Prepared for OVP Health · 2026 Strategy Review · Confidential — not for distribution
OVP Health
Ten Rural Health Clinics · Kentucky · West Virginia · Virginia · CY2026 Care-Management Rules

You Built Survey-Ready Rural Clinics Across Three States. Between-Visit Chronic Care Is the Service Line They Don't Deliver Yet.

Seven of OVP Health's ten Rural Health Clinics carry Joint Commission accreditation, in counties where roughly one resident in three lives with a disability. Chronic disease sits exactly where distance makes between-visit care hardest — and since January 1, 2026, clinics bill that between-visit work as individual Medicare codes, paid on top of the per-visit rate.

See the Value Analysis How It Works Download the Full Executive Report (PDF)
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Unique Patients in Active Remote Care (Month 24)
$0
24-Month Net Reimbursement
$0
Net to the Practice (24 Months)
0%
24-Month Practice Margin

The headline counts 443 unique patients in active remote care at Month 24. The enrollment chart and the Scenario Explorer show 679 active program enrollments (services): CCM and APCM cannot be billed for the same patient in the same month, so the 180 CCM and 158 APCM enrollments are 338 distinct care-management patients. Most of the 341 RPM enrollments are a second program on the same patient, and 105 are monitoring-only — together, 443 unique patients. Program enrollments are never labeled “patients.”

Start With What You've Already Done

Ten Clinics, Three States, Seven Gold Seals

OVP Health runs ten Medicare-certified Rural Health Clinics across the Kentucky, West Virginia and Virginia coalfields — six in Kentucky, three in West Virginia, one in Virginia — and the network has doubled since 2020. Seven of the ten hold Joint Commission Rural Health Clinic accreditation, earned between September 2024 and January 2025.

10

Rural Health Clinics

Independent, freestanding clinics — the newest certified in May 2025, with two more West Virginia locations operating outside the RHC designation today.

7 of 10

Joint Commission Accredited

Survey-readiness maintained across a ten-clinic rural network. That operating discipline — protocols, documentation, follow-through — is what a care-management program runs on.

19

Primary-Care Clinicians

Four physicians and fifteen nurse practitioners across the clinics. CCM and APCM run under general supervision, which fits an NP-led network the way the codes were written.

The capability is already in the building. An organization that carries Joint Commission accreditation at seven rural clinics already runs on defined protocols, documented handoffs and audited follow-through. Between-visit chronic care needs exactly that discipline — a named person who checks the readings, a defined escalation path, documentation that stands up to review. What the network hasn't had is the between-visit infrastructure itself, and the staffing to run it. That is the part CoachCare supplies.
The Counties Tell the Story

Chronic Disease Concentrates Where Distance Is Hardest

In the nine counties where the clinics sit, between 22% and 38% of all residents live with a disability — roughly double the national rate — and poverty runs 18–30%. These are the patients a quarterly office visit cannot hold steady, and the ones for whom a clinic trip can mean an hour of mountain road each way. Monitoring replaces windshield time.

CountyClinicMedicare BeneficiariesMedicare Advantage ShareResidents With a Disability
Pike, KYMillard + Pikeville15,61466.7%29.8%
Floyd, KYEastern9,78068.3%28.4%
Logan, WVLogan8,48765.5%29.6%
Jackson, WVRavenswood7,61861.9%22.1%
Buchanan, VAGrundy6,78965.1%37.7%
Mingo, WVWilliamson6,49669.7%31.9%
Johnson, KYPaintsville5,98165.8%26.1%
Lawrence, KYLouisa4,01063.5%24.0%
Martin, KYInez2,60768.6%32.1%
Nine clinic counties10 clinics67,38266.2%22–38%
66.2%

Medicare Advantage Share

Two of every three Medicare beneficiaries in these counties are on a Medicare Advantage plan — fifteen points above the national share. Total Medicare here means traditional Medicare plus MA at that local penetration, and the plan mix belongs on the discovery agenda.

76–90%

Household Broadband

Three clinic counties sit below 78% broadband subscription. The program runs on cellular-connected cuffs and meters that transmit on their own — no home WiFi, no app setup, no smartphone required.

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Remote-Care Billing Today

A CY2024 review of Medicare billing across every clinician who reassigns to OVP Health found no remote patient monitoring at meaningful scale and no care-management program attributable to the organization. The service line below starts from a clean slate.

Sourcing, stated plainly. Medicare counts are CMS enrollment data (May 2026); Medicare Advantage shares are the CMS penetration file (August 2026); disability and broadband are Census ACS 2024 five-year estimates. CMS suppresses any billing line under eleven patients, so the accurate claim is no billed remote-care program at meaningful scale — not “zero patients.”
The CY2026 Reimbursement Change

Care Management Stopped Being an Unfunded Cost

G0511 — the single bundled code that paid rural health clinics one flat amount for roughly twenty distinct care-management services — is gone. Since January 1, 2026, RHCs bill the individual CCM, RPM and APCM codes, each separately payable in addition to the clinic's per-visit all-inclusive rate.

Two rails, one claim

The visit rate is untouched

The all-inclusive rate still pays for the visit. Care management and remote monitoring pay on top of it rather than folding into it, so the program adds a second revenue rail instead of cannibalizing the first.

National rates

These codes pay national amounts on RHC claims

On a rural health clinic claim, the care-management codes pay national non-facility Physician Fee Schedule amounts. The forecast on this page is priced at local West Virginia rates, which run about 7% below those national amounts across this code set — roughly $92,500 of additional practice net over 24 months sits on top of every figure shown here.

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.

Why this lands well here. A ten-clinic network with four physicians runs on nurse practitioners and protocols. CCM and APCM operate under general supervision — the care team works the program between visits and the billing follows the documentation. The network is already shaped the way these codes work; what changed in January is that the work finally pays.
The Service Line

Three Programs, One Care Team, One Enrollment Engine

Modeled across an estimated 1,500-patient Medicare panel — traditional Medicare plus Medicare Advantage at the local ~66% penetration — with 19 referring clinicians. CoachCare supplies the devices, the enrollment staff, the monitoring hours and the documentation. The clinics supply the panel and the clinical decisions.

RPM
$608,325
24-month net reimbursement

Remote physiologic monitoring. Cellular blood-pressure cuffs and glucose meters that transmit on their own — 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 program.

CCM
$404,256
24-month net reimbursement

Chronic care management. Monthly non-face-to-face management for patients with two or more chronic conditions — in counties where a third of all residents live with a disability, that is most of the Medicare panel. 99490 and 99439.

APCM
$190,330
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 — about a quarter of Medicare beneficiaries in these counties are dual-eligible.

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 the model treats them as a partition rather than a layer: APCM takes the complex and dual-eligible slice where its top tier pays most, CCM takes the remainder. RPM sits on its own share because it can be billed alongside either. That is why 679 program enrollments resolve to 443 patients.
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Referring 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

Ten clinics across nine counties and three states. Enrollment requires no one to travel: the on-site specialist works the highest-volume clinic and telephonic outreach covers the rest.

Native Epic Integration

The Program Runs Inside Epic

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 clinics' 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 — filterable, trendable, and usable in quality reporting — not as scanned PDFs.
1

Integrated enrollment

Enrollment flags and trigger ordering sit inside the clinical workflow. The CoachCare team enrolls qualified Medicare patients on the clinics' 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 created new revenue and new work in the same stroke: per-program time tracking and per-program documentation, every month, for every enrolled patient. A ten-clinic network cannot absorb that as manual effort. Enrollment inside the existing workflow, structured vitals on the chart and automatic claim creation are what make the new rules workable. Patients begin receiving CCM and RPM services in under five days from flag.
“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 for a network whose clinics run on nurse practitioners and protocols, it is the part the care team should read first.

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 — which matters in counties where the next appointment can be a season away.

5

Three routes, so the clinic sees signal

Emergencies go to 911. Non-critical findings go to a named member of the clinic team. Stable-and-resolved goes into the record as an FYI, so the clinicians are 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 clinics 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. Those three touches are where the 45 avoided admissions in the forecast come from.
CoachCare Value Analysis · Modeled for OVP Health

The Value Analysis

A 24-month forecast across an estimated 1,500-patient Medicare panel, 19 referring clinicians, one CoachCare-funded on-site enrollment specialist and telephonic enrollment, priced at CY2026 West Virginia physician-fee-schedule rates — the conservative basis, since these codes pay national amounts on RHC claims. Medicaid revenue, transitional care management and the 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 443 patients. Provider referral plus one on-site enrollment specialist plus telephonic outreach, net of ~1.5% monthly attrition, with enrollment beginning in month 1. All three programs reach their eligible-population ceilings inside eight months — APCM 158 in month 4, CCM 180 in month 6, RPM 341 in month 8. The plateau is the size of the Medicare panel, not a limit on enrollment pace.

Monthly Economics — Net Reimbursement, Fees, Net to the Practice

Net reimbursement after denials and coinsurance bad debt, against total full-service fees including one-time implementation and integration. Month 1 is −$4,889, the only negative month, because one-time setup lands before the census ramps. Net to the practice turns positive in month 2 and settles near $25,000 per month once the census plateaus. The chart is drawn against a true zero baseline so the month-1 dip is visible rather than hidden.

24-Month Net Reimbursement Mix

$1,202,911 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$245,562$362,763$608,325
CCM net reimbursement$176,554$227,701$404,256
APCM net reimbursement$89,114$101,216$190,330
Total net reimbursement$511,230$691,680$1,202,911
CoachCare fees (incl. one-time)$297,895$390,904$688,799
Net to the practice$213,335$300,776$514,112
Practice margin41.73%43.48%42.74%
The on-site enrollment specialist is staffed at CoachCare's expense and is already inside the fees above. It is never a separate cost to the practice.
45.3

Hospitalizations Avoided

Roughly $680,000 of avoided acute cost over 24 months. That value accrues to hospital partners and payers rather than to the clinics, so it is excluded from every revenue figure above.

71,393

Readings Captured

Blood pressure, weight and glucose readings arriving between visits, from cellular devices that work regardless of home broadband.

20,464

Claims Generated

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

8,823

Care-Team Hours Delivered

About 4.24 full-time equivalents of care-management capacity, added without the clinics hiring anyone.

Scenario Explorer — Build Your Own Forecast

Adjust the assumptions and watch the 24-month forecast recompute. Eligibility is fixed at the CY2026 rural-health-clinic row — 65% RPM, 40% CCM, 35% APCM of the panel — and the acceptance sliders sit on top of it. Because the panel sets every program's ceiling, the panel slider is the one that moves everything.
24-mo net reimbursement
$1,202,911
Net to the practice
$514,112
Active enrollments · M24
679
Unique patients · M24
443
Hospitalizations avoided
~45
State Momentum · Context, Dated

Both Home States Are Funding Exactly This

The federal Rural Health Transformation Program awarded first-year funds to every state in December 2025. The two states holding nine of OVP Health's ten clinics both aimed theirs at rural chronic-disease infrastructure. No participation is asserted — this is the funding weather the program launches into.

West Virginia · $199.5M year one

~$14M announced for remote patient monitoring

West Virginia's “Connected Care Grid” initiative directs roughly $9.1M to outpatient remote monitoring and $4.9M to inpatient — connected blood-pressure cuffs, glucose monitors and chronic-disease management support, with applications through the state's wvOASIS portal. Three OVP clinics and the Huntington headquarters sit in West Virginia.

Kentucky · $212.9M year one

Chronic-care hubs lead the state plan

Kentucky's first flagship initiative is “Rural Community Hubs for Chronic Care Innovation” — hub-and-spoke collaboratives for obesity and diabetes with digital self-management tools. State guidance points to rural health clinics among eligible recipients; confirm in the application cycle. Six OVP clinics sit in Kentucky — the largest block in the network.

What it means here

A running program is an application-ready program

These funds reward organizations that can show working remote monitoring, care coordination and outcome data. A network that stands its program up now applies from operating experience — enrollment numbers, reading volumes, documented escalations — rather than from intent.

Getting Started

Live in 30 Days

Week 1

Confirm the panel and open the Epic ticket

Pull the exact Medicare count — traditional and Medicare Advantage — from the practice management system, confirm the Epic arrangement so the interface request goes into the right queue, and agree which clinic starts. Williamson carried the highest measured visit volume in the network's most recent cost-report year.

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 the clinics' own contacts, documentation templates mapped to the CY2026 individual-code requirements, and cellular devices staged — no patient WiFi required.

Week 4

First patients enrolled

Enrollment begins in month 1 — there is no dormant onboarding period. The on-site enrollment specialist works the flagship clinic and the telephonic pathway reaches the other nine from day one.

Months 2–8

Full eligible population enrolled

APCM reaches its ceiling in month 4, CCM in month 6 and RPM in month 8. From there the conversation turns to the panel's upper end, the two clinics not yet Medicare-certified as RHCs, and the state applications the running program now supports.

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.

Download the Full Executive Report (PDF)
Policy Watch · CMS-1848-P

The 2027 Proposed Rule, Priced Against This Forecast

CMS's proposed CY2027 Physician Fee Schedule cuts remote-monitoring rates. The scary number is real, and it is also the smallest part of this particular story — here is the same proposal priced against the forecast on this page.

1

The proposals are confined to RPM

The CCM and APCM families barely move — under the proposed rates they shift less than a point on this forecast's care-management dollars ($594,586 of the $1,202,911). The cuts land on the monitoring arm, and mostly on one code.

2

The operating model flexes with it

CoachCare is preparing contingencies ahead of the final rule: an unbundled software-plus-device-logistics offering, program enablement, and an arrangement where CoachCare manages the staffing while the practice owns the clinical program and the billing.

3

What comes after fee-for-service

CMS's proposed ACCESS Model would pay remote care as a risk-based monthly payment per patient, with half of each payment withheld and reconciled against outcome attainment. Programs with documented outcomes enter that world ready.

From the Headline Cut to This Forecast

Repriced at OVP Health's own West Virginia locality, on this forecast's program mix. The code table below uses national amounts; the cascade here uses the forecast's basis — the two differ by design.

−20.5%
The headline: device supply (99454), the largest single RPM code, under the proposed rates
→
−8.1%
The RPM patient-year: device supply is only part of it, and the treatment-management codes barely move
→
−5.0%
The whole service line: the care-management arm — half the forecast — is nearly untouched
RPM program alone$608,325 modeled · $49,442 comes off
−$49,442
−8.1% of the program
The whole service line$1,202,911 modeled · $60,607 comes off
−$60,607
−5.0% of the service line
Proposed reductionRemaining 24-month net reimbursement

Both bars share one dollar scale against the full $1,202,911 service line, so the same red dollars visibly shrink against the larger base. The care-management reductions ($11,163 across CCM and APCM) are inside the service-line bar.

The Code Families, Current vs. Proposed

National non-facility amounts from the proposed rule's Addendum B. The forecast on this page is priced at West Virginia locality rates, which sit a few percent below these.

CodeWhat it pays forCY2026CY2027 proposedChange
In scope — remote physiologic monitoring
99453RPM setup and patient education (one-time)$21.71$20.03−7.7%
99445RPM device supply, 2–15 days$52.11$41.38−20.6%
99454RPM device supply, 16–30 days$52.11$41.38−20.6%
99470RPM treatment management, first 10 min$26.05$20.69−20.6%
99457RPM treatment management, first 20 min$51.77$49.59−4.2%
99458RPM treatment management, each add'l 20 min$41.42$40.39−2.5%
Not in scope — the care-management arm of this forecast
99490CCM, first 20 minutes$66.13$64.04−3.2%
99439CCM, each additional 20 minutes$50.44$49.92−1.0%
G0556APCM, level 1$16.37$16.09−1.7%
G0557APCM, level 2$53.78$53.20−1.1%
G0558APCM, level 3$117.24$116.91−0.3%

Statutory guardrail: section 1848(c)(7) caps any single-year total-RVU reduction at 19% and phases the remainder over two years — CY2027 is a single-digit year for the patient-year, and the remainder lands no earlier than CY2028.

Nothing here is final. Comments on the proposed rule are due September 14, 2026; the final rule lands in early November and takes effect January 1, 2027. CoachCare is engaged in the comment process and will rerun this model against the final rates the week they publish.
Why CoachCare for OVP Health

Built for a Rural Health Network That Already Does the Work

Six reasons this fits OVP Health specifically, not remote care in general.

Health-center rail

We bill the way a rural health clinic bills

Individual APCM and CCM codes on the clinic claim at the national rate, in addition to the visit, filed by OVP's own reimbursement team. The 2026 split of G0511 into separately payable codes is the reason the forecast on this page exists, and the program is built around it.

Full service

The model that runs without hiring

Enrollment outreach, care managers at about 160 patients each, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. OVP inherits a running program across the ten clinics at a 42.74% practice margin, with no new positions to fill.

Build-on

We put a Medicare line under care you already deliver

The clinics already carry chronic disease between visits for a poor, rural panel across Kentucky, West Virginia and Virginia. This plan adds cellular devices, documented monthly clinical management and clinic billing to that shape of care. Where the care team stands today is the first discovery question.

Epic

Inside the chart you already run

CoachCare integrates bi-directionally with Epic: eligibility flags and orders leave the chart, and vitals, care documentation and claim-ready charges come back into it. One chart for clinicians across the ten clinics, one workflow for the reimbursement team, and no second system.

Payer mix

We work the Advantage majority on purpose

Medicare Advantage runs about 66% of this panel — fifteen points above the local penetration. The statutory floor pays a non-contracted MA plan no less than original Medicare, and the fee-for-service quarter bills per claim, month after month. That mix is worked deliberately here, not left to chance.

Aligned

No lock-in, no capital, paid as you enroll

Fees are per active patient per month; there is no capital outlay and no payroll ramp. If the census does not build, CoachCare does not get paid, and the forecast, Disclosures and workbook behind this page are yours to keep either way.

The ask: a working session to validate the panel against your own chart counts, confirm the Advantage mix by clinic, scope the Epic interface, and set the go-live cohort across the ten clinics.