New The outcomes case for APCM: what monthly check-ins do for Medicare patients. Read the whitepapers
Medicare APCM · Independent primary care

Your patients’ ally, between visits.

Alli checks in with your Medicare patients every month by phone, text, and email, supervised by your care team and reimbursed under APCM. Your practice earns the revenue, and your day doesn't change.

12 / year
check-ins per patient
100%
flags human-reviewed
Zero
new hires or workflow changes
Exhibit 01: The call 0:00
AlliHi Margaret, it's Alli from Dr. Lee's office for your monthly check-in. Is now still a good time?
PatientOh yes, hello dear. Now's fine.
AlliLast month you mentioned your knee was bothering you on the stairs. How's it been?
PatientBetter, actually. The exercises the doctor gave me are helping.
CARE-PLAN FOLLOW-UP · KNEE: IMPROVING · LOGGED
AlliThat's wonderful. And your blood pressure, do you have a recent reading?
PatientThis morning it was 152 over 88. That's a bit high for me.
BP 152/88 · ABOVE 3-MONTH TREND → FLAGGED
AlliThank you for checking it. Any dizziness or lightheadedness since we last spoke?
PatientA little, when I stand up quickly.
NEW SYMPTOM · ORTHOSTATIC DIZZINESS → FLAGGED
AlliI'll make sure the team sees both of those today. And your refills, do you have enough of everything?
PatientI'm nearly out of the metformin, come to think of it.
REFILL REQUEST · METFORMIN → ROUTED TO OFFICE
AlliDone. The office will call it in. You'll get a reminder before your visit with Dr. Lee on the twelfth. Take care, Margaret.
ALL APCM SERVICE ELEMENTS DOCUMENTED · G0557 · NOTE FILED
Simulated call · synthetic voice preview · unmute to listen NOTE FILED TO EMR
EMR-agnostic by design

No integration project. No data migration. Alli documents into the chart workflow you already run.

EpicathenahealtheClinicalWorksNextGenVeradigmTebraAdvancedMDElationDrChronoPractice Fusion+ yours
Exhibit 02: The escalation

What happens when something's wrong.

What the patient said, and everything that happens to it before it reaches you.

During a monthly call
Margaret T. · monthly check-in2:14 PM
AlliIs there anything else that's been bothering you since we last spoke?
Patient"…my ankles have been swelling all week, but I didn't want to bother anyone about it."
AlliI'm glad you told me. I'll make sure Dr. Lee's team hears about this today.
What happens next · before it reaches you

Flagged in seconds

Her exact words go into the record. Alli doesn't offer advice or reassurance. It notes the swelling and passes it on.

Reviewed by a clinician

A human on Alli's clinical team reads the transcript against Margaret's history and trend. Urgency separated from noise.

Delivered to your practice

Escalation · same dayAlli → Dr. Lee's team
Margaret T., new bilateral ankle swelling, 1 week. Transcript and trend attached.
Your channel of choicePhoneSecure faxEmailEMR note
You decide · outcome logged in the EMR · next check-in knows
Exhibit 03: The paper trail

Each check-in leaves a compliant record.

APCM is a billing program with real requirements. Alli tracks them per patient, files each note, and hands your biller a clean file at month end.

Consent record
PatientMargaret T.
ProgramAPCM · explained in plain language
Consent✓ Captured & documented
Filed toPractice EMR

Before a single check-in happens, enrollment consent is captured and copied into the chart.

Monthly note
TouchpointVoice call · 4 min
SummaryGlucose ↑, refill needed
Flags2 → human review
Filed to✓ EMR · care plan updated

Transcript, structured summary, and flags, filed automatically after every conversation.

Billing file
PeriodMonth end
Requirements✓ Tracked per patient
CodesG0556 / G0557 / G0558
Delivered toYour biller

A billing-ready export your practice or billing company ingests. Your practice submits the claims to Medicare.

Exhibit 04: The economics

Medicare already pays for this.

Advanced Primary Care Management pays a monthly rate per patient for care between visits. Alli does the work and your practice bills the codes.

CY2026 national rates · per patient / month
G0556
Level 11 chronic condition or fewer
$16.37≈ $196 / YR
G0557
Level 22+ chronic conditions
$53.77≈ $645 / YR
G0558
Level 32+ conditions, QMB
$117.23≈ $1,407 / YR
Illustrative revenue: your panel
500 enrolled patients
1001,000
$300,000
per year
$25,000
per month

Illustrative only. CY2026 national rates, blended patient mix (~$50/patient/mo). Actual reimbursement varies by locality and mix. Your practice bills Medicare and owns all billing decisions; Alli never bills Medicare or practices medicine.

Exhibit 05: The guardrails

Powerful because it's careful.

The rules are absolute, and they're the reason physicians trust Alli with their patients.

Alli never

  • Gives medical advice. If Margaret asks whether 152 over 88 is okay, Alli says the team will look at it today, and nothing more.
  • Makes clinical decisions. Alli's clinicians decide what to escalate, and your practice decides what to do about it.
  • Bills Medicare. Your practice does its own billing.
  • Replaces a visit. Check-ins surface what needs you sooner. They never substitute for you.

Alli always

  • Operates under a signed BAA. HIPAA Business Associate; encrypted in transit and at rest. SOC 2 in progress.
  • Keeps a human in the loop. A clinician reviews each flag before it reaches your practice.
  • Documents everything. The transcript, the flags, and what your team decided, filed in your EMR on the patient's chart.
  • Runs isolated per practice. Your patients' data lives in your instance. No pooling, no sharing.
96%

Almost nobody gets this care.

About 96% of eligible Medicare patients never received chronic care management. The program asked practices to log minutes for every patient, and a nurse only paid for herself once about 131 patients were enrolled, so most independent practices never staffed it. APCM replaced the minute logging with a monthly rate per patient. Alli supplies the staff.

SOURCE: CMS CLAIMS ANALYSIS · SEE PAPER 03: "THE END OF MINUTE-COUNTING"
What the evidence says

The case for between-visit care isn't ours. It's the literature's.

Programs with frequent contact, medication management, and transitions support reduced hospitalizations, while low-touch telephone programs without them repeatedly failed.

The care-management literature
Synthesized in Paper 01

Physician-led, primary-care-dominant ACOs generated $403 in net per-capita savings, roughly 1.8× their hospital-centric counterparts.

Medicare Shared Savings Program
Most recent results · Paper 02

CMS redesigned care management into APCM explicitly "to reduce the administrative burden associated with current coding and billing."

CMS · Federal rulemaking
CY2025 PFS · Paper 03
Read the full evidence series →
Exhibit 06: Talk to us

Hear a check-in call before you decide anything.

Twenty minutes with us. We'll run your panel's numbers, go through your workflow, and dial a live check-in so you can hear what your patients would hear.

Your panel's illustrative APCM math, modeled with you
A live check-in call, so you hear how it sounds to a patient
How an escalation reaches you, and what the paper trail looks like

Prefer email? hello@allihealth.ai

We reply within one business day. We don't add you to any list.