SERVICE · SPECIALIZED CARE PROGRAMS

Specialized care program services for practice growth.

Specialized care programs are structured services that help patients who need regular follow-up. These programs create a coordinated plan to track lab results, adjust medications, and coordinate referrals for better treatment. Prime Health United manages these programs end-to-end so patients receive consistent care and practices gain sustainable revenue.

Expand with Confidence

Nurse coordinating chronic care follow-up and medication review — CCM · RPM · BHI programs

WHY IT MATTERS

Improve patient outcomes and grow practice revenue.

Chronic diseases drive nearly 90% of U.S. healthcare costs, with 6 in 10 adults managing at least one chronic condition and 4 in 10 living with two or more. These patients need regular follow-up, medication management, and preventive monitoring for consistent care.

Prime Health United runs your specialized care programs so results are steadier, healthier, and stronger — generating a more predictable revenue stream for your practice.

Patient follow-up visit for chronic condition management — Regular follow-up, billed correctly

OUR PROGRAMS

CMS-recognized care programs.

Prime Health United runs care programs recognized by the Centers for Medicare & Medicaid Services (CMS), helping you improve patient outcomes and create steady reimbursement.

Chronic Care Management (CCM)

Supports patients with two or more chronic conditions. We handle monthly check-ins, care plan updates, and documentation so CCM codes can be billed without gaps.

High-risk patient receiving coordinated complex care

Complex Chronic Care Management (CCCM)

For patients with multiple high-risk conditions. We coordinate at least 60 minutes of structured care each month to meet billing requirements for complex patients.

Specialist managing a single high-priority condition

Principal Care Management (PCM)

Focuses on a single serious condition. We manage the monthly touchpoints and records so providers can bill PCM services accurately.

Connected devices feeding RPM data into the EHR

Remote Patient Monitoring (RPM)

PHU delivers remote patient monitoring through connected devices. We track and log results in the EHR to meet the highest quality and control standards.

Primary care and behavioral health collaborating

Collaborative Care Management (CoCM)

Brings together primary care, behavioral health, and psychiatric consultation through a structured, team-based model and shared plans so CoCM codes are supported.

Behavioral health notes documented in primary care

Behavioral Health Integration (BHI)

Integrates mental health with primary care. We document 20+ minutes of management for conditions like depression or anxiety and bill details accurately.

PRICING

A tiered payment model that grows with you.

As your patient panel grows, Prime Health United share steadily decreases, which means you keep more of the revenue. There are no complicated or hidden rules.

Tier Patient Count PHU Share Your Share

Tier 1 Up to 100 50% 50%

Tier 2 101–200 48% 52%

Tier 3 201–400 46% 54%

Tier 4 401–700 43% 57%

Tier 5 701–1000 39.5% 60.5%

Tier 6 1000+ 35% 65%

Note: For tier calculations, each program enrollment counts separately (e.g., if one patient is in two programs, they are counted twice). This ensures fair alignment between service usage and revenue sharing.

REFERRAL REWARDS

Referrals reward both sides.

For every practice you refer to PHU, your share increases by 1%, and that practice also starts with a 1% advantage.

For example, if you are in Tier 2 (150 patients), Prime Health United share is 48% (your share: 52%). After you refer another practice, PHU share for you drops to 47% (your share: 53%).

Note: Only one type of discount applies at a time — either your tier rate or your referral reward.

Practice leaders sharing a specialized-care referral — 1% advantage for both practices

How we work with you

Patient enrollment & eligibility
Program setup & care coordination
Monitoring, communication & documentation
Billing, compliance & reimbursements

Launch care programs

FAQs

Specialized care questions, answered.

Get started with specialized care programs today.

Care programs often face delays when requirements like documented consent and data thresholds are not consistently met. Prime Health United manages every part of the process — eligibility, consent, care activities, documentation, and billing preparation.

Grow with compliance