Prepared for Foster City Medical Center · 2026 Strategy Review · Confidential — not for distribution
Remote Care Service Line Strategy · Prepared for Foster City Medical Center

Turn the Panel You Already Manage Into a Profit-Generating Service Line.

The hypertension, type 2 diabetes, heart failure, CKD, and COPD patients your clinicians already care for can generate a recurring, margin-positive revenue line — with the enrollment, device, monitoring, and billing workload carried by CoachCare, not your staff.

$0
24-Month Net Reimbursement
$0
24-Month Practice Margin
0
Hospitalizations Avoided
0
Active Program Enrollments at Month 24
What You've Already Built

2026 Starts From a Position of Strength

Foster City Medical Center is not starting from zero. The practice already carries the two hardest assets in value-based primary care: a longitudinal Medicare panel it actually manages, and verified participation in two-sided shared-savings risk. What's missing is the service line that converts both into recurring revenue.

✓ Verified

Shared-Savings Participant — ENHANCED Track

Foster City Medical Center appears in the CMS PY2026 Medicare Shared Savings Program participant file under ACO A2098, "The Accountable Care Organization, Ltd." — the ENHANCED track, the program's highest two-sided risk level.*

✓ In Place

Physician-Owned & Independent

Full-spectrum primary care plus walk-in urgent care under one roof in Foster City — no hospital owner, no private-equity sponsor. This strategy is built to keep it that way.

✓ In Place

The Panel & the Payer Base

A multi-clinician internal-medicine and family-medicine roster, Medicare accepted alongside a broad commercial payer panel, and telehealth already offered — the substrate remote care programs bill against.

◎ Whitespace

No Remote Care Program Today

No RPM, CCM, or PCM program is marketed anywhere on the practice's website — no legacy vendor to displace, and none of this revenue is being captured today.

The chronic-disease work — checking blood pressures, following A1c trends, adjusting meds between visits — is already happening inside this practice. Medicare now pays specifically and recurringly for that work. A remote care service line is how the practice starts collecting.

*Participant match is by exact legal business name in the public CMS PY2026 participant file (the file does not publish TINs or addresses); confirm entity identity in discovery. Source: CMS Shared Savings Program ACO Participants dataset, file modified Feb 2026.

The 2026 Window

Three Reasons This Is a 2026 Decision

Care-management billing is the fee-for-service path Medicare deliberately built for practices that manage panels — and the 2026 code set, the practice's live risk contract, and the economics of independent primary care all point the same direction.

New for CY2026
99445 · 99470

Short-Window RPM Is Now Billable

New CY2026 codes 99445 (2–15-day device supply) and 99470 (first 10 minutes of management) remove the 16-day floor that used to block short monitoring windows — post-discharge stabilization, medication starts, and titration checks are now cleanly billable alongside the standard monthly RPM codes.

Verified · Live Now
ENHANCED

Two-Sided Risk Is Already Running

Through ACO A2098, the practice participates in the Shared Savings Program's ENHANCED track — upside and downside on total cost of care, this performance year. Every avoided admission and better-controlled chronic patient now has a second payoff beyond fee-for-service: shared-savings performance the practice participates in.

The Structural Case
~48%

Margin Without Headcount

Independent primary care can't hire its way to new revenue. This model adds a recurring service line at a modeled ~48% practice margin with the enrollment specialist, devices, 24/7 monitoring, and billing engine funded and operated by CoachCare — no new practice staff required.

Hypertension
Type 2 Diabetes
Heart Failure
Chronic Kidney Disease
COPD
The Operating Model

Your Panel, Your Protocols. CoachCare's Engine.

Not a gadget program bolted onto one condition — a named service line over the whole multi-chronic Medicare panel, with the practice's clinicians governing every protocol and clinical decision, and CoachCare operating everything underneath.

The Program Stack — RPM + CCM Workhorse, PCM Where It Fits
  • RPM Device-based physiologic monitoring — connected BP cuffs, scales, glucometers — the continuous early-warning and titration layer for the hypertension, diabetes, and heart-failure cohorts.
  • CCM Multi-condition chronic care management for the roughly two-in-three Medicare patients carrying two or more chronic conditions — the volume engine of the primary-care stack.
  • PCM Principal Care Management for the smaller cohort with a single dominant high-risk condition managed by the practice.
  • TCM Transitional Care Management at every hospital discharge — not included in the forecast below; every discharge worked is additive revenue and readmission defense.
The Engine — What CoachCare Operates and Funds
  • Enroll An on-site enrollment specialist working your waiting room and your call lists — staffed at CoachCare's expense, embedded value from the start.
  • Devices Cellular-connected devices shipped, provisioned, and supported — no patient Wi-Fi setup, no practice inventory.
  • Monitor 24/7 reading review, alert triage, and patient outreach by CoachCare's clinical team, escalating to your clinicians by protocol.
  • Bill Time-tracking, documentation, and claims generated automatically each month — audit-ready, every patient, every code.
The coordination rule: RPM stacks with CCM or PCM for the same patient in the same month; CCM and PCM address different patient profiles rather than combining. If the practice later adopts APCM (see below), it bundles — it cannot be billed with CCM, PCM, or TCM in the same patient-month — so the CCM-versus-APCM mix is a deliberate decision, made once, with real panel data.

The CY2026 Billing Stack

ServiceCodes~CY2026 MagnitudeUse in This Practice
Chronic Care Management99490 · 99439$62.10 + ~$47 add'lThe multi-chronic workhorse — 2+ conditions, 20 min/month
RPM setup & device supply99453 · 99454 · 99445 (new)~$20 setup · ~$52/moConnected BP cuffs, scales, glucometers; 99445 unlocks 2–15-day windows
RPM treatment management99457 · 99458 · 99470 (new)$50.66 + ~$41 add'lMonthly review, titration, escalation
Principal Care Management99426 · 99427$66.08 + ~$50 add'lSingle dominant high-risk condition, ≥3 months
Transitional Care Management99495 · 99496~$200 / ~$280Every discharge — additive; not in the forecast below

Dollar figures shown for 99457, 99490, and 99426 are MAC-locality rates auto-resolved for zip 94404 (Noridian JE, California locality 05); remaining magnitudes are illustrative national non-facility figures. Verify against the current CY Physician Fee Schedule.

Four Layers of Value

One Service Line, Four Ways It Pays

The forecast below counts only the first layer. The other three ride on the same infrastructure at no additional cost.

1 · Per-Panel Recurring Revenue
A modeled $1.10M in net reimbursement and $515,854 in practice margin over 24 months — recurring, subscription-like revenue from the panel the practice already manages, at a steady-state ~48% margin, with the on-site enrollment specialist and the entire operating engine funded by CoachCare. No new practice headcount.
2 · MIPS & Quality Defense
Documented monthly touches and physiologic data on the chronic panel — blood-pressure control, A1c follow-through, medication reconciliation, care-plan documentation — feed exactly the quality measures MIPS scores an independent practice on, turning reporting season from reconstruction into export.
3 · Shared-Savings Contribution
The practice's ENHANCED-track participation makes avoided utilization a second revenue channel. The model projects ~25 avoided hospitalizations over 24 months — roughly $378K of acute spend at $15K per admission — accruing to the total-cost-of-care performance the practice shares in through ACO A2098.
4 · Independence Preservation
Revenue diversification is the practical alternative to selling. A recurring service line that doesn't depend on visit volume strengthens the economics of staying physician-owned — the same panel, monetized twice: fee-for-service care management now, shared-savings performance on top.
Direct · Bi-Directional · Native

True Epic Integration, In the Chart You Already Use

Foster City Medical Center runs on Epic — and CoachCare integrates directly and bi-directionally with Epic. Your clinicians enroll and monitor remote-care patients inside built-in Epic workflows, without learning a new system: the whole program lives in the Epic environment.

Epic Foster City Medical Center's instance One chart & in-basket Orders & flags Flowsheets / vitals Health history Billing workqueues CoachCare Remote care platform Cellular devices 24/7 monitoring Health coaches Enrollment team Billing engine FROM EPIC Enrollment flags & trigger orders Patient health history BACK INTO EPIC Discrete vitals — in the flowsheet, not PDFs Care summary & compliance documentation Real-time enrollment status Claims — auto-generated, every patient, every month Clinicians never leave Epic — the program lives in the chart they already use

Integrated Enrollment

Enrollment flags and trigger orders sit inside the clinical workflow; CoachCare's team enrolls qualified Medicare patients on the practice's behalf, with enrollment status visible in Epic in real time.

Discrete Vitals & Documentation

Device readings land as discrete vitals in the chart — not PDFs — alongside an integrated care summary and audit-ready compliance documentation in the record.

Automated Claim Generation

The CoachCare billing engine assembles documentation and generates claims automatically — every patient, every month. Your billers submit; nobody reconstructs 20-minute logs.

< 5 days

from enrollment flag to a patient receiving billable RPM and care-management services.

The only one

CoachCare is the only care-management platform integrated with Epic that provides automated claims creation via its billing engine.

"Key to achieving a program that is efficient, effective and sustainable, is creating a seamless, intuitive user experience for the patient and provider, and that's what our integration with Epic accomplishes."

Epic integration fees are already reflected in the forecast below at catalog pricing ($4,000 one-time setup). The practice's exact Epic instance and hosting arrangement are confirmed as a routine step in contracting.

Verified-Eligible · Unmodeled Upside

The APCM Build-Toward

Advanced Primary Care Management (G0556–G0558) is Medicare's bundled monthly per-beneficiary payment for primary-care panel management — no time-logging, tiered by patient complexity, and reserved in practice for value-model participants. Foster City Medical Center already clears that bar: its verified Shared Savings Program participation is precisely the posture APCM was designed around. None of it is in the forecast on this page — deliberately. Because APCM bundles (it cannot be billed with CCM, PCM, or TCM in the same patient-month), the CCM-versus-APCM mix is a decision best made after launch, with real enrollment data by patient complexity tier. Until then, APCM stands as verified-eligible, unmodeled upside on top of everything below — and the service line built here is the same infrastructure an APCM program would run on.
CoachCare Value Analysis · Modeled for Foster City Medical Center

The Value Analysis

A 24-month forecast for the RPM + CCM + PCM stack: a 2,000-patient Medicare panel (an estimate — credible range 1,600–2,700, the first discovery-validation item), six referring clinicians, one CoachCare-funded on-site enrollment specialist, MAC-locality rates for zip 94404. TCM, APCM, and shared-savings dollars are not in these numbers — they are upside on top. All figures are illustrative, modeled — verify against practice data.

Enrolled Patients Under Active Remote Care

Monthly active census by program · clinician referrals + on-site enrollment specialist, net of discharges. Ceilings bind early: PCM saturates at 25 (month 3), RPM at 180 (month 6), CCM at 200 (month 7) — this account is ceiling-limited, not pace-limited.

Monthly Economics — Revenue, Fees, Margin

Net reimbursement (after denials and coinsurance bad debt) vs. CoachCare fees. $6,500 of one-time setup (implementation + Epic integration) lands in month 1; margin turns positive in month two (~45%), cumulative breakeven arrives the same month, and margin steadies near 48%.

24-Month Net Reimbursement Mix

$1.10M total across the three-program stack — CCM leads, exactly as a primary-care panel should

The Financial Summary

ProgramYear 1Year 224-Month
RPM net reimbursement$207,261$270,378$477,640
CCM net reimbursement$229,655$325,139$554,795
PCM net reimbursement$30,322$33,520$63,842
Total net reimbursement$467,239$629,037$1,096,276
Practice margin (after fees)$215,206$300,648$515,854
Includes an on-site enrollment specialist staffed at CoachCare's expense — embedded value already reflected in the fees above, never deducted from practice margin.

Figures are illustrative and modeled — verify against practice data. Full model available as a companion workbook.

Scenario Explorer — Build Your Own Forecast

Adjust the assumptions and watch the 24-month forecast recompute live. Directional, calibrated to the CoachCare Value Analysis engine — the companion workbook remains the source of truth. Note: in the modeled scenario the program ceilings (panel × eligibility × conversion) bind by month 7, so outreach sliders mainly change ramp speed — the panel size slider is the one that moves the ceilings themselves.
24-mo net reimbursement
$1.10M
24-mo practice margin
$516K
Enrollments at month 24
405
Hospitalizations avoided
~25
16,335

Billed Claims / Units

Recurring, subscription-like professional-fee volume over 24 months.

39,653

Physiologic Readings

A continuous clinical picture of the hypertension, diabetes, and heart-failure panels between visits.

~25

Hospitalizations Avoided

≈ $378K in avoided acute cost at $15K per admission — accruing to shared-savings performance.

3.62

FTE-Equivalents Absorbed

~7,540 care-team hours of monitoring, outreach, and documentation handled by the service line.

Implementation

Chartered in 30 Days.
At Ceiling by Month 7.

CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while Foster City Medical Center's physicians govern protocols and every clinical decision. Full-service delivery means launch requires no new practice headcount, the Epic integration follows CoachCare's standard build, and the one discovery item that sharpens this forecast — a chart count to validate the panel estimate — is a first-week question.

Schedule the Working Session
0–30 Days

Discovery & Charter

Run a chart count to validate the 2,000-patient Medicare panel estimate (discovery item #1). Charter the service line, stand up the Epic integration and billing configuration, sign off protocols for the hypertension, diabetes, heart-failure, CKD, and COPD pathways.

31–90 Days

Launch Enrollment

The CoachCare-funded on-site enrollment specialist begins working the panel; connected devices ship to the first RPM cohorts; CCM enrollment runs in parallel. PCM reaches its modeled ceiling by month 3.

91–210 Days

Reach Steady State

RPM saturates its modeled ceiling in month 6, CCM in month 7 — from there the model holds ~405 active program enrollments and ~$52K/month in net reimbursement at a ~48% practice margin.

Months 7–12

Decide the APCM Question

With real enrollment data by complexity tier, weigh the CCM-versus-APCM mix that the practice's verified shared-savings posture makes available — and revisit the panel definition if the chart count supports a larger in-scope population.

About CoachCare

The Experience to Get It Right

The service line described on this page runs on infrastructure already proven at national scale.

500,000+

Patient Management Expertise

Over 400 managed conditions for 500,000+ patients.

10,000+

Clinician Success

Providers committed to remote care excellence.

1,000+

In-Market Success

Successful program implementations.

5M+

Operational Excellence

Care plan coding and billing generating over 5 million claims.

100M+

Unprecedented Scale

Over 100 million vitals recorded and 4 million+ care actions enabled.

Transparency

Assumptions & Sources

Every number on this page traces to the CoachCare Value Analysis workbook or cited public data. The key assumptions:

Population sizing & ceilings
  • 2,000 Medicare patients is an estimate, not a chart count — modeled from ~5–6 adult primary-care clinicians × ~450 Medicare patients each, discounted for the walk-in/urgent-care visit mix. Credible range: 1,600–2,700. This is the first discovery-validation item, and because the program ceilings bind, the 24-month forecast scales roughly linearly with it.
  • Program ceilings = panel × eligibility × enrollment conversion: RPM 2,000 × 30% × 30% = 180 (saturates month 6); CCM 2,000 × 40% × 25% = 200 (month 7); PCM 2,000 × 5% × 25% = 25 (month 3).
  • Total active plateaus at 405 program enrollments from month 7. That is a sum of program counts, not unique patients — unique patients ≈ 248 (RPM 180 + 0.3 × 225 via the 70% dual-enrollment assumption).
  • The account is ceiling-limited, not pace-limited: adding clinicians or a second enrollment specialist accelerates the ramp but does not raise the plateau; the eligibility definitions (and the panel size itself) are the constraint.
  • Enrollment pathways: clinician referrals (5/clinician/month across 6 modeled referring clinicians at 70% acceptance) plus one on-site enrollment specialist at 80 enrollments/month, staffed at CoachCare's expense.
Rates & revenue mechanics
  • CY2026 Physician Fee Schedule rates auto-resolved by MAC carrier/locality for zip 94404 (Noridian JE, California locality 05 — e.g., 99457 $50.66, 99490 $62.10, 99426 $66.08); 2.5% denial rate; 20% coinsurance with 25% coinsurance bad debt; 1.5% monthly attrition.
  • Month 1 is modeled at −$4,696: one-time implementation ($2,500) and the Epic integration setup fee ($4,000) land ahead of the enrollment ramp. Margin turns positive in month two (~45%), the program reaches cumulative breakeven in month 2, and margin steadies near 48% from month 3.
  • Epic integration fees are applied at catalog pricing: $4,000 one-time setup + $150/month + $1.50 per patient-month. The practice's exact Epic instance and hosting arrangement are confirmed as a routine step in contracting.
  • No bulk discount is applied — the model is priced at list, and the 24-month margin holds at 47.1%.
  • Code-level capture assumptions (e.g., share of managed months billing 99457 or adding a 99458 unit) are itemized in the companion Value Analysis workbook.
Verified facts & vintages (July 2026)
  • Shared Savings Program participation: "Foster City Medical Center" appears as a participant legal business name in the CMS PY2026 Shared Savings Program ACO Participants file (modified Feb 2026), under ACO A2098 — "The Accountable Care Organization, Ltd." — ENHANCED track, low-revenue ACO, agreement period 4. Match is by exact legal business name; the public file carries no TIN or address, so entity identity should be confirmed in discovery.
  • Practice profile: physician-owned primary care + urgent care, single site in Foster City, CA (organization NPI 1255731980); Medicare accepted alongside a broad commercial payer panel; telehealth offered — per the practice website and NPPES, July 2026.
  • Remote-care whitespace: no RPM, CCM, or PCM program marketed anywhere on the practice website as of July 2026.
  • EMR: Epic — confirmed by the practice, July 2026. Integration modeled at Epic catalog pricing ($4,000 setup + $150/month + $1.50 per patient-month); exact instance and hosting arrangement confirmed in contracting.
  • New CY2026 RPM codes 99445 and 99470 per the CY2026 Physician Fee Schedule final rule; verify current-year values at the time of decision.