Question 1

How does APCM automation impact MSSP shared savings?

Accepted Answer

Automated APCM identifies and engages high-risk beneficiaries consistently, reducing hospitalizations and ER visits. By lowering the total cost of care (TCOC) through proactive AI monitoring, ACOs increase their margins for shared savings while simultaneously generating fee-for-service revenue.

Question 2

Can AI-driven CCM reduce the total cost of care?

Accepted Answer

Yes. Tile’s AI identifies clinical trends before they escalate into acute events. By automating monthly check-ins and medication adherence calls, the platform ensures that chronic conditions are managed at the primary care level, preventing high-cost specialist or inpatient interventions.

Question 3

Does the platform assist with beneficiary assignment and retention?

Accepted Answer

Our AI outreach helps maintain high levels of patient engagement, which is critical for voluntary alignment. By providing a superior patient experience through consistent communication, patients are more likely to remain within the ACO network, stabilizing the attributed population.

Question 4

How does APCM revenue offset ACO operational costs?

Accepted Answer

APCM provides a predictable, recurring revenue stream that can fund the infrastructure of an ACO. By automating the labor-intensive outreach and documentation, Tile reduces the overhead required to capture these codes, allowing the revenue to be reinvested into population health initiatives.

Question 5

How can an ACO roll out CCM across hundreds of participating practices?

Accepted Answer

Tile Healthcare acts as a centralized AI hub, allowing ACO administrators to deploy standardized care management protocols across all participating TINs. This eliminates the need for individual practices to hire staff or manage separate CCM vendors, ensuring network-wide consistency.

Question 6

Does the AI integrate with multiple EHRs across an ACO network?

Accepted Answer

Tile is designed for interoperability. We aggregate data from diverse EHR systems within the ACO to provide a unified view of the patient. The AI then pushes documentation and care gap data back into the respective practice systems to maintain a single source of truth.

Question 7

How does AI ensure consistent care plan adherence across the network?

Accepted Answer

The AI follows standardized clinical pathways approved by the ACO quality board. Regardless of which practice the patient belongs to, the AI delivers a consistent engagement experience, ensuring that every beneficiary receives the same high standard of chronic care management.

Question 8

Can the system handle centralized or decentralized care management models?

Accepted Answer

Our platform is flexible. It can support a centralized ACO care management team by handling the bulk of patient outreach, or it can be deployed to support individual practices while reporting performance data up to the ACO administrative level.

Question 9

How does APCM overlap with ACO quality reporting requirements?

Accepted Answer

Many APCM requirements, such as preventative screening and medication reconciliation, directly align with MSSP quality measures. Tile’s AI automatically captures this data during patient interactions, making it easier to meet GPRO and APP reporting requirements without manual chart audits.

Question 10

Can AI help close care gaps for GPRO or APP reporting?

Accepted Answer

Absolutely. During routine CCM/APCM calls, the AI identifies outstanding care gaps—such as missing A1c tests or colonoscopies—and can even assist the patient in scheduling the necessary follow-up appointments within the ACO network.

Question 11

How does the platform handle CMS documentation for CCM billing?

Accepted Answer

The system logs every second of patient interaction and automatically generates the required documentation for the 20 minutes of non-face-to-face care. This ensures that every claim is audit-ready and meets the strict CMS requirements for chronic care management.

Question 12

Is the platform compliant with HIPAA and MSSP data privacy rules?

Accepted Answer

Tile Healthcare is fully HIPAA-compliant and uses enterprise-grade encryption. We sign Business Associate Agreements (BAAs) with the ACO and ensure that all data handling meets the specific privacy and security requirements mandated by the MSSP program.

Question 13

How does Tile’s AI handle complex patient inquiries?

Accepted Answer

Our AI uses advanced Natural Language Processing (NLP) specifically trained on medical terminology. It can answer common questions about chronic conditions, medications, and care plans, providing a conversational experience that feels natural to the patient.

Question 14

How does the system escalate clinical issues to human care managers?

Accepted Answer

If a patient reports symptoms that exceed predefined clinical thresholds, the AI immediately flags the case and can perform a live transfer to a nurse or care manager within the ACO, ensuring that urgent needs are addressed by a human professional.

Question 15

Does the AI support multi-lingual outreach for diverse populations?

Accepted Answer

Yes. To ensure equitable care across the entire ACO population, our AI supports multiple languages, allowing it to engage with beneficiaries in their preferred language, which significantly improves adherence and quality outcomes.

Question 16

Can the AI identify high-risk patients for proactive intervention?

Accepted Answer

By analyzing patient responses and historical data, the AI identifies 'rising risk' individuals who may be trending toward a hospitalization. These insights allow the ACO to intervene early with specialized care management resources.

CCM Automation Guide for ACOs | Tile Healthcare

MSSP & Shared Savings Strategy

Network-Wide Implementation

Quality Measures & Compliance

AI Call Handling Technology

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