to capitation inside fee-for-service | G0556G0557G0558 |
| Transitional Care Management (TCM) | The 30 days after discharge — the single biggest readmission window | 9949599496 |
| Principal Care Management (PCM) | Focused management of one high-cost condition driving the spend | 99424994259942699427 |
| Behavioral Health Integration (BHI) | The comorbid depression and anxiety that drive medical cost in every risk pool | 99484994929949399494 |
| Medication Therapy Management (MTM) | Adherence and polypharmacy — directly tied to Star Ratings and HEDIS measures | 996059960699607 |
| Remote Therapeutic Monitoring (RTM) | Respiratory status, adherence and therapy response between visits | 98975989769898098981 |
| Principal Illness Navigation (PIN) | Navigation and unmet-need support for serious illness, including health-related social needs | G0023G0024G0140G0146 |
Model it before you commit. Enter your eligible panel and the revenue calculator estimates what these programs are worth across it, and see the current requirements for every code in the CPT code library.
Know The Terrain
How Value-Based Payment Models Actually Work
“Value-based care” is not one payment model. It is a ladder from pure volume to pure risk, and where you sit on it determines which capabilities you have to own. HealthArc supports every rung — and the further along it you go, the more the between-visit work decides the outcome.
Rung 1
Fee-for-Service
Paid per service rendered, coded with CPT and ICD-10. No accountability for outcomes or total spend.
Rung 2
Pay-for-Performance
Fee-for-service plus a quality bonus or withhold — MIPS, commercial quality programs, Medicaid VBP.
Rung 3
Shared Savings
Beat a spending benchmark for an attributed panel and keep a share. One-sided first, then two-sided — MSSP and ACO REACH.
Rung 4
Bundled & Episode Payments
One price for a whole episode of care, including complications and readmissions. The CMS TEAM model is the current example.
Rung 5
Capitation & Full Risk
A fixed per-member-per-month payment covering a defined scope of services. Every avoided admission is margin; every missed one is loss.
Volume — revenue rises with utilizationRisk — margin rises with prevention
New to the vocabulary? Our explainers go deeper on how capitation payments work and on what care gaps are and how to close them faster — the two concepts that decide most value-based results.
The Scorecard
The Five Numbers Your Contract Is Scored On
Whatever the model is called, reconciliation comes down to the same short list. Each one has a specific between-visit activity behind it — which is why a value-based care company that only reports on them is of limited use.
Total cost of care
Spend per attributed member against benchmark. Driven mostly by inpatient and ED utilization, not by office visits.
Lever: earlier interventionReadmissions
Thirty-day returns after discharge — penalized directly and a large share of avoidable episode cost.
Lever: TCM + daily vitalsQuality & care gaps
HEDIS measures, Star Ratings and MIPS quality — screenings, controlled blood pressure and HbA1c, adherence rates.
Lever: continuous gap closureRisk-adjustment accuracy
Whether the conditions you are actually managing are documented and coded. Under-coding hands back a benchmark you needed.
Lever: documented encountersPatient experience & engagement
Survey scores, and the enrollment and adherence rates underneath them. A program nobody stays enrolled in moves nothing.
Lever: no-app enrollment
Why Enrollment Decides Everything
The Patients Who Move Your Numbers Are the Ones Most Programs Lose
Your highest-cost members are typically older, sicker and less likely to own a smartphone or home broadband. Any program that requires an app download, a Bluetooth pairing sequence and a Wi-Fi password systematically excludes them — and they are precisely the members whose admissions decide your reconciliation.
HealthArc ships FDA-cleared cellular devices that arrive activated, with their own multicarrier SIM. There is no app, no pairing and no account for the patient to create. That is not a hardware preference; it is what makes the difficult half of your panel actually enrollable.
- No app, no Wi-Fi, no pairing — the patient takes a reading and it transmits.
- Devices shipped, configured and supported by us — your staff does not run a help desk.
- Patient training and adherence follow-up included, so enrollment does not decay after month two.
- 40+ connected devices supported — keep compatible hardware you already own.
Daily signal, not quarterly claims
Blood pressure, weight, glucose, oxygen and symptom data arrive the day they are taken, so a decompensating heart-failure patient is a phone call this week rather than an inpatient claim next quarter.
Thresholds set per patient, not per population
Alerting is configured by condition and by individual baseline, which is what keeps a care team responding to real deterioration instead of triaging noise.
Audit-ready as a by-product
Consent, transmission days, care-team minutes and escalations are time-stamped as the work happens, so payer and OIG documentation is a report rather than a reconstruction project.
Who We Work With
Different Risk Positions, Different Starting Points
An ACO already carrying downside risk needs something different from an independent practice deciding whether to take any. Both start with the same infrastructure.
ACOs, CINs, IPAs & MSOs
You already own performance against a benchmark. What you usually lack is consistent between-visit execution across independent member practices.
- One care-management layer standardized across every participating site
- Programs targeted at the rising-risk tier, not just the top 5%
- Care-gap and quality-measure work carried out continuously through the year
- Care-management revenue that offsets the cost of running it
Health systems & independent practices
You are somewhere between fee-for-service and risk, and you need capability that pays for itself while you decide how far to go.
- Launch with RPM, CCM or APCM and bill from the first eligible month
- No new hires — a dedicated clinical pod works under your provider’s name and NPI
- Readmission reduction in the 30-day post-discharge window
- A documented track record before you sign for downside risk
Payers & employers
You hold the risk and need the member-level activity that changes it, plus evidence that it happened.
- Monitoring and care management for high-cost, high-utilization members
- Support for Star Ratings, HEDIS and quality-withhold performance
- Member-level reporting on enrollment, adherence and escalations
- Programs deployable across a network without per-practice rollouts
Evaluating Vendors
What Buyers Ask Before Choosing a Value-Based Care Platform
These are the questions that decide value-based care software selections, and our straight answers to them. If a vendor will not answer them this plainly, that is itself an answer.
| Is this software, or a service? | Both, deliberately. You get the platform — monitoring, care-management workflows, documentation and billing reports — and, if you want it, a dedicated clinical pod of RNs, LPNs, MAs and enrollment specialists that does the outreach under your provider’s name and NPI. Software-only and co-managed models are also available. Buying the software without the staffing is the most common reason value-based programs stall. |
|---|---|
| Does it integrate with our EHR? | Yes. HealthArc maintains bi-directional HL7 FHIR integrations with major systems including Epic, athenahealth, eClinicalWorks, Kareo/Tebra, DrChrono, Greenway, NextGen, Allscripts/Veradigm, Cerner/Oracle Health and AdvancedMD, with REST API access available. Readings, care-manager notes and billing data land in the patient chart, so clinicians are not asked to work in a second system. |
| How customizable is it? | Alert thresholds are set per patient and per condition; care protocols, escalation paths, enrollment scripts and documentation templates are configured to your workflow rather than ours. Reporting is built around the measures your contract is actually scored on. |
| Will it scale? | It runs today for 2,000+ providers and 100,000+ monitored patients across 45+ states, from single independent practices to multi-site networks. Adding a site or a program does not mean a new implementation project. |
| What does support look like? | A named account team, plus direct patient-facing support: we ship and configure the devices, train the patients, chase adherence and handle the technical calls. Your staff does not become the device help desk. |
| How is it priced? | Per enrolled patient per month, with no long-term contract and no large upfront hardware purchase — you own devices from day one and pay monthly. In most programs the associated CMS reimbursement exceeds the cost, which is why the revenue calculator exists. |
| Is it compliant and secure? | HIPAA compliant and SOC 2 Type II certified. Data is encrypted in transit (TLS 1.2+) and at rest (AES-256), protected by role-based access controls and MFA, and held in U.S.-based HIPAA-eligible cloud infrastructure; SOC 2 reports, security questionnaires and BAA documentation are available for vendor evaluation. Devices are FDA-cleared, which CMS requires for RPM — consumer wearables do not satisfy it. |
| How long until we are live? | Roughly 30 days is typical, from contracting to first enrolled patients. Programs launch one at a time and stack: most organizations start with RPM or CCM and add others once the workflow is settled. |
| How do we know it is working? | Enrollment and adherence rates, alert and escalation volumes, care-gap closure, 30-day readmissions and billable-month completion — reported monthly at patient and panel level, not annually at reconciliation. |
| How do you compare with other vendors? | We publish that directly: see the value-based care and remote monitoring vendor comparisons, including where another platform is the better fit. |
Getting Started
From Contract to Enrolled Patients in About 30 Days
No eighteen-month transformation program. One panel, one program, measurable results, then expand.
1
Find the eligible panel and the money in it
We segment your population by condition, risk and program eligibility, then size the reimbursement and the performance opportunity so the business case is settled before anything is built.
2
Choose the first program and connect the EHR
Usually RPM, CCM or APCM, depending on where your contract exposure is. Integration, protocols, alert thresholds and escalation paths are configured to your workflow during the same window.
3
Enrol patients and ship devices
We handle consent, enrollment outreach, device shipping and patient training. Cellular devices arrive activated, so enrollment does not depend on the patient’s phone or broadband.
4
Run the work, report the numbers, add the next program
The care team performs monthly contact and escalation; the platform tracks time, transmissions and billable months. Once the first program is steady, stack the next — the same infrastructure supports all nine.
FAQ
Value-Based Care Questions, Answered
What providers, ACOs and payers ask us most often when they start evaluating value-based care companies.
What is a value-based care company?
A value-based care company helps healthcare organizations get paid for outcomes instead of volume. In practice the category covers three quite different things: risk-bearing partners that take on contracts alongside you, analytics vendors that report on performance, and execution partners that deliver the care management the model requires. HealthArc is the third. We provide the platform and the clinical team that run continuous, documented between-visit care across nine CMS programs, which is what actually moves total cost of care, quality scores and readmissions.
Is HealthArc a value-based care platform or a service?
Both, and that is the point. The platform covers device data, care-management workflows, per-patient alert thresholds, time tracking, documentation and billing reports. The service layer is a dedicated clinical pod — RNs, LPNs, MAs and enrollment specialists — performing enrollment, monthly patient contact, escalation and follow-up under your provider’s name and NPI. You can also run it co-managed, or software-only with your own staff. Organisations that buy only software usually discover the constraint was never the software — it was staffing the work.
How do RPM and CCM support value-based care?
They supply the two things fee-for-service does not: continuous data and continuous contact. Remote patient monitoring surfaces deterioration in days rather than in a claim next quarter, which is where avoidable admissions and ED visits are prevented. Chronic care management provides the coordination time that closes care gaps and keeps quality measures on track. Both are reimbursed fee-for-service by Medicare, so they build value-based capability while paying for themselves.
Do we have to be in an ACO or take on risk to use HealthArc?
No. Most organizations we work with start in fee-for-service and use the CMS care-management programs to build capability before taking on downside risk. If you are already in MSSP, ACO REACH, a Medicare Advantage arrangement or a commercial value-based contract, the same infrastructure works against those benchmarks — there is no separate product.
Which value-based payment models do you support?
All of them, because the underlying work is the same: fee-for-service with quality incentives, pay-for-performance and MIPS, shared savings under MSSP and ACO REACH, bundled and episode payments including the CMS TEAM model, primary care capitation, and full-risk per-member-per-month arrangements. The further along that ladder you sit, the more the between-visit work decides your margin.
Does HealthArc integrate with Epic, Cerner and other EHRs?
Yes. HealthArc maintains bi-directional HL7 FHIR integrations with major electronic health records including Epic, athenahealth, eClinicalWorks, Kareo/Tebra, DrChrono, Greenway, NextGen, Allscripts/Veradigm, Cerner/Oracle Health and AdvancedMD, with REST API access for tech-forward organizations. Device readings, care-manager notes and time logs post back to the patient chart, so clinicians are not asked to work in a parallel system and your billing team is not reconciling two sources.
How is value-based care different from fee-for-service?
Under fee-for-service, a provider is paid for each service delivered and revenue rises with utilization. Under value-based care, payment is tied to outcomes, quality and total cost for a defined population — through shared savings, bundled payments or capitation, where a fixed amount per member per month covers an agreed scope of services. The incentive inverts: preventing an admission becomes margin rather than lost revenue.
Will this work for a small independent practice?
Yes, and small practices often see the effect fastest because no internal reorganization is required. There is no upfront hardware purchase, no long-term contract and no new hires — a HealthArc clinical pod supplies the capacity under your NPI, and the CMS programs reimburse from the first eligible month. Practices commonly launch a single program on a defined panel and expand from there.
How quickly can a value-based care program launch?
About 30 days is typical from contracting to first enrolled patients, covering panel analysis, EHR integration, protocol configuration, device shipping and enrollment. Additional programs stack onto the same setup afterwards without a new implementation.
How do you measure value-based performance?
Against the five numbers your contract is settled on: total cost of care versus benchmark, 30-day readmissions, quality and care-gap closure (HEDIS, Star Ratings, MIPS), risk-adjustment documentation accuracy, and patient experience — supported by operational metrics like enrollment, adherence, alert response and billable-month completion. Reporting is monthly at patient and panel level, so a problem is visible during the performance year rather than at reconciliation.
Ready When You Are
See What Value-Based Care Looks Like When Someone Actually Runs It
- A panel analysis showing eligible patients and program revenue
- The platform and the care team, walked through end to end
- Nine CMS programs on one platform — start with one, stack the rest
- Bi-directional HL7 FHIR integration with your EHR
- No long-term contract and no upfront hardware purchase
Book a Demo
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HIPAA Compliant • SOC 2 Type II Certified • No long-term contracts
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Resources
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