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| Valuation of Care Coordination Services and Value-Based Care (2335Q) |
Course CPE: 1 hour
Field(s) of Study: Finance–1 hr
Program Level: Intermediate
Prerequisites: Previous training or research on subject matter being taught. Such persons are often at a mid-level within the organization, with operational and/or supervisory responsibilities.
Advanced Preparation: None
Delivery Method: QAS Self-Study |
Item
Number: 26HC0819VCC
Shipping Weight: 0lbs. 0oz. |
| Price:
$99.00 |
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Recording Date: August 19, 2026
Presenter: Jessica Bailey-Wheaton, Todd Zigrang
Program Description:
This course will provide valuation professionals with a comprehensive examination of the rapidly evolving care coordination services sector and the broader transition to value-based care, both of which have emerged as critical areas of healthcare valuation practice.
The U.S. healthcare industry has undergone a fundamental transformation over the past decade, driven by the shift from volume-based to value-based care delivery models and the growing recognition that fragmented care systems contribute to suboptimal patient outcomes and inflated costs. Care coordination services have emerged as a critical infrastructure component, bridging the gaps between primary care providers, specialists, hospitals, post-acute care facilities, and community-based organizations.
The presentation will analyze the key demand drivers for care coordination services, including the aging U.S. population, the increasing prevalence of chronic disease, and the ongoing primary care physician shortage, alongside the supply-side constraints shaping the competitive landscape. Attendees will gain a working understanding of the Medicare reimbursement framework for care coordination, including chronic care management (CCM), transitional care management (TCM), remote patient monitoring (RPM), principal care management (PCM), and the newly introduced advanced primary care management (APCM) codes, as well as how the Medicare Physician Fee Schedule and its 2026 conversion factor update affect provider revenue.
The course will address the federal regulatory environment governing these arrangements, including the Anti-Kickback Statute, the Stark Law, and the value-based arrangement exceptions and safe harbors finalized under the Regulatory Sprint to Coordinated Care initiative. Recent federal enforcement actions, including the Bluestone Physician Services settlement and OIG scrutiny of RPM billing patterns, will be discussed to highlight current compliance risks.
Finally, the course will examine the technological innovations reshaping care coordination, including care coordination information technology (CCIT), artificial intelligence applications in risk stratification and workflow automation, and the continued expansion of telehealth and remote monitoring. Participants will leave equipped to identify valuation considerations unique to care coordination arrangements, including fair market value and commercial reasonableness determinations for compensation structures in value-based arrangements.
Takeaways
After completing this course, attendees will be able to evaluate care coordination arrangements within the context of the evolving value-based care landscape and the federal regulatory framework governing healthcare compensation. Attendees will be equipped to analyze Medicare reimbursement for care coordination services and to recognize the compliance risks highlighted by recent federal enforcement actions involving CCM and RPM billing. Attendees will also be able to assess the technological capabilities that are reshaping the competitive environment for care coordination providers and understand how those capabilities affect valuation conclusions. Finally, attendees will be positioned to render fair market value and commercial reasonableness opinions for care coordination service arrangements, including value-based arrangements structured under the Stark Law and Anti-Kickback Statute safe harbors and exceptions.
After completing this course, you will be able to:
- Identify the role of care coordination services in the U.S. healthcare delivery system and the market forces driving demand, including the shift to value-based care, the aging population, the growing prevalence of chronic disease, and the primary care physician shortage
- Recognize the mechanics of the Medicare Physician Fee Schedule (MPFS), including the resource-based relative value scale (RBRVS) system, geographic practice cost indices (GPCIs), and the impact of the 2026 conversion factor update on provider reimbursement
- Identify how the federal Anti-Kickback Statute and Stark Law apply to care coordination arrangements, including the value-based arrangement safe harbors and exceptions finalized under the Regulatory Sprint to Coordinated Care initiative
- Determine the significance of recent federal enforcement actions targeting improper billing of care coordination services, including the OIG’s identified billing patterns warranting heightened scrutiny in remote patient monitoring
- Recognize the technological innovations transforming care coordination delivery, including care coordination information technology (CCIT) platforms, artificial intelligence applications for predictive risk stratification and workflow automation, telehealth, and remote patient monitoring
- Select appropriate fair market value and commercial reasonableness principles for compensation arrangements involving care coordination services, including value-based arrangements with varying levels of financial risk
For more information regarding refund or concerns, please contact our offices at (800) 677-2009.
The Consultants’ Training Institute (CTI) is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org. |
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