Three patient lanes, sorted by who bears the economics. Broad enrollment where AHVI keeps the margin and no ACO benchmark is touched. Selective post-discharge enrollment where care-management spend enters Envoy's benchmark and has to earn its place. One infrastructure that serves fee-for-service today, Envoy's total cost of care now, and the Ambulatory Specialty Model from 2027.
AHVI founded Envoy Integrated Health ACO. That changes the arithmetic of a remote care program. For a patient outside any ACO benchmark, every dollar of RPM and PCM is practice margin. For a patient Envoy is accountable for, the same dollar also raises Envoy's benchmark, and the program has to avoid enough admissions to pay that back. The deployment below sorts every Medicare heart failure and hypertension patient on that one question first, and the clinical context second.
Retrospective assignment means the operational filter is the referring primary care physician: the six Envoy primary care TINs. Roughly a third of AHVI's heart failure panel sits inside the benchmark; two thirds sits outside it.
Non-attributed heart failure and hypertension patients bill RPM and PCM with no ACO exposure at all. Breadth is free, so these two lanes are staffed to run at full enrollment-specialist capacity from month one.
Only a post-discharge heart failure cohort avoids enough admissions to outrun the care-management spend it adds to Envoy's benchmark. So attributed patients enter through a qualifying discharge, not a panel sweep.
| Lane A · Non-attributed heart failure | Lane B · Envoy-attributed heart failure | Lane C · Non-attributed hypertension | |
|---|---|---|---|
| Population | Non-attributed HF | Envoy-attributed HF | Non-attributed HTN without HF |
| Primary program | RPM + PCM | TCM + RPM + PCM | RPM + selective PCM |
| Enrollment trigger | Eligible HF patient | Qualifying acute discharge | Active HTN management need |
| Deployment posture | Broad | Selective | Broad |
| Primary beneficiary | AHVI | AHVI + Envoy | AHVI |
| Clinical objective | Longitudinal HF management | Fewer readmissions and ED visits | Blood-pressure control and longitudinal management |
| Key economic risk | Enrollment throughput and operating capacity | Care-management spend enters the ACO benchmark | Enrollment capacity, PCM eligibility and documentation |
Broad enrollment makes sense where AHVI captures the economics directly. Attributed beneficiaries require a higher clinical-value threshold, and the model holds Lane B to it.
AHVI's own census: 5,038 Medicare patients with heart failure and 12,011 with hypertension and no heart failure. The two cohorts are mutually exclusive, so nothing here is counted twice. The Envoy split is applied to both.
Medicare heart failure patients, the cohort the Ambulatory Specialty Model will measure AHVI on from January 2027.
Medicare hypertension patients. Heart failure patients are already excluded from this count, so Lane C cannot overlap Lanes A or B.
Each lane connects a population to a program, a posture, and the engine it feeds. The same enrollment specialists, devices, monitoring, and athenaOne integration run all three.
Two dedicated, CoachCare-funded enrollment specialists, each with roughly 80 enrollments a month of capacity. One runs heart failure and staffs the post-discharge window first. The other runs hypertension and nothing else.
Lane B, ~29 a month. Qualifying post-discharge heart failure patients are staffed first. The post-discharge window is perishable, and Lane B is the only lane whose enrollment has to clear an avoided-utilization test, so it gets capacity before anyone else.
Lane A, ~51 a month. Non-attributed heart failure absorbs whatever capacity Lane B leaves, until Lane A reaches its 1,146 ceiling in month 27 and drops to replacement enrollment.
The full specialist runs one lane. Against a 7,807-patient pool and a 2,342 ceiling, 80 a month less attrition reaches about 2,238 active patients by month 36. Lane C becomes capacity-constrained before it becomes population-constrained.
Additional enrollment capacity is a future scale lever, once the economics and clinical performance validate. The population is not the binding constraint.
A 36-month forecast of the three lanes on AHVI's own census, at Anchorage Medicare rates, net of denials and coinsurance bad debt, after every CoachCare fee. Launch is modeled at January 2027, alongside the first ASM performance year.
| Line | 2027 | 2028 | 2029 | 36-Month |
|---|---|---|---|---|
| Net reimbursement, all lanes | $2,538,038 | $6,151,735 | $8,508,737 | $17,198,510 |
| CoachCare fees, all lanes | $1,332,888 | $3,266,969 | $4,531,505 | $9,131,362 |
| Net to practice (after fees) | $1,205,150 | $2,884,766 | $3,977,233 | $8,067,148 |
| Lane A · non-attributed HF | $440,079 | $1,088,621 | $1,466,104 | $2,994,803 |
| Lane B · attributed HF | $229,209 | $403,914 | $404,573 | $1,037,695 |
| Lane C · non-attributed HTN | $535,862 | $1,392,231 | $2,106,556 | $4,034,650 |
| Practice margin | 47.5% | 46.9% | 46.7% | 46.9% |
Full model available as a companion Deployment Value Model workbook.
With implementation and integration waived, the deployment is purely variable-cost. Expense scales alongside reimbursable events, so there is no payback period to finance and no modeled month in which cumulative cash is negative. The decision is less about financing a long payback than about validating enrollment throughput, clinical eligibility, reimbursement realization, and operational execution.
Attribution moves both pools at once: a higher Envoy share shrinks Lanes A and C and enlarges the discharge flow feeding Lane B. Penetration and enrollment rate set each lane's ceiling; the specialists set how fast the lane climbs toward it. Once a lane stops reaching its ceiling inside 36 months, a higher ceiling buys runway past month 36 rather than a larger 36-month total.
Across the two heart failure lanes over 36 months, at a 40% reduction on a 40% annual admission rate. Lane C claims revenue only.
The attributed post-discharge cohort alone, with about 92 emergency department visits avoided beside them.
Cumulative over 36 months, against 1,029 post-discharge enrollments in Lane B and 2,880 in Lane C.
Monthly for all three lanes, with ASM shown by payment year and Envoy by performance year.
Every Lane B care-management dollar raises Envoy's benchmark. Selective post-discharge enrollment lets the avoided admissions and emergency visits outweigh that spend, so the lane improves Envoy's total cost of care while AHVI still earns positive practice economics on it.
Care-management spend that lands inside the Envoy benchmark: 0.95 points of it, against a 1.5-point budget.
Gross utilization savings from roughly 62 admissions and 37 emergency department visits avoided each year on a ~308-patient census.
$834K over 36 months. About 153 admissions and 92 ED visits avoided across the horizon.
| Principal care management attach on Lane B | 0% | 25% | 50% | 70% · modeled | 100% |
|---|---|---|---|---|---|
| Benchmark drag | 0.61 pts | 0.73 pts | 0.86 pts | 0.95 pts | 1.10 pts |
| Net TCoC benefit to Envoy | +$599K/yr | +$511K/yr | +$422K/yr | +$351K/yr | +$244K/yr |
| Avoided admissions needed per 100 to break even | 8.9 of 20 | 10.7 of 20 | 12.5 of 20 | 13.9 of 20 | 16.1 of 20 |
| AHVI Lane B net | $246K/yr | $303K/yr | $359K/yr | $405K/yr | $472K/yr |
Every point of attach moves both directions at once: it raises what Envoy absorbs and raises the avoided admissions the lane must deliver to pay for itself. The modeled cohort delivers 20 avoided admissions per 100 enrollee-years, so the lane clears at every attach shown, with 1.44× cushion at the modeled 70%.
Total ACO savings must clear the MSR before any savings are shared. Below it, distributable shared savings fall to zero regardless of how well Lane B performs. The cushion is the number to watch.
About 27.8% at Envoy's 71.03 reference score. The same avoided utilization is worth roughly a third less below the threshold, which yields ~$138K of incremental earned savings at the year-three run rate.
After the infrastructure, care-redesign, and participant allocations, AHVI's share of the distribution is minor. The enterprise value sits in total cost of care, not in the distribution check. AHVI gets rich on practice margin.
ACO economics strengthen the enterprise case for Lane B, but remain secondary to AHVI's direct fee-for-service investment case.
Fifteen AHVI clinicians appear on CMS's preliminary CY2027 participant list for the heart failure cohort, on a historical Part B base of about $5.91M. From the 2027 performance year, paid in 2029, that base carries a two-sided adjustment that widens every year. The remote monitoring, post-discharge intervention, and longitudinal management the three lanes deliver are the same work ASM measures.
ASM adjustments apply to covered professional Part B reimbursement broadly, not only to remote care claims. That is what makes the exposure base $5.91M rather than the program's own billing.
Fewer inpatient and emergency events, plus better expected-cost capture, from the two heart failure lanes at a 60% ASM-managed share of the census. A direction, not a predicted CMS score.
Only the 2029 payment (~$240K) falls inside the 36-month window, and it is the one ASM figure carried into the total AHVI value above. The maximum downside at a zero score runs $564K in the first payment year.
Proceed with a three-lane deployment: maximize direct practice economics in the non-attributed populations, selectively manage attributed heart failure patients where acute-utilization savings justify the ACO spend, and use the resulting infrastructure to strengthen AHVI's position as specialty reimbursement moves further toward value.
Validate the actual Envoy attribution overlap.
Validate real enrollment conversion and staffing capacity.
Validate utilization and hypertension management outcomes.
Confirm ASM participation; monitor Envoy's MSR and quality.
Implement remote care infrastructure, activate the two enrollment specialists, launch all three patient lanes, establish the financial and clinical baselines, and operationalize the athenaOne integration.
Enrollment conversion and throughput. Net reimbursement and practice margin. Heart failure admissions, ED utilization, and blood-pressure control. PCM eligibility and documentation. ACO economics and ASM-related heart failure performance.
Add enrollment capacity where realized contribution margin stays attractive, retention validates the assumptions, clinical outcomes support deployment, Lane C demand still exceeds throughput, and AHVI operating capacity supports expansion.
Where AHVI's data was unavailable we used a documented placeholder rather than a guess, and tiered each one by how far it moves the forecast. Replacing an assumption is one cell, not a rebuilt analysis.
| Input | Modeled | Where the real value comes from |
|---|---|---|
| Tier one · moves the forecast most | ||
| Share of HF patients attributed to Envoy | 35% | Envoy's attribution feed, or a query of your HF patients against the six Envoy primary care TINs by referring physician. |
| Annual hospitalization rate, HF cohort | 40% | athenaOne joined to hospital discharge records; Envoy's claims feed for the attributed share. |
| Share of discharges the program captures | 50% | Your HF clinic's current 7-to-14-day post-discharge follow-up rate. Clinical director and APP leadership. |
| Tier two · shifts the ACO and ASM layers | ||
| Medicare cost per acute admission, Alaska | $16K | Envoy's claims data: actual Medicare paid amounts on HF admissions for attributed patients. |
| 12-month readmission rate, post-discharge | 50% | Hospital readmission reporting or your own follow-up data. The break-even test is most sensitive to this. |
| HF episode cost, observed and expected | $30K / $29K | Your CMS episode-based cost measure feedback report, via the QPP portal. |
| Share of census managed by ASM clinicians | 60% | The same CMS feedback report, or your own general-versus-procedural clinician split. |
| Tier three · fine-tunes the revenue model | ||
| Denial rate and coinsurance collection | 2.5% / 75% | Revenue cycle reporting. Sets the 92.6% gross-to-collected conversion, which moves every figure proportionally. |
| Envoy savings rate and distribution terms | 10.58% | Envoy directly: its 2025 performance results and the participation agreement's terms across 14 practices. |
Available through the QPP portal. It replaces four separate placeholders in the Ambulatory Specialty Model layer at once, and it is the highest-value single document for that half of the analysis.
One admission-reduction lever drives Lane A's clinical impact, Lane B's avoided admissions, and the ASM inpatient bucket, so the model cannot claim different effect sizes in different rooms. The PCM attach on Lane C is a modeling estimate of the documented uncontrolled share, and a chart review is what confirms it.
The deployment 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 day to day.
Programs stood up and running in market.
Care-plan coding and billing behind more than 5 million claims.
Over 100 million vitals recorded; 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 deployment on this page absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That lands directly on this forecast: PCM carries $7.50M of the modeled $17.20M in 36-month net reimbursement, and the TCM episode that opens every Lane B enrollment adds $272K more. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the deployment'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 three lanes.
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 deployment 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 and TCM 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. Of the $890,647, RPM accounts for $852,852 and PCM for $37,795; TCM does not move.
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 programs in this forecast are RPM, PCM, and TCM.
| 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% |
| 99470 · management, 10 min | Practice expense recrosswalked | $26.05 | $20.69 | −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 | ||||
| 99426 / 99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 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 a few percent 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.