RPM, CCM and APCM Program Overview
Remote Patient Monitoring, Chronic Care Management and Advanced Primary Care Management with HealthSnap
Prepared for our partners
Organizations
170+
Healthcare organizations trust HealthSnap
Patients
100K+
Chronic patients remotely monitored and managed
EHRs
80+
Bi-directional integrations
Enrollment
35–40%
Patient enrollment rates
Agenda · select a section to jump there
Agenda
HealthSnap · RPM, CCM and APCM Program Overview
Solution overview
170+ Healthcare Organizations Trust HealthSnap
- Proven scale with enterprise health systems
- Remotely monitored and managed 100k+ chronic patients
- Peer-reviewed and published clinical outcomes and Total Cost of Care (TCOC) reduction
170+
Organizations
100K+
Patients
HITRUST
Certified
HealthSnap · Solution overview · Contents
Solution overview · select a program
Complementary Care Management Programs that Enable Personalized Care at Home
Clinical notes are logged in HealthSnap and integrated with the EHR · CPT codes covered by Medicare + secondary insurance
| Code | Billing overview |
|---|
HealthSnap · Solution overview · Contents
Solution overview · one patient, two program designs · select a call topic
Combining RPM with APCM
Example patient
72-year-old with hypertension and hyperlipidemia, on a cellular BP cuff. Started atorvastatin three weeks ago.
Scope
RPM time covers the monitored reading. Care management covers the whole care plan: medications, side effects, follow-ups, lifestyle and psychosocial needs.
Clinical
Adherence and side effects drive many uncontrolled readings. One navigator can address the cause, not just the number.
Claim capture
Work already happening on the call becomes documented care-management work that supports the monthly claim, instead of an unbilled redirect.
HealthSnap · Solution overview · Contents
Solution overview · select a pillar
Turnkey Virtual Care Management Solution for All Chronic Conditions
HypertensionHeart FailureObesityType II DiabetesCOPD / Asthma100+ chronic conditions through care plans
HealthSnap · Solution overview · Contents
Solution overview · select a capability
All-in-One RPM & CCM Platform
HealthSnap · Solution overview · Contents
Pre-configured | Cellular enabled | Ready to use and shipped direct to home
Deliver a Frictionless and Scalable Remote Monitoring Experience
Device agnostic
HealthSnap is not tied to a single manufacturer. Devices are matched to each program and patient, and readings flow into one platform and the EHR.
HealthSnap · Solution overview · Contents
Solution overview · driving customer brand-loyalty and highly engaged patients · select a step
White-Labeled Enrollment & Care Management Services
Everything branded for you
Branded Direct Mail
Provider Call Blast
Outbound Patient Calls
Calls display your practice name, not an unknown number.
Leads to
35–40%
Patient enrollment rates
HealthSnap · Solution overview · Contents
Solution overview
Clinical Team is Regional & Dedicated to You
HealthSnap’s clinical staff serves as an extension to your team.
- Clinical Operations Manager owns your program end to end
- Nurse Supervisors oversee clinical quality and escalations
- HealthSnap Care Navigators (LPNs) make enrollment, onboarding, alert and monthly care calls
HealthSnap · Solution overview · Contents
Solution overview
HealthSnap Enables Personalized Care in the Home
Centered around unique patient needs across 100+ chronic conditions.
Remote Patient Monitoring
CPT Codes 99453, 99445, 99454, 99470, 99457, 99458
- Customizable population, patient, and provider specific alerts
- Direct-to-home and on-site device fulfillment
- Patient and population data trends: % in range, highs, lows, averages
- Personalized RPM goals for every patient
- Automated RPM billing
Chronic Care Management and APCM
CCM 99490, 99439 · APCM G0556, G0557, G0558
- Flexible care plans for 100+ conditions
- A dedicated HealthSnap Care Navigator team
- Care plan goals, symptom management, SDOH and preventive appointment tracker
- Monthly medication tracking, adherence and reconciliation
- Automated CCM and APCM billing
HealthSnap · Solution overview · Contents
Workflow overview · flexible protocols, purpose built for your organization · select a sample
Program Documentation
Only HealthSnap Care Navigators are trained to master their DOMAIN
DData trends
OObtain reliable measures
MMedication compliance
AAssessment of goals
IIntegrative strategies
NNext appointment
HealthSnap · Workflow overview · Contents
Workflow overview · select an alert, then an outcome
Sample RPM Alert Triage Protocols
Alert level
HealthSnap care navigatorClient practice
First response
Outcome of the call
Workflow
Select Critical or Moderate alert to start.
HealthSnap · Sample protocol; thresholds and escalation paths are configured with each practice · Contents
Workflow overview · RPM, CCM and APCM
How It Works
1
Patient Identification & Enrollment
- Patients identified for RPM, CCM or APCM
- Provider or HealthSnap obtains patient consent
- HealthSnap enrolls the patient
2
Patient Device Shipment
- A pre-configured cellular device ships to the patient
- A HealthSnap Care Navigator supports setup
- The navigator ensures data transmission
CPT 99445, 99454
3
Communication & Reimbursement
- Care Navigator and ordering provider document care management
99470, 99457, 99458, 99490, 99439, G0556–G0558 - HealthSnap generates the monthly billing report
- The organization submits claims and is reimbursed
HealthSnap · Workflow overview · Contents
Workflow overview · select a phase
Customer Launch Phases
Working together in this phase
Workflow Strategy Guide
A thorough, fully customized guide documenting your combined CCM and RPM programs: patient identification, communication, enrollment, care monitoring, monthly calls, documentation, and billing/compliance.
HealthSnap · Workflow overview · Contents
EHR integration overview
Integrates with 80+ EHRs
EHRHL7HealthSnap
User clicks “Launch HealthSnap”
SSO →
Opens on the patient’s profile
Order sent (single, bulk or BPA)
ORM →
Order fulfilled to home
Vitals stored discretely
← ORU
Readings from cellular device
Note stored in the encounter
← MDM
Care-navigator note submitted
Encounter created
ADT →
Encounter number stored
Charges dropped to encounter
← DFT
Monthly eligibility report
Bi-directional EHR interface. Supporting documentation is stored in unique encounters, and charges are automatically dropped on the respective encounters. No manual intervention necessary.
HealthSnap · EHR integration overview · Contents
EHR integration overview · example: Epic · select a step, click the image to enlarge
EHR Integration in Epic
HealthSnap · EHR integration overview · Contents
Outcomes · across all HealthSnap portals · select a cell
Heat Map of Engagement and Outcomes
Blood pressure · hypertensive-baseline patients
Starting at ≥160 mmHg
−33.7 vs −24.3
Mean SBP change at 6–7 vs ≤3 readings per week
Reached control, ≥160 mmHg
35.6% vs 18.0%
At 6–7 vs ≤3 readings per week
Within every starting band, the most engaged patients had the largest change. Frequency is self-selected, so the pattern is an association.
HealthSnap · Program-wide BP extract, Aug 2025, de-identified and pooled across client portals (cells sum to 28,336) · Contents
Outcomes · across HealthSnap portals · select a view
Glucose Outcomes
Fasting glucose by starting level
mg/dL mean within-patient change
Program-wide · n = 4,647
HealthSnap · Program-wide: HealthSnap Glycemic Control in RPM white paper; regional: de-identified health system, paired t-tests; associations · Contents
Outcomes · interactive · baseline, frequency, duration and age
Outcomes Explorer
Starting systolic BP
Readings per week
Days on program
Patient age
Projected SBP Δ
Projected SBP
Observed control
Lifetime QALYs
Based on the program-wide heat map. Starting SBP is the band midpoint; the observed change is scaled by a typical HealthSnap fixed-cohort time course (time constant 40 days), capped at 6 months. QALYs apply a published cost-utility model (Taylor et al., JSCAI 2025) at the selected age, assuming the reduction is sustained. Illustrative, not an individual prediction.
HealthSnap · Outcomes · Contents
Outcomes · fixed cohorts, same patients every period · select a measure
Reduction in Alerts Over Time
Systolic BP alerts, month 2 to 12
−92%
1.50 → 0.12 alert days per patient; 94% had no systolic alert in month 12 (n = 2,910)
High-glucose alerts, bins 2 to 10
−70%
1.81 → 0.55 alerts per patient per 10 readings (n = 429)
Low-glucose alerts, bins 2 to 10
−74%
1.32 → 0.34 alerts per patient per 10 readings (n = 267)
Built to lift admin burden
Alert protocols are set with each practice so HealthSnap Care Navigators call, recheck, educate and document. Providers see an alert only when the protocol calls for escalation.
92%
of escalated alerts were closed by the navigator with no treatment change or emergency referral: a call to the patient, a recheck, education. 873 escalated alerts across four partner programs.
HealthSnap · Trends: program-wide fixed cohorts, period 1 elevated by construction (hollow). 92%: automated text-classification of navigator notes on escalated alerts · Contents
Program-wide evidence · peer-reviewed · Telemedicine and e-Health, 2026
Published Evidence: Total Cost of Care
Smith W, Orsky A, Ewing JA, Flanagan C. Short-Term Impact of Remote Patient Monitoring on Total Cost of Care Among High-Acuity Medicare Beneficiaries. Telemed J E Health. 2026. doi:10.1177/15305627261475507
Median TCOC
−$10,932
$25,956 → $11,792 per patient · p < 0.001
Hospitalizations
−40.9%
770.5 → 455.6 per 1,000 · p < 0.001
ED visits
−19.9%
1,269.7 → 1,016.8 per 1,000 · p < 0.001
Illustrative ROI
9.0:1
$6.47M net at $100 PPPM
HealthSnap · 597 Medicare beneficiaries, pre-enrollment TCOC ≥$12,000, ≥5 months enrolled · retrospective pre–post, no concurrent control · Contents
Value-based care · select a model
Readmission Reduction and Value-Based Care Programs
HealthSnap · Value-based care · Contents
Value-based care · working with health plans · select a measure
Improving HEDIS Measures and Star Ratings
| Star Ratings measure | Part | Weight |
|---|
Weights from the CMS 2026 Star Ratings measure list. Select a measure.
HealthSnap · CMS 2026 Star Ratings measure weights; HEDIS alignment conceptual, not a certified quality submission · Contents
Economics · select a program
Fee-for-Service Programs and Reimbursement
Each program is billed by the ordering organization under Medicare and secondary insurance. HealthSnap delivers the documented services that support each code.
| Code | Service | National avg. reimbursement |
|---|
National average Medicare reimbursement as used in the 2026 HealthSnap Care Management ROI Calculator; actual payment varies by locality and payer.
HealthSnap · Economics · Contents
Economics
HealthSnap Fee Schedule
Per patient, per month unless noted. HealthSnap covers one device per patient at no cost.
Device
$0
One cellular device per patient; $1 per month cellular fee
Alignment
Time and transmission fees apply only when the corresponding code is met that month.
Source
2026 HealthSnap Care Management ROI Calculator.
HealthSnap · Economics · Contents
Economics · interactive
Revenue Calculator
Monthly code compliance, % of enrolled patients
Gross reimbursement
HealthSnap fees
Net revenue to the organization, annually
Net by program
Mirrors the 2026 HealthSnap ROI Calculator: national average Medicare reimbursement, default monthly code-compliance rates, 12 months of enrollment, setup billed once. Actual results vary with locality, payer mix and engagement.
HealthSnap · Economics · Contents
Partner success stories · select a partner
Partner Success Stories
Patient outcomes white papers available for each partner on request.
HealthSnap · Partner success stories · Contents
Partner success stories · in their words · select a quote
Real Partner and Patient Testimonials
Our mission: To empower patients with chronic conditions, anytime anywhere.
HealthSnap · Partner success stories · Contents
Summary · select a topic
Summary & Joint Action Plan
HealthSnap · Summary · Contents