FAQACOs (Accountable Care Organizations)

CCM Automation Guide for ACOs | Tile Healthcare

Optimize MSSP shared savings and quality measures with AI-powered APCM and CCM automation designed for Accountable Care Organizations (ACOs).

As Accountable Care Organizations (ACOs) navigate the transition to Advanced Primary Care Management (APCM) and the Medicare Shared Savings Program (MSSP), scaling chronic care initiatives becomes a financial necessity. Tile Healthcare provides AI-powered call center solutions that automate patient outreach, care gap closure, and documentation, ensuring your ACO maximizes shared savings while r...

MSSP & Shared Savings Strategy

4 questions

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.

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.

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.

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.

MSSP & Shared Savings Strategy

How does APCM automation impact MSSP shared savings?

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

Does the platform assist with beneficiary assignment and retention?

How does APCM revenue offset ACO operational costs?

Network-Wide Implementation

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

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.

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

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.

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

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.

Can the system handle centralized or decentralized care management models?

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.

Quality Measures & Compliance

How does APCM overlap with ACO quality reporting requirements?

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.

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

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.

How does the platform handle CMS documentation for CCM billing?

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.

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

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.

AI Call Handling Technology

How does Tile’s AI handle complex patient inquiries?

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.

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

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.

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

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.

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

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.

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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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