How Alaska Heart & Vascular Institute turns RPM and PCM into a self-funding remote care service line — phased at a pace a care team can absorb — and the operating model its heart-failure cardiologists will need when CMS's Ambulatory Specialty Model makes them accountable for heart-failure cost and quality on January 1, 2027.
The headline counts 6,566 deduped unique patients in active remote care at Month 24. The enrollment chart and scenario calculator show 8,220 active program enrollments (services), because patients dual-enrolled in RPM plus PCM are counted once as a patient but more than once as enrollments — mirroring the distinction between Enrolled Patients and Enrolled Services.
CMS's Ambulatory Specialty Model (ASM) is a mandatory, two-sided-risk program that makes cardiologists individually accountable for the cost and quality of the heart-failure patients attributed to them. The first performance year applies a Part B payment adjustment of −9% to +9% and requires an electronic collaborative-care arrangement with primary care. AHVI does not opt in; ASM is a change in how heart failure gets paid.
Fifteen Alaska Heart & Vascular cardiologist NPIs appear on the live CMS CY2027 preliminary ASM participant list, heart-failure cohort, under the billing legal name “Alaska Heart Institute”.
ASM reconciles attributed heart-failure spend and quality against a benchmark. This is two-sided risk from day one — year-one adjustments swing Part B professional revenue by up to nine points in either direction, escalating through 2031.
ASM requires an electronic collaborative-care arrangement with primary care and structured longitudinal management between visits — exactly what a remote care service line operationalizes.
A geography note that changes the door, not the stakes: Anchorage sits outside TEAM but inside ASM. No Alaska CBSA is among the 188 TEAM mandatory-bundle markets, so hospital-side bundling pressure does not apply here — accountability arrives through the cardiology and ambulatory door instead. The wedge is simple: one service line is your ASM heart-failure chassis. The RPM and PCM programs modeled on this page are the same infrastructure ASM will demand — continuous physiologic monitoring, protocolized management, and documented care coordination. Build it now, and enter January 2027 with a running program instead of a blank page.
Alaska's dominant independent cardiology group — full sub-specialty depth, a dedicated Advanced Heart-Failure clinic, and the accountability ASM rewards. The honest read: strong specialty capability and device-level HF monitoring today, with scalable software remote care as open ground.
Fifteen cardiologists on the CMS CY2027 preliminary ASM heart-failure list — the practice already carries the accountability the service line is built to serve.
~28 cardiologists plus ~31 advanced-practice providers (~59 clinicians) across an Anchorage hub and peninsula/Mat-Su sites. Physician-owned by a deliberate independence strategy — no PE or hospital owner.
A physical Advanced Heart-Failure / CHF clinic led by a Duke-trained advanced heart-failure and transplant cardiologist — the natural launch cohort for an RPM/PCM overlay. Today's CardioMEMS monitoring (via Providence) is device-specific, advanced-HF only.
An InteliChart patient portal (engagement only) but no general RPM or care-management program, chronic-care app, or software telehealth today — clean whitespace on the athenahealth backbone, not a rip-and-replace of a vendor.
This is a named service line with its own owner, P&L, and scorecard — not a point solution bolted onto one diagnosis. AHVI's cardiologists run it, following the Medicare patient between visits on the athenahealth backbone. Two billable programs, one shared engine — a cardiology panel, purpose-built for the specialty rather than a primary-care roster.
| Service | Codes | Cardiovascular Use |
|---|---|---|
| RPM setup & device supply | 99453 · 99454 · 99445 (new 2026) | 99445 unlocks 2–15-day post-episode monitoring windows |
| RPM treatment management | 99457 · 99458 · 99470 (new 2026) | Monthly review, titration, escalation |
| Principal Care Management | 99426 · 99427 | The single high-risk cardiac condition — or cardiovascular disease as one clinical domain |
Rates auto-resolve to AHVI's Alaska MAC locality (Noridian, carrier 02102, locality 01) from the CY2026 Physician Fee Schedule — a locality that carries a statutory work-GPCI floor among the nation's most favorable. Blended net reimbursement per active patient-month, after denials and coinsurance bad debt, is modeled at ~$115.57 RPM and ~$114.10 PCM. Code-level rates and capture are itemized in the companion Value Analysis workbook.
Alaska is the national Medicare Advantage outlier — roughly 1–3% MA penetration, the only state with essentially no individual MA plans, because insurers cannot build low-cost networks in a high-cost state. AHVI's Medicare panel is therefore ~99% traditional fee-for-service. No MA carve-outs, no network exclusions: every RPM and PCM code bills across essentially the whole Medicare population — and it is the same population ASM attributes.
Where the national Medicare book is now more than half Medicare Advantage, Alaska is the inverse — a ~99% traditional fee-for-service book. Every code bills across that population with no MA network to carve out.
Care-management codes bill across the full Medicare population; nothing is excluded to a Medicare Advantage network. The billable base and the attributed base are the same people.
Near-pure FFS today with ASM as the single downside-risk exposure — an unusually clean story where one infrastructure bills fee-for-service and de-risks ASM.
AHVI serves a vast, dispersed state and already travels to its patients. In a place where distance and weather gate access, continuous physiologic monitoring substitutes for weather-dependent travel and catches decompensation between the visits that are hardest to schedule.
The hardest question this program has to answer is logistical, not clinical: does remote monitoring actually work in the bush? AHVI serves dispersed communities where terrestrial fiber and traditional Wi-Fi do not exist, and where a device that assumes a home router and a wall outlet fails on arrival. This is the connectivity, hardware, and delivery model built for that reality.
Kotzebue, Noorvik, Kiana, Selawik, Point Hope, and Point Lay — coastal and river communities reached from a single regional hub.
Bethel, Toksook Bay, Hooper Bay, Emmonak, and Chevak — among the most connectivity-constrained communities in the state.
Utqiaġvik (Barrow), Nuiqsut, and Wainwright — the northernmost patient geography in the United States.
CoachCare's own community-level connectivity audit (2026). GCI is the foundational carrier across all 22 communities, occasionally alongside ASTAC, OTZ, or Bristol Bay. Ten communities (~45%) have no 4G LTE at all and run entirely on legacy 2G/3G — yet indoor home-signal coverage stays strong, several at 100%. That contrast is exactly what determines which kit a patient receives.
| Community | ZIP | Homes w/ Indoor Signal | 4G LTE | Kit Implication |
|---|---|---|---|---|
| Strong indoor coverage · no 4G LTE — legacy 2G/3G only | ||||
| Hooper Bay | 99604 | 100% | 0% | Store-and-forward kit; cached readings flush on signal |
| Toksook Bay | 99637 | 99.9% | 0% | Store-and-forward kit; cached readings flush on signal |
| Point Lay | 99759 | 94.5% | 0% | Store-and-forward kit; cached readings flush on signal |
| Emmonak | 99581 | 79.8% | 0% | Store-and-forward kit; clinic-based backstop |
| Full 4G LTE — standard cellular kit | ||||
| Mountain Village | 99632 | 100% | 100% | Standard cellular kit |
| Kotzebue | 99752 | 99.8% | 99.6% | Standard cellular kit |
| Dillingham | 99576 | 99.8% | 99.0% | Standard cellular kit |
| Petersburg | 99833 | 98.5% | 98.3% | Standard cellular kit |
| Nome | 99762 | 99.4% | 97.8% | Standard cellular kit |
| Bethel | 99559 | 94.3% | 94.3% | Standard cellular kit |
A representative extract of the 22-community audit, selected to show the coverage contrast that drives kit selection. Figures are CoachCare audit percentages (2026), refreshed quarterly.
Every device in the kit is CoachCare's own proprietary hardware — one vendor, one platform, one accountability chain — so provisioning, kit selection, and replacement never depend on a third-party device manufacturer.
Embedded SIM, battery-powered. No wall outlet, no home router, no Wi-Fi credentials, no Bluetooth pairing. Wrap the cuff, press one button, and the data pushes on its own — built for off-grid dry cabins and “sync in town” portability.
For patients on more than one vital — blood pressure plus pulse oximetry — with every device running on the same proprietary CoachCare platform.
Daily weight tracking for fluid retention — the core congestive-heart-failure protocol, and the measurement that ties this section directly to AHVI's heart-failure focus.
Where: Anchorage bowl, Mat-Su, Kenai, Fairbanks, Juneau — roughly 75% of the state's population.
Transit: 1–3 business days.
Kit: Standard cellular, dense LTE/5G; no special handling.
Where: Bethel, Nome, Kotzebue, Utqiaġvik, Dillingham, Sitka, Ketchikan, King Salmon, Unalakleet.
Transit: 2–5 business days on daily jet mainline, with a same-day option available.
Kit: GCI LTE native; cellular with Wi-Fi fallback.
Where: ~200 roadless villages served from the hubs by bush carriers.
Transit: 3–10 business days, weather-buffered.
Kit: Coverage-checked; store-and-forward or Wi-Fi/Starlink where there is no cellular; clinic-based backstop.
The model is designed to work with Alaska's existing tribal health system — ANTHC (AFHCAN telehealth), YKHC, Norton Sound, and Maniilaq — using village clinics as local activation points, with Community Health Aides as force multipliers for delivery confirmation, hands-on patient activation, and troubleshooting. Billing is configured for rural FQHC, RHC, and tribal facility reimbursement rules. No partnership or affiliation with these organizations is in place or implied.
Regional fiber and satellite investment continues to raise the floor underneath this program — AIRRAQ, TERRA, Quintillion, and Starlink bonded gateways are all extending usable bandwidth toward the hubs and villages.
CoachCare's supply-chain leadership comes from medical-device and life-science backgrounds, including global supply-chain work for organizations such as Medtronic and Boston Scientific, with direct supplier oversight and Pan-Pacific sourcing experience. This describes the team's prior experience only — not a partnership, endorsement, or affiliation.
Every reading runs through a documented protocol — not ad hoc triage. In a state where the nearest emergency room can be a bush flight away, what happens when a reading goes wrong matters more here than anywhere. Every RPM and PCM reading is governed by CoachCare's documented Care Management Standard Operating Procedures (v. March 2026) — exactly the escalation discipline a risk-bearing ASM heart-failure program has to be able to show.
Every RPM and PCM reading runs the same decision logic, so escalations are consistent rather than subjective — and a critical value escalates regardless of symptoms.
A vital arrives from the patient's cellular device — blood pressure, weight, or pulse oximetry — into the monitoring queue.
A critical value escalates regardless of symptoms. An out-of-range value first gets a retake plus a symptom check before anything reaches the practice.
A trend is defined objectively — 3 consecutive out-of-range readings ≥1 hour apart (blood pressure / glucose), or 3 within 7 days (heart rate) — never a single stray number.
If the patient can't be reached, the care team leaves a voicemail with a callback line and still escalates a critical value or out-of-range trend. Every escalation documents vital, findings, method, contact, outcome, and follow-up.
Any of these, reported live during outreach, moves straight to the emergency pathway:
For a dispersed Alaska panel, this is the guarantee that matters most: the emergency response does not wait on a callback from the office.
Clinical changes split four ways — with CoachCare's internal RN team as the first line of review — so physicians are not paged for what does not need them, a real consideration for a busy cardiology group.
Active emergent symptoms follow the emergency pathway immediately — the clinic is informed, but the response never waits on it.
Every non-emergent escalation is first worked by CoachCare's internal registered nurses — retake, symptom check, protocol review — and the overwhelming majority resolve there, without ever touching the practice.
A non-critical clinical change that needs the practice is routed to a defined member of the practice's care team for review and follow-up — the right person, not a broadcast page.
A stable or resolved reading is documented as an FYI in the record — visible for continuity, without interrupting anyone.
Any ER visit or hospitalization in the last 60 days triggers a fixed three-touch sequence — the concrete readmission-prevention loop behind this account's hospitalizations-avoided number. Each touch documents and escalates per protocol, and heart-failure decompensation is exactly what it is built to catch early.
Identify precipitating factors, reconcile medications, confirm a PCP or specialist follow-up in 7–14 days, and assess symptoms.
Verify medication adherence, re-evaluate triggers, confirm the follow-up appointment happened, and verify labs.
Review medications and risk, review the outcomes of the completed visit, and re-assess symptoms.
Every element ASM will require of a heart-failure program is an element this service line already runs. Build once for reimbursement today; be ready for accountability in 2027.
AHVI's EHR is athenahealth — currently on athenaPractice (the legacy on-prem platform, formerly GE Centricity), actively migrating to athenaOne (cloud EHR / practice management / RCM). athenahealth is one of CoachCare's integrated ICP EHRs, and CoachCare integrates natively with athenaOne. The athenaPractice→athenaOne cutover is the native moment to stand up remote care — build it into the new cloud platform instead of bolting onto the system you are leaving.
Enrollment, discrete vitals, care-management documentation, and claim-ready charges flow between CoachCare and athenaOne — clinicians and billers never leave their workflow.
Standing up remote care during the athenaPractice→athenaOne cutover means it is native from day one — not a retrofit onto a platform AHVI is retiring.
athenahealth sits among CoachCare's core integrated EHRs — AHVI is an integrated-EHR account, so the interface is a configured integration, not a custom build.
A 24-month forecast for the cardiology service line — built on AHVI's own in-scope census of 17,049 patients with heart failure, hypertension, or both (Alaska's ~99% traditional-FFS book means essentially that whole cohort bills fee-for-service), across AHVI's Anchorage hub and peninsula / Mat-Su sites, 50 referring providers, three CoachCare-funded on-site enrollment specialists, telephonic enrollment, Alaska MAC-locality rates, and native athenaOne integration. Two programs: RPM and PCM. Enrollment is governed by a phased rollout cap — the pace the practice can absorb, not the size of the cohort. ASM episode performance and avoided-admission savings are not in these numbers; they are upside on top.
| Line | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Total net reimbursement | $2,423,626 | $8,453,965 | $10,877,591 |
| Total CoachCare cost (fees + ancillary) | $1,388,093 | $4,817,675 | $6,205,768 |
| Net to practice (after fees) | $1,035,533 | $3,636,290 | $4,671,823 |
| 24-month net reimbursement by program: RPM $7,734,362 · PCM $3,143,228 | |||
| Delivered full-service — telephonic enrollment, devices, and 24/7 monitoring handled by CoachCare. The three on-site enrollment specialists are CoachCare's expense, embedded in the program and never subtracted from practice margin. No new practice headcount required to launch. | |||
24-month practice margin: 43.0% of net reimbursement (Year 1 42.7%, Year 2 43.0%).
Full model available as a companion Value Analysis workbook.
AHVI has 50 referring providers. At eight referrals each per month, at an 80% acceptance rate, that is 320 referrals a month of genuine referral supply — before the three on-site enrollment specialists add another ~240 a month at full ramp. The constraint is not supply. It is that nobody onboards that volume into a new program in month one, and no care team absorbs it. So the forecast on this page is phased deliberately, and a standing capacity rule caps it at roughly 3,000 unique active patients at month 12 and 7,000 at month 24.
Averaged across year one, rising to about 365 a month once the referral, on-site, and telephonic pathways reach their year-one setting.
The second wave activates at month 13. In unique-patient terms that is roughly 232 net-new patients a month in year one and 315 in year two.
At a 165-patient care-manager caseload, 2,786 unique active patients at month 12 needs about seventeen care managers behind them.
6,566 unique active patients at month 24 — a staffing curve the service line can hire against, quarter by quarter.
Enrollment begins in month 1 in every scenario. Acceptance sets each program's ceiling as a share of the in-scope cohort; the onboarding pace sets how fast the phased rollout climbs toward it. Once a program stops reaching its ceiling inside 24 months, further acceptance buys runway past month 24 rather than a larger 24-month total — which is the whole point of a pace-limited forecast.
Recurring, subscription-like professional-fee volume over 24 months.
A continuous clinical picture of the heart-failure, CAD, and hypertension panels between visits.
≈ $6.69M in avoided acute cost at ~$15K per admission — a system-level, indirect benefit.
≈ 36.8 FTE-equivalent of monitoring, outreach, and documentation handled by the service line.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while AHVI cardiologists govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount; the staffing model formalizes as census grows.
Named owner, P&L, scorecard; athenaOne integration and billing configuration; attribution policy for shared patients; protocol sign-off for the heart-failure, CAD, and hypertension pathways.
The decompensation-risk heart-failure panel first — RPM plus PCM, protocolized GDMT titration, telephonic enrollment, and TCM at discharge for the highest-acuity patients.
Extend RPM and PCM to CAD and hypertension across the peninsula, Mat-Su, and rural echo footprint; monthly scorecard reporting to service-line governance, including onboarding throughput against the phasing plan.
Formalize electronic collaborative-care arrangements, harden the titration production process, and enter January 2027 with roughly 2,786 unique patients enrolled and a running program.
AHVI already operates a dedicated Advanced Heart-Failure clinic — the natural launch cohort. The heart-failure patients attributed to the fifteen ASM-listed cardiologists are exactly the population ASM will hold the practice accountable for. Starting there concentrates enrollment where the clinical and financial stakes converge, and produces the internal evidence the panel-wide rollout decision needs: census, capture rate, revenue per patient-month, and decompensation signal.
| Milestone | Target |
|---|---|
| athenaOne integration + protocol sign-off | Day 30 |
| First billable enrollments | Day 30–45 |
| RPM device-connectivity rate | ≥ 85% |
| Documented GDMT titration touch, per patient/mo | ≥ 1 |
| Active enrollments by Day 90* | ~593 enrollments |
| Go / scale decision with full unit economics | Day 90 |
*The modeled month-3 total active census (~421 RPM + ~172 PCM ≈ 593 active program enrollments) for the whole service line, concentrated in the Advanced HF cohort during the pilot phase. Enrollment begins in month 1 and the phasing plan governs the pace from there.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs on the CoachCare platform.
Programs implemented and operating in market.
Care plan coding and billing that has produced over 5 million claims.
Over 100 million vitals recorded and 4 million+ care actions enabled.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how the operating model behind this service line absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That distinction lands directly on this forecast — PCM carries $3.14M of the modeled $10.88M in 24-month net reimbursement, and the TCM touch at discharge anchors the three-touch post-discharge cadence. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the service line's economics hold wherever the rule settles. One unbundles the program into its parts — SaaS platform, device logistics, and program enablement — priced as components. Another engages CoachCare to run the staffing itself, an MSO-style arrangement in which AHVI owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is among its four clinical tracks. What earns under that structure — controlled pressures, titrated GDMT, decompensations caught early — is what this service line is built to produce.
Both bars run on the same dollar scale, so the red slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the PCM revenue RPM alone does not include.
Repriced at Alaska's own geographic adjusters, which cushion the reduction: the RPM cuts fall almost entirely on practice expense, and Alaska carries a statutory 1.5 work GPCI — the highest in the country — so the untouched work component is weighted more heavily here than anywhere else. The same repricing at national rates would be −8.8% on RPM. Of the $654,353, RPM accounts for $641,128 and PCM for $13,224.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. AHVI's locality-adjusted amounts run above these; the forecast repricing above uses the Alaska figures. The two programs in this forecast are RPM and PCM.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99424–99427 · PCM | No structural change proposed | $87.51 | $84.40 | −4% |
| 99490 / 99439 / 99491 · CCM | No structural change proposed | $66.13 | $64.04 | −3% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. PCM and CCM rows show the lead code in each family; every code in both families moves within about 4% in either direction, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, and CMS publishes the affected codes, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.