Eight engines.
One platform.

The Annual Wellness Visit is the highest-volume Medicare revenue opportunity in primary care — and the most consistently missed. Most practices capture less than 40% of their eligible panel. Alema identifies every Medicare patient overdue for their AWV and automates the entire outreach and scheduling process.

• Medicare pays ~$180 per completed AWV — recurring annually for every eligible patient
• A panel of 500 Medicare patients with 60% completion gap = $54,000 in recoverable annual revenue
• AWVs also open the door to HCC coding, APCM enrollment, and VBC quality measure completion
• No AWV = no annual comprehensive assessment = missed downstream revenue across multiple engines

• Patients who complete annual wellness visits have better chronic disease management outcomes
• The AWV is often the only time a physician reviews a patient's full medication list and advance directives
• Early detection of cognitive decline, depression, and functional limitations happens at the AWV

• Scans your Medicare panel daily for patients 305+ days since last AWV
• Sends automated SMS outreach — no staff involvement required
• Tracks scheduling, appointment completion, and billing status
• Writes completed AWV back to athenaOne encounter record
• Logs revenue to your Realized Revenue dashboard automatically

Transitional Care Management is the most time-sensitive revenue opportunity in primary care. When a patient is discharged from a hospital or skilled nursing facility, CMS requires contact within 2 business days and a follow-up visit within 7 or 14 days to bill TCM. Miss the window — miss the revenue. Alema monitors the athenahealth ADT feed in real time and fires alerts the moment a discharge is detected.

• ~$215 per episode for moderate complexity (99495) — higher for high complexity (99496)
• Most practices capture less than 40% of eligible TCM episodes due to missed discharge alerts
• The 2-day contact window is non-negotiable — Alema fires the alert within hours of discharge
• TCM is fully automated — Alema contacts the patient, tracks the window, and logs the result

• Post-discharge follow-up reduces hospital readmission rates by up to 20%
• Patients discharged without follow-up are 3x more likely to be readmitted within 30 days
• TCM visits catch medication errors, missed referrals, and incomplete discharge instructions

• Monitors athenahealth ADT feed for hospital and SNF discharge events in real time
• Fires immediate alert — flags 2-day contact window and 7/14-day visit deadline
• Sends automated SMS to patient within the contact window
• Tracks visit completion and billing eligibility
• Logs captured TCM revenue to Realized Revenue dashboard

Chronic Care Management allows practices to bill monthly for non-face-to-face care coordination for patients with two or more chronic conditions. It is one of the highest-ROI recurring revenue streams in primary care — and one of the most underutilized. Alema identifies every eligible patient, sends consent via SMS, and manages monthly check-ins automatically.

• ~$62 per patient per month — recurring, predictable revenue with no additional visits required
• A panel of 100 enrolled CCM patients = $74,400 in annual recurring revenue
• CCM requires patient consent — Alema handles consent collection via SMS automatically
• Time tracking requirement (20 min/mo) is managed and documented by Alema

• Patients with chronic conditions benefit from regular care coordination and medication review
• CCM reduces ER visits and hospitalizations for high-risk patients
• Monthly touchpoints catch deteriorating conditions before they become emergencies

• Identifies all patients with 2+ chronic conditions from your EHR data
• Surfaces eligible patients for your team — consent obtained via SMS where applicable, by phone call, or in person at the visit
• Guides your team through enrollment, billing, and coding requirements — then manages monthly care management touchpoints and time tracking
• Monitors enrollment status and flags patients approaching billing thresholds

Advanced Primary Care Management is CMS's newest care management program — introduced in 2024 — and it pays significantly more than CCM for complex patients. APCM stratifies patients into three tiers based on complexity and pays $100, $110, or $195 per patient per month. Crucially, APCM does not require a separate qualifying visit — established patients seen within 3 years with 2+ conditions can enroll immediately.

• Tier 3 (G0558) pays ~$195/mo per patient — the highest per-patient care management rate CMS offers
• No new visit required for established patients — immediate enrollment for qualifying panel members
• AI-generated care plans reduce physician documentation burden significantly
• APCM and CCM cannot be billed together — Alema optimizes which program each patient enrolls in

• High-complexity patients receive more structured, coordinated care under APCM
• Care plans ensure all chronic conditions are actively managed and documented
• Monthly maintenance catches gaps in care before they become acute episodes

• Stratifies your panel by complexity tier using your EHR diagnosis data
• Surfaces eligible patients for your team — consent obtained via SMS where applicable, by phone call, or in person at the visit · established patients seen within 3 years require no new visit
• Generates AI care plans — physician reviews and signs
• Tracks monthly maintenance checklists and enrollment status across your panel

Hierarchical Condition Categories are the CMS risk adjustment model that determines how much Medicare Advantage pays for each patient. Every documented HCC diagnosis increases your patients' RAF score — and higher RAF scores mean higher capitation payments from MA plans. Alema maps your panel against CMS-HCC V28, surfaces every undocumented diagnosis code, and generates provider-ready documentation prompts.

• Each undocumented HCC can represent $2,000–$8,000 in annual capitation revenue per patient
• HCC codes must be documented every year — conditions from prior years do not carry forward
• Alema prioritizes patients by RAF score impact so you focus on the highest-value gaps first
• Provider-ready documentation prompts make it easy to capture codes during the visit

• Accurate HCC documentation ensures MA plans allocate appropriate resources for complex patients
• Underdocumented patients are systematically underfunded by their MA plans
• Proper RAF scores reflect true patient complexity and support appropriate care planning

• Maps your entire panel against CMS-HCC V28 diagnosis codes
• Surfaces unaddressed codes prioritized by RAF score impact
• Generates provider-ready documentation prompts per patient
• Tracks code capture and RAF score improvement over time

Value-based care contracts pay bonuses when practices hit quality measure thresholds — but navigating payer contracts, tracking HEDIS measures, and knowing which patients to prioritize is nearly impossible without the right tools. Alema's VBC Command Center is the first tool built specifically for independent practices to manage payer bonus contracts at the patient level.

• AI parses your payer bonus contracts — measures, thresholds, tiers, deadlines, and exclusions
• Every quality measure in your payer contract tracked against your patient panel in real time
• Surfaces the patients most likely to move your performance score per measure
• VBC bonuses can represent tens of thousands in annual revenue — most practices never collect them

• HEDIS measures represent evidence-based quality benchmarks for chronic disease management
• Patients whose care gaps are closed perform better on blood pressure, diabetes, and cancer screening measures
• VBC-aligned care is proactive, not reactive — better outcomes at lower cost

• Upload your payer bonus contract as PDF, CSV, or photo
• AI extracts measures, thresholds, tiers, attribution rules, and deadlines
• Maps your patient panel against each measure and surfaces gaps
• Recommends 3–5 patients per gap most likely to move your score
• Auto or manual outreach toggle — your choice

Most primary care physicians undercode their E&M visits — billing 99213 for encounters that clearly support 99214 or 99215. The reasons are well-documented: fear of audits, uncertainty about documentation requirements, and time pressure. Alema analyzes your E&M coding distribution against national benchmarks and surfaces every encounter where the documented complexity supports a higher level of service than was billed.

• $30–$80 per undercoded encounter — multiplied across hundreds of encounters per month
• The average primary care physician leaves $15,000–$30,000 per year on the table from undercoding alone
• Alema uses GPT-4o to analyze documentation complexity and suggest the appropriate code
• Provider reviews and confirms — Alema never changes a code without physician approval

• Accurate coding ensures the complexity of care is properly reflected in the medical record
• Undercoding can create gaps in the patient's documented medical history
• Proper E&M coding supports appropriate risk stratification for future care

• Analyzes your E&M coding distribution against national benchmarks by specialty
• Flags encounters where documentation supports a higher level of service
• Generates provider-ready code suggestion with rationale
• Physician reviews and confirms before any code change is made

Every denied claim costs your practice $25 to rework — and most practices have denial rates exceeding 10%. Alema catches problems before they become denials: missing modifiers, code pair conflicts, timely filing deadlines approaching, and payer-specific rules that vary by carrier.

• Payer-specific timely filing tracking — Medicare gives you 365 days, but Cigna and UHC can be as low as 90. Alema tracks every deadline by payer.
• NCCI code pair validation catches bundling conflicts before claim submission
• Denial reason trending identifies your top denial categories so you fix the process, not just the claim
• Clean claim rates above 95% reduce rework costs and accelerate cash flow

• Denied claims create surprise bills and confusing EOBs for patients
• Prior authorization delays are the #1 patient-reported barrier to accessing care
• Clean claims mean faster insurance processing and fewer patient phone calls

• Tracks every pending claim against payer-specific filing deadlines with color-coded urgency
• Validates code pairs against quarterly NCCI edits before submission
• Surfaces denial reason trends by category, volume, and dollar amount
• Flags missing modifiers and documentation gaps on same-day procedure + E/M billing