Cadence, a remote monitoring service provider, has stealthily created an advanced primary care business to help health systems provide better care with artificial intelligence and connected devices.
Reimbursement continues to decline for physicians, and primary care providers are among some of the lowest-paid providers in healthcare, according to the Assistant Secretary for Planning and Evaluation. Yet, the specialty is of immense import for identifying chronic diseases, annual wellness exams and treating mental health and substance use disorders.
The Centers for Medicare and Medicaid Services (CMS) has undertaken a variety of initiatives to enhance access to primary care, including through models at its innovation center. CMS took decisive action on the matter when it created the Advanced Primary Care Model (APCM) in November 2024, under its annual physician fee schedule (PFS). Payments for APCM went live on Jan. 1, 2025 with the aim of providing longitudinal primary care for Medicare beneficiaries.
The APCM model is an additional monthly bundled payment that promotes the ongoing relationship between primary care providers and patients. It pays for things like having 24/7 access to the provider’s team, coordinating care within a week of a hospital discharge, home visits, expanded hours and secure messaging options.
CMS wrote in the proposed calendar year 2025 physician fee schedule that the advanced primary care model intentionally reflects the language of chronic care management and principle care management codes, which have not been widely used.
“Significant resources are used on virtual, asynchronous patient interactions, collaboration across clinical disciplines, and real-time management of patients with acute and complex concerns, that are not fully recognized or paid for by the existing care management codes,” CMS wrote in its CY2025 PFS proposed rule.
Cadence has provided remote monitoring services since 2021. The company’s medical practice – staffed with nurse practitioners, registered nurses and medical assistants – now monitors the physiologic data of 50,000 patients per day across 18 health systems.
Chris Altcheck, CEO of Cadence, said the company worked extensively with the former Administrator of CMS Seema Verma, and others involved in creating the remote monitoring codes, to understand the vision for the code set. It again was on the ground floor with the agency in its creation of the APCM, he said.
RPM has scaled dramatically since the codes became available in 2019. The Peterson Health Technology Institute reported that the cost of the services to the Medicare program rose from $6.8 million in 2019 to $194.5 million in 2023. The rise in spending has caused them, and others, to question if the services should be more restricted.
In Cadence’s experience, APCM is scaling even faster than RPM. While the company enrolled 1,000 RPM patients in its program over its first year, the company enrolled 1,000 APCM patients in its first 60 days.
The rapid scale is due to the fact that APCM is a practice-level decision, whereby a primary care department enrolls all beneficiaries that qualify. The CMS intended for the program to be leveraged at a large scale, as the agency wrote in its rulemaking.
Under the model, one physician would be responsible for a Medicare beneficiary’s care and care coordination across the month, and the physician would be paid prospectively in a bundle for the month’s-worth of service. With Cadence, that physician does not incur any significant burden to supervise the delivery of the services.
Cadence then uses its Proactive Care Engine to find care gaps within the patient’s electronic health record. The model creates potential care goals for the patient, based on their medical history and current needs. After the patient selects which goals they want to pursue, Cadence will provide them with daily reminders to help them work on their goals.
“Cadence’s APCM solution is really all centered around our AI-powered proactive care engine that's embedded inside of Epic and the big EMRs,” Altcheck said. “It's continually scanning the patient record. It's finding risks, finding gaps, and routing those gaps to the Cadence medical group that's operating 24 hours a day, seven days a week, and that operation is able to actually close those gaps, take action on them, without creating more work for the clinics. We're trying to deliver concierge-like medicine at Medicare scale.”
Cadence has launched the services with Lifepoint Health and Community Health Systems (CHS), and it plans to enroll four additional health systems in short order.
“We're creating these really simple, easy to follow, AI-enabled experiences for patients, where they're getting proactive nudges multiple times a day to stay on their care plan, whether it's exercise, meds, nutrition, etc,” Altcheck said.
Altcheck explained that, on average, the patient starts with four and a half care goals, and patients achieve 30% of those goals in the first 90 days in the program.
“Thirty-five percent of these are preventative care. Twenty-two percent are specific to conditions, whether it's heart failure or diabetes. Twenty-two percent are lifestyle and then 18% are social needs, like transportation, housing insecurity, food insecurity,” he said.
The care goals and other relevant patient interaction data are easily accessible to the primary care provider through the electronic health record.