Prepared for The Nephrology Group, Inc. · 2026 Strategy Review · Confidential — not for distribution
Kidney Care Service Line Performance & Optimization

You Proved Remote Care Works.
Now Scale It — Without Building the Machine.

The Nephrology Group built its own hypertension RPM, its own app, its own analytics — and turned CKCC losses into $1.86M of shared savings. Scaling that program should not depend on a two-person dev team. CoachCare runs the same infrastructure full-service, natively integrated with Greenway.

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24-Month Net Reimbursement
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24-Month Practice Margin
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Hospitalizations Avoided
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Unique Patients in Active Remote Care · Month 24

Month-24 census is ~2,809 active program enrollments (RPM ~2,069 + PCM ~740); the headline patient figure is 2,291 unique patients after de-duplicating those enrolled in both programs.

Credit Where It's Due

TNG Already Proved the Thesis

Most practices need convincing that remote care works. TNG doesn't — it built the evidence itself. That conviction is the asset. The question is whether the next thousand patients should run on self-maintained infrastructure.

✓ Built in-house

AHA-Certified Hypertension Program

A dedicated hypertension center with self-run blood-pressure remote monitoring — clinical buy-in for RPM is already institutional.

✓ Built in-house

TNG Mobile App

A self-published patient app (App Store & Google Play, 2025) tracking BP, weight, and glucose — maintained by an in-house team of one manager, one engineer, and two interns.

✓ Built in-house

6-Person VBC Care Team

NPs and PAs running care management manually — clinically excellent, operationally expensive, and the first place scale breaks.

★ The result

The CKCC Turnaround

PY2023: −$2.2M, 50% quality. PY2024: +$1.86M shared savings, 75% quality — as anchor practice of DaVita's Integrated Kidney Care of Central California.

CKCC has been extended through December 2027 — with tightened savings methodology from PY2026. The savings get harder to earn at exactly the moment operational leverage matters most.

The Build-vs-Partner Reality

The Walls Every Self-Built Program Hits

None of these are criticisms — they're the structural costs of running a monitoring company inside a medical practice. Every practice that builds in-house meets the same six walls, usually between patient 200 and patient 1,000.

The math that matters: every hour your six-person VBC team spends on device troubleshooting, data chasing, and billing documentation is an hour not spent on GDMT titration, CKD education, and the KCE metrics that just earned $1.86M.
📦

Device logistics

Shipping, provisioning, replacements, returns — an app-based model also excludes every patient who can't or won't use a smartphone, in a Medicare/Medi-Cal-heavy market.

🌙

24/7 monitoring coverage

Readings don't keep office hours. Alert triage at 2am either goes unstaffed or burns out the day team.

🧾

Billing-rule compliance

16-day supply counts, time-based documentation, code-stacking rules that changed again in CY2026 — audit exposure grows with every enrolled patient.

📱

App maintenance

OS updates, store review cycles, HIPAA-grade security patches — carried by a two-developer team whose time the practice funds.

🔌

EHR integration

Home-grown data lives outside Greenway unless someone builds and maintains the pipes — so vitals end up in a portal nobody charts in.

📈

Scale economics

In a self-built model every added patient adds staff load. In a full-service model every added patient adds margin.

Full Service · Turnkey · Greenway-Native

Keep What You Built. Replace What's Holding It Back.

TNG keeps its clinical protocols, its physician governance, its VBC team, and its patient relationships. CoachCare replaces the infrastructure underneath — as a service, not a project.

CapabilityTNG's Self-Built Program TodayCoachCare Full-Service
Clinical protocols & governanceYours — proven by the AHA certification & KCE resultsStays yours. Physicians govern every decision.
DevicesApp-dependent (smartphone required)Cellular-connected devices — no app, no Wi-Fi, no smartphone needed; logistics handled end-to-end
MonitoringBusiness hours, VBC team capacity24/7 clinical monitoring & alert triage, escalation to your protocols
EnrollmentManual, clinic-by-clinicDedicated enrollment engine — two on-site enrollment specialists (at CoachCare's expense) + telephonic outreach across all 9 offices
Billing & complianceSelf-managed rules & documentationBilling-grade documentation for every claim: day counts, time logs, audit trail
EHR integrationData outside the chartNative Greenway integration — vitals, alerts, and encounters flow into the record your clinicians already use. $2,500 one-time; $0 monthly; $0 per-patient
App & platform maintenance2-person dev teamCoachCare's platform team — your developers return to analytics & KCE reporting
Unit economicsEach patient adds staff loadEach patient adds margin — modeled below
Why this matters doubly under CKCC: the same monitored population that generates RPM/PCM fee-for-service revenue is the population whose avoided hospitalizations flow into KCE shared savings. One infrastructure, paid twice — and TNG's 2024 reinvestment commitment shows the budget mechanism already exists.
CoachCare Value Analysis · Modeled for TNG

The Value Analysis

A 24-month forecast using TNG's footprint — ~40 referring providers across 9 Central Valley offices, two on-site enrollment specialists, MAC-locality rates for zip 93720 (Noridian JE), and Greenway integration — for RPM + PCM across CKD 3b–5, hypertension, and transition-of-care populations. Conservative enrollment mechanics; CKCC shared-savings amplification not included in these numbers.

Active Program Enrollments Under Remote Care

Monthly active census by program — active program enrollments, not unique patients · physician referrals (5/provider/mo, 70% acceptance) + 2 on-site enrollment specialists (40 enrollments/mo each), net of discharges. Neither program reaches its ceiling inside 24 months.

Monthly Economics — Revenue, Fees, Margin

Net reimbursement (after denials, coinsurance bad debt) vs. CoachCare fees; one-time setup lands in month 1 and margin turns positive in month 2 — there is no negative-margin quarter. On-site enrollment staffing is CoachCare's expense and is never deducted from practice margin.

24-Month Net Reimbursement Mix

$3.53M across the nephrology two-program stack (CCM/APCM excluded by specialty eligibility)

The Financial Summary

ProgramYear 1Year 224-Month
RPM net reimbursement$657,044$2,005,950$2,662,994
PCM net reimbursement$209,529$655,761$865,291
Total net reimbursement$866,573$2,661,711$3,528,285
CoachCare program fees$482,168$1,507,725$1,989,893
Ancillary & one-time fees$20,253$17,620$37,873
Practice margin (after all fees)$364,153$1,136,366$1,500,518
Includes two on-site enrollment specialists staffed at CoachCare's expense — ≈$240,000 of embedded staffing value over 24 months. That value is CoachCare's expense and is never subtracted from the practice margin above.

24-month practice margin: 42.5% of net reimbursement (Year 1 42.0%, Year 2 42.7%).

Full model available as a companion workbook.

268,684

Physiologic Readings

Continuous BP, weight, and glucose surveillance across the CKD and hypertension panels — cellular devices, no app required.

~171

Hospitalizations Avoided

≈ $2.56M in avoided acute cost at $15K each — cost that also flows into CKCC shared-savings performance.

13.4

FTE-Years Absorbed

27,833 care-team hours of monitoring and documentation lifted off the VBC team — redeployed to top-of-license KCE work.

62,244

Billed Claims / Units

Recurring monthly professional-fee volume with billing-grade documentation behind every claim.

Implementation

Migration, Not a Restart

Because TNG already runs protocols and a monitored panel, launch is a migration: your existing hypertension RPM patients move onto cellular devices and 24/7 coverage first, then the funnel opens to the full CKD 3b–5 population. CoachCare full service means no new headcount to launch — and your dev team gets its roadmap back.

Days 0–30

Greenway Integration & Protocol Port

Native Greenway integration configured; your hypertension-program protocols and escalation rules ported into CoachCare workflows; billing rules mapped for Noridian JE.

Days 30–90

Migrate the Proven Cohort + Embed On-Site Enrollment

Existing in-house RPM patients transitioned to cellular devices and 24/7 monitoring; two on-site enrollment specialists embedded across the highest-volume clinics — zero clinical disruption, immediate billing-grade documentation.

Months 3–6

Open the CKD Funnel

Referral enrollment across all 9 offices for CKD 3b–5 and PCM; VBC team redeploys to titration, education, and KCE metric management.

Months 6–12

Full KCE Population Leverage

~1,159 unique patients under management by month 12 (~1,420 program enrollments), on a trajectory to ~2,291 unique patients (~2,809 enrollments) by month 24 — still climbing, well inside the program ceilings; monitored-population data feeding CKCC quality measures and the PY2026 tightened-methodology savings case.

Policy Watch · CMS-1848-P

2027 Proposed Rule Insights

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.

1

The Proposal Is Confined to RPM

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 $865,291 of the modeled $3,528,285 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.

2

CoachCare Is Building the Contingencies Now

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 the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.

3

ACCESS Moves Remote Care to Risk-Based PMPM

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 therapy, decompensations caught early — is what this service line is built to produce.

What the Proposal Actually Takes Off This Forecast

This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality rather than national averages. Same enrollment, same phasing plan — only the rates move.

−20.6%
The headline per-code cut — device supply (99454 / 99445), the code the proposal reprices hardest.
→
−9.3%
The RPM patient-year, because device supply is only 32% of it — the management codes barely move.
→
−7.0%
The whole service line, because PCM carries 24.5% of the forecast and is not in scope.
RPM alone — the only code family in scope$2,662,994 over 24 months
−$247,284
−9.3% of RPM
The whole service line — RPM + PCM$3,528,285 over 24 months
−$248,259
−7.0% of the whole

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 care-management revenue RPM alone does not include.

RPM, retained at CY2027 proposed rates The proposed reduction PCM — not in scope

Repriced at this locality's own geographic adjusters. The RPM reductions fall almost entirely on practice expense, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be −8.8% on RPM. Of the $248,259, RPM accounts for $247,284 and the care-management arm for $974.

Where the Proposal Lands, Code Family by Code Family

CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.

Code familyWhat CMS proposedCY2026CY2027 proposedChange
In scope — remote physiologic monitoring
99454 / 99445 · device supplyPractice expense recrosswalked$52.11$41.38−21%
99457 · management, first 20 minDirect practice expense removed$51.77$49.59−4%
99458 · management, each addl 20 minDirect practice expense removed$41.42$40.39−2%
99453 · setup and patient educationCrosswalked; one-time per patient$21.71$20.03−8%
Not in scope — the codes the proposal does not reach
99424–99427 · PCMNo structural change proposed$67.80$67.00−1%
99495 / 99496 · TCMNot addressed by the proposalOutside the remote-monitoring provisions entirely

National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those 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.

None of this is final. CMS-1848-P is a proposed rule. Comments are due September 14, 2026, the final rule is expected in early November, and it takes effect January 1, 2027. CoachCare is leading the advocacy — filing comments, putting the device cost and pricing evidence in front of CMS that the rule itself states the agency does not have, and helping practices file their own. This practice gets the final rates, and the model rerun against them, the week they publish.
Why CoachCare for The Nephrology Group

Built for the Way This Practice Runs

Six reasons this partnership fits TNG specifically, not remote care in general.

We run inside the chart you already use

CoachCare integrates bi-directionally with Greenway: eligibility flags and orders leave the EHR, and discrete vitals, care documentation and claim-ready charges come back into it. One chart for the nephrologists, one workflow for billing, and no second system to learn to start.

The model that runs without hiring

Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. TNG inherits a running program the month it turns on, at a 42.5% practice margin, with no hiring cycle. On-site enrollment is our expense — telephonic outreach converts about 8%, so we staff the clinic instead.

The practice stays in charge

Your nephrologists set the protocols, sign the care plans and make every clinical decision, and claims go out under TNG's own entity and NPIs. CoachCare supplies the staff, devices, platform and billing preparation under that governance — the operating model an independent group keeps control of.

One spine under the CKD panel

Continuous blood-pressure, weight and glucose surveillance is the early-warning and titration layer for chronic kidney disease and the hypertension that drives it. Principal Care Management is written for a specialist managing one complex condition and does not require you to be the primary care physician. Both run as one remote care service line.

The same work the ACCESS Model rewards

On the fee schedule the ACCESS Model pays remote care as a risk-based line, and it rewards exactly the between-visit management that keeps CKD patients out of the hospital. The forecast on this page models the reimbursement first; the model readiness sits on top of it.

Paid as you enroll — no capital, no lock-in

Fees are per active patient per month; there is no capital outlay and no payroll ramp. Because the forecast is set by enrollment pace, throughput is the lever. 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 Medicare panel against your own chart counts, scope the Greenway interface, and set the go-live cohort across the referring network.