Prepared for Mercy Care · 2026 Strategy Review · Confidential — not for distribution
Federally Qualified Health Center · Atlanta's Health Care for the Homeless Grantee · CY2026 Care-Management Rules

Forty Years of Going Where the Patients Are. Medicare Now Pays for the Days Between Visits.

Mercy Care runs eight clinics, two mobile units, street medicine that works day and night, and 33 medical respite beds. Inside that mission sits a 1,132-patient Medicare panel — 63% of it dual-eligible — whose hypertension and diabetes are decided in the weeks between appointments. Since January 1, 2026, that between-visit work bills code by code at national rates, on top of the PPS encounter. This is the business case for staffing it without hiring anyone.

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Unique Patients in Active Remote Care (Month 24)
$0
24-Month Net Reimbursement
$0
Net to the Health Center (24 Months)
0%
24-Month Margin to the Health Center

The headline counts 334 unique patients in active remote care at Month 24. The enrollment chart and the Scenario Explorer show 512 active program enrollments (services): CCM and APCM cannot be billed for the same patient in the same month, so the 136 CCM and 119 APCM enrollments are 255 distinct care-management patients. Most of the 258 RPM enrollments sit inside those cohorts as a second program on the same patient, and the balance are monitoring-only — together, 334 unique patients. Program enrollments are never labeled “patients.”

Start With What the Federal Data Already Says

The Hardest Panel in Atlanta, and the Discipline to Match

Mercy Care reports its clinical quality to HRSA every year on a panel most practices never see: 18,089 patients, two-thirds of them homeless, more than half uninsured. The CY2025 report card shows an organization that screens, documents and follows up with rigor — on the measures a visit can control.

90.2%

Tobacco Screening & Cessation

Nine of ten patients screened and counseled — on a panel that is among the hardest to reach in the country.

83.4%

Depression Screening & Follow-Up

Screening with a documented follow-up plan, run at scale alongside a full behavioral health service line.

80.8%

Statin Therapy for High-Risk Patients

2,234 of 2,766 patients with cardiovascular risk on statin therapy — prevention working where it is hardest to deliver.

✓ Reach

8 clinics · 2 mobile units · street medicine day and night

Founded by the Sisters of Mercy in 1985, Mercy Care is Atlanta's Health Care for the Homeless grantee — clinics inside Gateway Center, City of Refuge and the Salvation Army, and teams that go to the encampments.

✓ Digital Spine

Epic at every site · structured SDOH screening

OCHIN Epic across all sites and providers, a MyChart portal, kiosks, automated outreach for care-gap closure, and 7,173 patients screened for social needs with results structured in the chart.

✓ Recovery Infrastructure

33 medical respite beds

A 19-bed men's unit at Gateway Center and a 14-bed women's unit at City of Refuge give discharged patients a place to recover — post-hospital transition care, already staffed and running.

The engagement engine already exists. Mercy Care finds patients other systems lose, screens them, and keeps structured records of both the clinical and the social picture. The one rail that engine has not been pointed at is Medicare care management — the rail that, since January 1, 2026, pays for that work code by code.
The Same Report Card, Read Forward

The Gap Is Between Visits — and It Is Measured in Your Own UDS

Blood pressure and blood sugar are decided in the weeks between appointments — medication taken or missed, symptoms caught or not. For a panel where housing itself is unstable, the visit-based ceiling arrives early. Mercy Care's own CY2025 submission shows exactly where.

Controlling High Blood Pressure

Share of hypertensive patients with blood pressure under control, from a 3,819-patient hypertension registry. The overall rate is 62.1% — and the spread across the panel is the finding: 56.3% in the non-Hispanic Black cohort (2,347 hypertensive patients) against 75.3% in the Hispanic cohort. The gap is not in the exam room; it is in the days between exams.
Hispanic75.3%
White73.4%
All patients62.1%
Black56.3%
A cellular cuff at home — no smartphone, no WiFi, no app required — produces a reading a week instead of a reading a quarter, from patients whose next appointment may be months away.

Diabetes — HbA1c Poor Control Above 9%

Share of diabetic patients whose HbA1c exceeds 9% or was never tested, from a 1,939-patient diabetes registry. Lower is better. At 32.5%, one in three diabetic patients is uncontrolled or unmeasured — and for a homeless patient, “unmeasured” usually means unreachable between visits.
In control67.5%
Above 9% / untested32.5%
Glucose monitoring paired with a monthly care-management call is the standard intervention, and it is billable under all three programs modeled below.
1,132

Medicare Patients

Up 28% since 2021. The panel these programs bill on — and the one slice of Mercy Care's population whose care management pays fee-for-service from day one.

714

Dual-Eligible — 63.1%

Nearly two-thirds of the Medicare panel also carries Medicaid. That drives the top APCM payment tier, and it removes the out-of-pocket barrier to enrollment for most patients.

3,118

Patients Aged 55–64

The aging-in pipeline. Nearly three times the current Medicare panel is approaching eligibility, so every ceiling in this model rises each year.

The CY2026 Reimbursement Change

Care Management Stopped Being an Unfunded Cost

G0511 — the single bundled code that paid health centers one flat amount for roughly twenty distinct care-management services — is gone. Since January 1, 2026, federally qualified health centers bill the individual CCM, RPM and APCM codes at national non-facility Physician Fee Schedule rates, each separately payable in addition to the PPS encounter rate.

Two rails, one claim

The encounter rate is untouched

PPS still pays for the visit. Care management and remote monitoring pay on top of it rather than folding into it, so a remote-care program does not cannibalize the encounter.

Set by statute

One national rate, everywhere

These codes pay the same national amount at every Mercy Care site — Decatur Street, Chamblee, the shelter clinics, the mobile units. The rate card is set in Washington, not by the locality index.

The catch

New work arrived with the new revenue

Each program now needs its own time capture and its own documentation, every month, for every enrolled patient. That is the operational cost of the change, and it is the part CoachCare absorbs.

What Mercy Care bills for remote care today. A review of CY2024 Medicare claims across every clinician enrolled under Mercy Care found no remote physiologic monitoring, no individual chronic care management, no APCM and no transitional care management on any clinician's professional claims. Health-center billing runs on institutional claims that this data does not capture, and CMS suppresses lines billed to fewer than eleven patients — so the accurate statement is that no billed Medicare remote-care program at meaningful scale is visible, not that there are zero patients. Mercy Care's own HRSA filing lists remote patient monitoring as a telehealth modality in use; whatever sits behind that entry is where the first working session starts. The service line below is built on that basis.
The Service Line

Three Programs, One Care Team, One Enrollment Engine

Modeled across the 1,132 Medicare patients in Mercy Care's CY2025 panel — the population where these codes pay at Medicare rates. CoachCare supplies the devices, the enrollment staff, the monitoring hours and the documentation. The health center supplies the panel and the clinical decisions.

RPM
$507,220
24-month net reimbursement

Remote physiologic monitoring. Cellular blood-pressure cuffs and glucose meters that transmit on their own — no smartphone, no WiFi, no fixed address required. 99453 setup, 99454 device supply, 99457 and 99458 treatment management, plus the CY2026 short-window codes 99445 and 99470. Reaches 65% of the panel and stacks with either care-management rail.

CCM
$324,152
24-month net reimbursement

Chronic care management. Monthly non-face-to-face management for patients with two or more chronic conditions — in a panel with 3,819 hypertension and 1,939 diabetes diagnoses, that is most of the Medicare population. 99490 and 99439.

APCM
$188,788
24-month net reimbursement

Advanced primary care management. No minute thresholds and no time sheets — a monthly per-patient payment tiered by complexity. G0556, G0557 and G0558, where the top tier pays most for qualified Medicare beneficiaries who also carry Medicaid. 714 of Mercy Care's 1,132 Medicare patients — 63.1% — are dual-eligible, which points this panel at the strongest APCM tier there is.

CCM and APCM split one pool. They do not stack. The two codes cannot be billed for the same patient in the same month, so they are modeled as a partition rather than a layer: APCM takes the dual-heavy slice where the top tier pays most, CCM takes the remainder. RPM sits on its own share because it can be billed alongside either. That is why 512 program enrollments resolve to 334 patients. And for most of this panel the usual coinsurance objection disappears: qualified Medicare beneficiaries cannot be billed Medicare cost-sharing, so enrollment carries no out-of-pocket surprise.
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Referring Adult-Medicine Clinicians
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On-Site Enrollment Specialist — CoachCare's Expense
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CoachCare-Delivered Hours (24 Months)
0
FTE-Equivalent of Care Capacity Added

The enrollment model meets patients where Mercy Care already does — at the clinic, at the shelter, at the respite bed, through the mobile units. One CoachCare-funded specialist works the highest-volume sites while telephonic outreach covers the rest, and enrollment materials are built plain-language first: more than a third of Mercy Care's patients are best served in a language other than English.

Native Epic Integration

The Program Runs Inside Epic

Mercy Care runs OCHIN Epic at every site, with MyChart, kiosks and automated care-gap outreach already live. CoachCare builds on Epic's own workflows, so the care team enrolls and monitors patients without learning a second system. Readings, documentation and claims all land in the chart the clinicians already work in.

What Moves in Each Direction

Epic the health center's chart CoachCare devices, staff, monitoring Eligible patients · health history · enrollment orders Discrete vitals · care summaries · generated claims
Readings arrive as discrete vitals in the chart, not as scanned PDFs, so they are filterable, trendable and usable in the quality reporting behind the UDS measures above.
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Integrated enrollment

Enrollment flags and trigger ordering sit inside the clinical workflow. The CoachCare team enrolls qualified Medicare patients on the health center's behalf, and enrollment status is visible in Epic in real time.

2

Exchange of health history

Bi-directional at intake, so the care team starts with the same problem list, medications and history the clinic has.

3

Discrete vitals in the chart

Blood pressure, weight and glucose readings post as structured data on the patient record rather than as attachments nobody opens.

4

Audit-ready documentation

An integrated care summary lands in the record. Under the CY2026 individual-code rules each program needs its own time capture and its own documentation, and this is what substantiates the billed time when a payer asks.

5

Automated claim generation

Claims are created by the CoachCare billing engine. CoachCare is the only care-management application integrated with Epic that generates claims automatically, which removes the manual per-patient, per-month claim step entirely.

This is the answer to the operational half of the 2026 change. Unbundling G0511 into individual codes created new revenue and new work in the same stroke: per-program time tracking and per-program documentation, every month, for every enrolled patient. Enrollment inside the existing workflow, structured vitals on the chart and automatic claim creation are what make the new rules workable for a lean billing office. Patients begin receiving CCM and RPM services in under five days from flag. One implementation note stated plainly: Mercy Care runs Epic through OCHIN, so interface work goes through the OCHIN queue — a well-worn path, and week one's first ticket.
“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.”
Clinical Governance

Every Reading Routes Through One Escalation Engine

The economics prove the service line pays. This is what keeps it safe — and what lets 14 busy clinicians delegate monitoring without inheriting noise.

1

A reading arrives out of range

The care team retakes it and screens for symptoms before anything escalates. A single high number is a measurement; a confirmed one is a finding.

2

Critical values escalate regardless of symptoms

A patient who feels fine with a critical reading still escalates. Feeling well is not a reason to wait.

3

Trends are defined objectively

Three readings at least an hour apart for blood pressure or glucose, or three within seven days for heart rate. Not a judgment call, and not a different threshold depending on who is working.

4

Unreachable patients still escalate

Voicemail and a callback attempt are logged, and a critical value or confirmed trend escalates anyway. Silence never closes a case — a discipline this panel demands more than most.

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Three routes, so the clinic sees signal

Emergencies go to 911. Non-critical findings go to a named member of the practice team. Stable and resolved goes into the record as an FYI, so the clinic is not paged for readings that resolved themselves.

6

Every escalation documents the same six things

Vital, findings, method of contact, who was reached, outcome, and follow-up. That record is also what substantiates the billed time.

The emergent pathway, and who owns it. Chest pain, new shortness of breath, stroke signs, syncope, a worst-ever headache or sudden swelling trigger a 911 call with the patient still on the line. If the patient refuses, the care team routes them to the clinic; if they refuse that, CoachCare activates 911. CoachCare's urgent and emergent policy supersedes any client-specific escalation preference — that is not adjustable in configuration, and it is why the clinic can delegate monitoring without inheriting the risk.
The post-discharge three-touch cadence. Any emergency-department visit or hospitalization in the previous sixty days triggers a fixed sequence: a call on day one or two, another on day five to eight, and a third on day twelve to fourteen. Mercy Care already operates 33 medical respite beds for exactly this window — the cadence extends that same discipline to every monitored patient, and it is where the 35 avoided hospitalizations in the forecast come from.
CoachCare Value Analysis · Modeled for Mercy Care

The Value Analysis

A 24-month forecast across the 1,132-patient Medicare panel, 14 referring adult-medicine clinicians, one CoachCare-funded on-site enrollment specialist, telephonic enrollment, and CY2026 national non-facility PFS rates. Grant revenue, Medicaid and the dollar value of avoided admissions are not in these numbers.

Active Program Enrollments Under Remote Care

Monthly active census by program — active program enrollments, not unique patients; the headline is 334 patients. Provider referral plus one on-site enrollment specialist plus telephonic outreach, net of ~1.5% monthly attrition, with enrollment beginning in month 1. Every program reaches its eligible-population ceiling — APCM 119 in month 3, CCM 136 in month 5, RPM 258 in month 8. The plateau is the size of the Medicare panel, not a limit on enrollment pace — and that panel has grown 28% since 2021.

Monthly Economics — Net Reimbursement, Fees, Net to the Health Center

Net reimbursement after denials and coinsurance bad debt, against total full-service fees including one-time implementation and integration. Month 1 is −$4,929, the only negative month, because one-time setup lands before the census ramps. Net to the health center turns positive in month 2 and settles near $20,763 per month. The chart is drawn against a true zero baseline so the month-1 dip is visible rather than hidden.

24-Month Net Reimbursement Mix

$1,020,160 in total. RPM leads because it reaches the widest slice of the panel at 65% eligibility, while CCM and APCM divide the care-management pool between them.

The Financial Summary

ProgramYear 1Year 224‑Month
RPM net reimbursement$209,142$298,078$507,220
CCM net reimbursement$143,540$180,612$324,152
APCM net reimbursement$89,195$99,593$188,788
Total net reimbursement$441,878$578,283$1,020,160
CoachCare fees (incl. one-time)$260,042$329,124$589,166
Net to the health center$181,835$249,159$430,994
Margin to the health center41.15%43.09%42.25%
The on-site enrollment specialist is staffed at CoachCare's expense and is already inside the fees above — never a separate cost to the health center. Run the model without any enrollment specialist and 24-month net reimbursement falls by $88,423: the funded specialist pays for itself before the first invoice.
35

Hospitalizations Avoided

Roughly $520,000 of avoided acute cost over 24 months. That value accrues to payers and to the system, not to Mercy Care's revenue line, so it is excluded from every figure above.

54,675

Readings Captured

Blood pressure, weight and glucose readings arriving between visits, where the hypertension and diabetes measures are decided.

15,648

Claims Generated

Coded, documented and submitted with the time capture the CY2026 individual-code rules require.

6,747

Care-Team Hours Delivered

About 3.2 full-time equivalents of care-management capacity, added without the health center hiring anyone.

Scenario Explorer — Build Your Own Forecast

Adjust the assumptions and watch the 24-month forecast recompute. Eligibility is fixed at the CY2026 FQHC row — 65% RPM, 40% CCM, 35% APCM of the in-scope panel — and the acceptance sliders sit on top of it. Because the panel sets every program's ceiling, the population slider is the one that moves everything; the upper bound reflects the aging-in pipeline already visible in Mercy Care's own age bands.
24-mo net reimbursement
$1,020,160
Net to the health center
$430,994
Active enrollments · M24
512
Unique patients · M24
334
Hospitalizations avoided
~35
Act Two

Medicare Is 6% of This Panel. The Infrastructure Serves All of It.

The forecast above covers 1,132 Medicare patients. Mercy Care serves 18,089 — and the devices, the escalation engine and the enrollment staff built for the Medicare rail are the same ones the whole mission can use. What differs is the payment rail, and Georgia's is specific.

The Georgia baseline

Medicaid is not the paying rail today

Georgia Medicaid does not reimburse remote patient monitoring as a separate service, and care management sits inside the encounter. That is exactly why the sequencing starts with Medicare — the rail that pays code by code from month one, at every site.

The growth already booked

The panel is aging in

3,118 patients aged 55–64 sit behind a Medicare panel that has grown 28% since 2021 — and 270 units of affordable housing are rising next to the Decatur Street clinic. Every ceiling in the model moves up each year without a single new patient acquired.

The mission flywheel

One data stream, every scoreboard

Continuous blood-pressure and glucose data moves the UDS quality measures, strengthens every grant narrative with documented longitudinal touch, and extends naturally to the respite beds and street-medicine follow-up — on Mercy Care's terms, at Mercy Care's pace.

The sequencing this implies. Build the Medicare service line first: it is federal, it pays the same national rate at every site, and it funds itself from month two. Let it prove the model on the panel that pays, while the aging-in wave grows the ceiling every year — and extend the same infrastructure across the mission when Mercy Care chooses.
Getting Started

Live in 30 Days

Week 1

Confirm the panel and open the OCHIN ticket

Pull the exact Medicare and dual-eligible count from the practice management system, submit the interface request into the OCHIN queue, and agree which sites start — Decatur Street and Chamblee carry the deepest Medicare concentration.

Weeks 2–3

Build the Epic interface and configure

Enrollment flags and trigger orders built into the existing workflow, discrete vitals mapped to the chart, escalation routing set to Mercy Care's own contacts, documentation templates mapped to the CY2026 individual-code requirements, plain-language multilingual enrollment materials, cellular devices staged, and the on-site enrollment specialist placed.

Week 4

First patients enrolled

Enrollment begins in month 1 — there is no dormant onboarding period. Telephonic outreach and the shelter clinics extend reach beyond the flagship sites from the start.

Months 2–8

Full eligible population enrolled

APCM reaches its ceiling in month 3, CCM in month 5 and RPM in month 8. From there the program grows with the panel itself — the aging-in pipeline is three times the current Medicare panel — and the conversation turns to the respite beds, the housing development, and the rest of the mission.

About CoachCare

The Experience to Get It Right

500,000+

Patients Managed

Over 400 managed conditions.

10,000+

Clinicians on the Platform

Providers running remote care programs day to day.

1,000+

Implementations

Programs stood up and running in market.

5 million+

Claims Generated

Care-plan coding and billing behind more than five million claims.

100 million+

Vitals Recorded

Over 100 million vitals recorded and more than 4 million care actions enabled.