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.
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.
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.
A dedicated hypertension center with self-run blood-pressure remote monitoring — clinical buy-in for RPM is already institutional.
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.
NPs and PAs running care management manually — clinically excellent, operationally expensive, and the first place scale breaks.
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.
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.
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.
Readings don't keep office hours. Alert triage at 2am either goes unstaffed or burns out the day team.
16-day supply counts, time-based documentation, code-stacking rules that changed again in CY2026 — audit exposure grows with every enrolled patient.
OS updates, store review cycles, HIPAA-grade security patches — carried by a two-developer team whose time the practice funds.
Home-grown data lives outside Greenway unless someone builds and maintains the pipes — so vitals end up in a portal nobody charts in.
In a self-built model every added patient adds staff load. In a full-service model every added patient adds margin.
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.
| Capability | TNG's Self-Built Program Today | CoachCare Full-Service |
|---|---|---|
| Clinical protocols & governance | Yours — proven by the AHA certification & KCE results | Stays yours. Physicians govern every decision. |
| Devices | App-dependent (smartphone required) | Cellular-connected devices — no app, no Wi-Fi, no smartphone needed; logistics handled end-to-end |
| Monitoring | Business hours, VBC team capacity | 24/7 clinical monitoring & alert triage, escalation to your protocols |
| Enrollment | Manual, clinic-by-clinic | Dedicated enrollment engine — two on-site enrollment specialists (at CoachCare's expense) + telephonic outreach across all 9 offices |
| Billing & compliance | Self-managed rules & documentation | Billing-grade documentation for every claim: day counts, time logs, audit trail |
| EHR integration | Data outside the chart | Native 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 maintenance | 2-person dev team | CoachCare's platform team — your developers return to analytics & KCE reporting |
| Unit economics | Each patient adds staff load | Each patient adds margin — modeled below |
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.
| Program | Year 1 | Year 2 | 24-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.
Continuous BP, weight, and glucose surveillance across the CKD and hypertension panels — cellular devices, no app required.
≈ $2.56M in avoided acute cost at $15K each — cost that also flows into CKCC shared-savings performance.
27,833 care-team hours of monitoring and documentation lifted off the VBC team — redeployed to top-of-license KCE work.
Recurring monthly professional-fee volume with billing-grade documentation behind every claim.
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.
Native Greenway integration configured; your hypertension-program protocols and escalation rules ported into CoachCare workflows; billing rules mapped for Noridian JE.
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.
Referral enrollment across all 9 offices for CKD 3b–5 and PCM; VBC team redeploys to titration, education, and KCE metric management.
~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.
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 $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.
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.
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.
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.
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.
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.
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 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 | $67.80 | $67.00 | −1% |
| 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. 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.
Six reasons this partnership fits TNG specifically, not remote care in general.
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.
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.
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.
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.
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.
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.