On January 1, Medicare stopped paying rural health clinics one bundled rate for care management and started paying for each service separately — chronic care management, remote monitoring, and advanced primary care management, each on its own code, each paid on top of the all-inclusive rate. North Caddo's six certified Rural Health Clinics already hold the panel. This is what building the service line around it looks like.
For years, rural health clinics billed care management through a single bundled code, G0511, at one flat rate no matter how much care was delivered. CMS sunset that code on September 30, 2025. Since January 1, 2026, RHCs and FQHCs bill the individual CPT and HCPCS codes at national non-facility rates — and a single patient can carry chronic care management, remote monitoring, and behavioral health integration at the same time, each separately payable on top of the visit.
Care management was a single bundled payment. Doing more for a complex patient than a simple one produced exactly the same revenue, so there was little reason to build depth.
CCM (99490/99439), RPM (99445/99454/99457/99458/99470), and APCM (G0556/G0557/G0558) each bill on their own. Documented time and complexity now translate directly into revenue.
Unbundling multiplies claim volume. At the scale modeled here that is roughly 22,054 individual claims across 24 months — which is precisely why the billing engine, not the clinical protocol, is the part that usually breaks.
CMS added 99445 (device supply for 2–15 days of readings in a 30-day period) and 99470 (10–20 minutes of monitoring management time). The first matters disproportionately in a rural panel: under the old rules a patient who transmitted fewer than 16 days of readings in a month generated nothing at all. Patients who travel, lose power, or lose signal for part of a month are now billable rather than written off. In the model on this page those two codes carry $81,780 of 24-month reimbursement — 17% of all remote-monitoring revenue, from codes that did not exist two years ago.
All six sites are provider-based Rural Health Clinics of the hospital's Medicare certification. Under the current rules, an RHC bills these individual care-management codes at national non-facility rates — separately from, and in addition to, the all-inclusive rate for the visit itself. This is new revenue on top of what the clinics already bill, not a reallocation of existing revenue.
Louisiana's local Medicare rates run roughly 7–13% below national rates across this code set. Every figure on this page is modeled at the lower Louisiana rates — so if the national RHC basis applies as expected, the real numbers are approximately 8% higher, and because CoachCare's fees are fixed per patient per month, essentially all of that difference falls to North Caddo. We have deliberately left it out rather than quote you a number we cannot yet tie to a published rate table.
In December 2025 CMS awarded Louisiana $208.4 million in Year 1 Rural Health Transformation Program funding — an estimated $1.4 billion over five years. The Louisiana Department of Health's funded plan names rural health clinics and critical access hospitals as target recipients and explicitly funds remote-monitoring devices, care-coordination technology, and "innovative care models not traditionally billable." LDH committed to CMS on chronic-care outcome measures — blood-pressure and A1c control, and a reduction in potentially preventable emergency visits.
A remote care service line is close to a direct expression of what the state told CMS it would fund. And North Caddo is a critical access hospital operating six rural health clinics in a parish ranked 48th of 64 in Louisiana for health outcomes.
Sub-grant windows are open right now. As of late July 2026, LDH has three application deadlines pending:
August 5 — Rural Collaborative Provider Models · August 7 — Rural Medicaid Alternative Payment Model · August 14 — Regional Care Conveners & Navigation Networks, and Food is Medicine
A Rural Provider VBC/APM Readiness Survey is also live.
These two funding paths also have to be reconciled with each other. Attachment 12 of the HRSA notice exists specifically for applicants who participate in or benefit from their state's CMS Rural Health Transformation Program. Where it applies it is mandatory, and it must explain how the HRSA-funded work is non-duplicative, coordinated and complementary to the CMS-supported work. Reviewers do not score it — but omitting it when it applies is a compliance problem.
Critical access hospital and rural health clinic reimbursement is cost-based — for much of what North Caddo does, growing volume also grows the allowable cost base it is paid against. Care management billed at the fee schedule is different. It is separately payable, at a published rate, on top of the all-inclusive rate — one of the few places where new revenue is genuinely incremental margin rather than a larger number on both sides of the ledger. That is the structural reason this service line is worth building even though the clinics are already busy.
Certification status verified against the CMS Provider of Services file (Q2 2026).
North Caddo runs six family-practice sites from the hospital campus on South Pine Street in Vivian out to South Bossier — about 35 miles end to end, across two parishes. That footprint is the organization's greatest strength and the exact reason chronic disease is hard to hold steady between visits.
A hypertensive patient in Oil City is seen a few times a year. In between, nobody sees a blood pressure. Remote care closes that gap without asking the patient to drive: the reading comes to the clinic, a care manager works it, and the patient is only asked to travel when travel is actually the answer.
Straight-line distance from the Vivian hospital campus to South Bossier Medical — the widest point of a six-site footprint.
Ten physicians and eight advanced practice providers across the six clinics, the emergency department, and surgery.
Every clinic is a certified Rural Health Clinic of the hospital — three of them added since 2021, while the regional system next door divested.
Six decades of continuity, and the same chief executive for the last twenty. The relationship that makes enrollment work is already there — that is the hardest part to buy.
These are not our estimates. They are CMS and CDC figures for the two parishes North Caddo's clinics serve.
Caddo Parish standardized Medicare spend runs $15,831 per beneficiary against $12,553 nationally.
274 covered stays per 1,000 beneficiaries against 225 nationally — the gap remote monitoring is built to close.
664 ER visits per 1,000 against 591 nationally. Bossier Parish is higher still at 683.
In Caddo Parish, against 17.2% with diabetes — both well above national rates, and both directly monitorable.
Distances computed from the clinic coordinates published on ncmcla.com (retrieved July 2026); road distance is longer. Clinician roster and founding year as published by North Caddo Medical Center. Utilization figures: CMS Medicare Geographic Variation, CY2024. Chronic disease prevalence: CDC PLACES, 2024 release, crude prevalence among adults 18+. Rural Health Clinic certification verified in the CMS Provider of Services file, Q2 2026.
This model is built on a Medicare panel of 4,000 patients across the six clinics. Nothing here depends on growth, new referral sources, or new service lines — only on serving the panel that already walks through the door.
The starting population across all six family-practice sites.
An estimated 75% carry at least one condition appropriate for remote care. With 44% of Caddo Parish adults hypertensive and 17% diabetic — before adjusting for a Medicare-age panel — this is a conservative read.
Deduplicated across programs — roughly 30% of the in-scope population, reached at a deliberate pace.
RPM 683 · CCM 360 · APCM 315. Many patients carry both monitoring and care management.
All three programs reach their modeled ceilings by month 12 and hold flat thereafter. Fourteen panel-owning providers plus one enrollment specialist fill a 3,000-patient scope inside a year. So the size of this service line is set by the eligible population and the enrollment rates, not by how fast it is staffed. More enrollment capacity reaches the same ceiling sooner — a second specialist is worth roughly $46,000 more over 24 months, with diminishing returns after that — but it cannot raise the ceiling. Confirming a larger eligible population can, and moves the forecast close to proportionally. The Scenario Explorer below lets you test both.
The 4,000-patient panel is a figure supplied for this analysis. It is consistent with the footprint: Caddo and Bossier Parishes hold 75,451 Medicare beneficiaries, so 4,000 is about 5.3% of the two-parish Medicare population — a modest share for the only critical access hospital and six-clinic primary care network in the northern half of that market.
One enrollment engine, one device and triage operation, and one billing pipeline serve the same Medicare panel through whichever code fits each patient — rather than three separate programs bolted onto the clinics.
Cellular-connected blood pressure cuffs, scales, and glucometers on the sickest slice of the panel. Readings arrive daily; a care manager works them against protocol.
683 patients at month 24 · $931,939 over 24 months — the largest single line
Monthly non-face-to-face coordination with a comprehensive care plan, for patients carrying two or more chronic conditions. This is the work your nurses already do without being paid for it.
360 patients at month 24 · $700,014 over 24 months
A monthly per-patient payment for longitudinal primary care — no time threshold to document. Built for exactly the population a rural clinic serves.
315 patients at month 24 · $390,306 over 24 months
APCM pays on three tiers, and the top tier exists specifically for Qualified Medicare Beneficiaries — dual-eligible patients with two or more chronic conditions. In Louisiana that tier pays $110.46 per patient per month against $15.49 for the base tier: seven times the rate, for exactly the patients a rural clinic in a high-poverty parish sees most.
And that tier is unusually well populated here. Per CMS enrollment data, 18.1% of Caddo Parish Medicare beneficiaries are QMB — against a national share around 12–13% — with 28.2% dual-eligible overall. Combined with 44% hypertension and 17% diabetes prevalence, a large share of the enrollable panel falls into G0557 or G0558 rather than the base tier.
| APCM tier | Who qualifies | 2026 LA rate / patient / month | Modeled share |
|---|---|---|---|
| G0556 — Tier 1 | One or fewer chronic conditions | $15.49 | 15% |
| G0557 — Tier 2 | Two or more chronic conditions | $50.67 | 55% |
| G0558 — Tier 3 | QMB dual-eligible with two or more chronic conditions | $110.46 | 30% |
| Blended rate at the modeled tier mix | $63.33 | 100% | |
The 15 / 55 / 30 tier mix is an estimate and is the single largest lever on APCM revenue. The modeled 30% Tier-3 share sits above the 16% population-wide QMB share across the two parishes, on the reasoning that enrollment concentrates among the chronically ill, who skew dual-eligible.
Rates shown are 2026 Medicare non-facility rates for the Louisiana locality (Novitas JH). CCM and APCM are mutually exclusive for the same patient in the same month — patients sit in one or the other, never both.
| Code | Service | Frequency | 2026 LA rate |
|---|---|---|---|
| 99453 | RPM — device setup and patient education | Once per episode | $19.26 |
| 99445 New 2026 | RPM — device supply, 2–15 days of readings | Monthly | $46.14 |
| 99454 | RPM — device supply, 16+ days of readings | Monthly | $46.14 |
| 99470 New 2026 | RPM — monitoring management, 10–20 minutes | Monthly | $24.30 |
| 99457 | RPM — treatment management, first 20 minutes | Monthly | $48.26 |
| 99458 | RPM — treatment management, each additional 20 minutes | Monthly | $39.09 |
| 99490 | CCM — first 20 minutes, two or more chronic conditions | Monthly | $62.54 |
| 99439 | CCM — each additional 20 minutes | Monthly | $47.45 |
| G0556 / G0557 / G0558 | APCM — advanced primary care management, by tier | Monthly | $15.49 / $50.67 / $110.46 |
All six North Caddo clinics are certified provider-based Rural Health Clinics, so these services should be paid at national non-facility rates rather than the Louisiana locality rates shown above — which run 7–13% lower across this code set. That difference is deliberately not included in any figure on this page; the model uses the more conservative Louisiana basis throughout.
A CoachCare-funded enrollment specialist works on site, plus telephonic outreach. Consent, education, and device fitting are ours.
Cellular-connected devices shipped, activated, and replaced. No clinic Wi-Fi dependency, no patient smartphone required.
Health coaches review readings daily against protocol and escalate by the rules in the next section. 9,904 hours over 24 months — about 4.8 full-time equivalents your clinics do not hire.
Your providers keep every clinical decision, order, and care-plan approval. The escalation routes to your team — the labor around it does not.
| Function | North Caddo | CoachCare |
|---|---|---|
| Identify the eligible population | Run the population reports from Veradigm | Risk-stratify, determine program eligibility and primary device, return the reviewed list |
| Enroll patients | Provider referral at the visit; the Coordinator and Enrollment Specialist own the conversation | On-site enrollment specialist during launch at our expense; telephonic campaigns once the program is established |
| Devices & logistics | Nothing | Sourcing, fulfillment, patient setup, replacement and end-of-life |
| Monitoring & triage | Nothing | RNs, LPN/LVNs and CMAs monitor readings, contact patients, verify and triage |
| Care plans & med reconciliation | Clinical sign-off | Care plan development and follow-through; medication reconciliation as part of CCM |
| Clinical escalation | Receive escalations in a designated triage bucket and act on them | Escalate only what exceeds nursing scope, with clinical context attached |
| After hours | Your existing after-hours pathway | Follows your protocol; direct emergency activation where warranted |
| Chart documentation | Nothing — no scanning, no keying | Evidence-of-care documents written to the patient chart automatically |
| Claims | Submit; work denials | Automated claim creation in the practice management system |
| Revenue cycle | Monthly reconciliation for the first six months, then quarterly | Supply the reconciliation reporting and join the review |
| Reporting | Review; set the measure set | Monthly performance report; custom measures built with your client success advisor |
The one genuine ask is a named program champion. Everything in the middle column is either existing work or a few hours a month — except enrollment, which is where clinic engagement determines the outcome.
The on-site enrollment specialist is staffed at CoachCare's expense. It is embedded value in this arrangement, not a cost carried by North Caddo, and is never deducted from the margin shown on this page.
The 2026 unbundling created a billing problem before it created a revenue opportunity: roughly 22,000 individual claims over 24 months, each tied to documented time on a specific patient in a specific month. That is where rural programs stall.
CoachCare is the only care management application integrated with Veradigm Practice Management that creates claims automatically through its own billing engine — eliminating the manual claim-creation step for each patient, every month.
Enrollment flags and trigger ordering by service appear in the workflow your providers already use. Enrollment status is visible in real time — no separate system to learn, no parallel worklist.
Evidence of Care, vitals reports, and care plans attach to the patient's chart monthly. When an audit asks what was delivered, the answer is already in the record — where a reviewer expects it.
Claims generate into Practice Management from the billing engine. This is the difference between a program that scales past a few hundred patients and one that does not.
Patients typically begin receiving services within five days of enrollment. North Caddo runs Veradigm on the clinic side — which is where care-management billing lives — and Oracle Health on the hospital side; the integration described here targets the clinic environment where the program operates.
Every reading from every program — monitoring, care management, advanced primary care — routes through one escalation engine with one set of rules. Your team sees signal, not noise.
Escalates regardless of symptoms. There is no judgment call and no waiting for a pattern — a critical reading is acted on when it arrives.
Worked through a retake and symptom check first, so a bad cuff placement does not become a phone call to your nurse.
Defined objectively, not impressionistically: three consecutive readings at least an hour apart for blood pressure or glucose, or three readings within seven days for heart rate.
Chest pain, new shortness of breath, stroke signs, syncope, worst-ever headache, or sudden swelling: 911 is called with the patient still on the line. If the patient refuses, they are directed to the clinic; if they refuse that, CoachCare activates 911 anyway. This urgent and emergent policy supersedes any client-specific escalation preference — including North Caddo's.
Routed to the specific person North Caddo designates, by clinic site, during defined hours. Not a general inbox.
Documented as an FYI in the chart. No interruption, but a complete trail.
Triggered automatically by any emergency visit or hospitalization in the previous 60 days — the window where rural readmissions are won or lost, and where a 15-bed hospital feels every avoidable return.
Medication reconciliation, red-flag review, confirmation the patient understands what changed.
Symptom and adherence check; follow-up appointment confirmed and barriers to getting there surfaced early.
Stability confirmation and hand-back into the routine monitoring cadence.
Each touch documents and escalates clinical alerts under the same protocol above.
Unreachable patients are pursued on a fixed cadence — voicemail and callback, with escalation proceeding anyway if the value was critical or part of a trend. If a patient cannot be reached, the clinic is notified and the case re-escalates every 30 days rather than quietly lapsing. Every escalation documents the vital, the findings, the contact method, who was reached, the outcome, and the follow-up. The practice is notified at every decision point.
Built from North Caddo's published footprint and 2026 Louisiana Medicare rates. Because the HRSA pilot starts at one site, the service line is modeled in two phases — the tables below the next one describe Phase 2, the mature network.
| Two phases, because the grant starts at one site | Phase 1 — Vivian pilot | Phase 2 — full network |
|---|---|---|
| Medicare panel | 1,000 | 4,000 |
| In scope (75% with a qualifying condition) | 750 | 3,000 |
| Panel-owning providers | 3 | 14 |
| Enrolled services at ceiling | 340 | 1,358 |
| Unique enrolled patients | 221 | 885 |
| Ceiling reached | Month 3–6 | Month 6–18 |
| 24-month net reimbursement | $640,862 | $2,022,259 |
| 24-month net to North Caddo | $269,328 | $871,589 |
| 24-month margin | 42.0% | 43.1% |
Everything below this table describes Phase 2 — the mature service line across all six clinics. The pilot reaches full census by month five, because three providers and one on-site enrollment specialist saturate a 750-patient in-scope panel quickly. That leaves a long measurement window for the grant's quality reporting.
| Financial summary | Year 1 | Year 2 | 24-month |
|---|---|---|---|
| Net reimbursement | $665,453 | $1,356,805 | $2,022,259 |
| CoachCare fees (incl. setup & integration) | $384,496 | $766,173 | $1,150,669 |
| Net to North Caddo | $280,957 | $590,632 | $871,589 |
| Margin | 42.2% | 43.5% | 43.1% |
| By program · 24 months | Net reimbursement | Fees | Net to NCMC |
|---|---|---|---|
| Remote Patient Monitoring | $931,939 | $532,984 | $398,954 |
| Chronic Care Management | $700,014 | $347,020 | $352,994 |
| Advanced Primary Care Mgmt | $390,306 | $216,680 | $173,626 |
| Implementation, integration & enrollment | — | $53,985 | −$53,985 |
| Total | $2,022,259 | $1,150,669 | $871,589 |
Month 1 carries the implementation and integration cost and runs slightly negative (−$3,488); the program is net-positive from month 2 onward and every month thereafter. The on-site enrollment specialist is CoachCare's expense and is not deducted above.
Over 24 months — roughly $542,600 in avoided admission cost, against a parish that runs 22% more inpatient stays per 1,000 beneficiaries than the national rate.
About 4.8 full-time equivalents of enrollment, monitoring, and care-management labor CoachCare supplies — in a market where hiring nurses is the binding constraint.
Blood pressures, weights, and glucose values that would otherwise not exist between visits — and that make the chronic-disease conversation concrete.
Created automatically through the Veradigm Practice Management integration rather than keyed by hand, patient by patient, month by month.
Avoided hospitalizations are modeled from remote-monitoring patient-months using the analysis's standard assumption and valued at $15,000 each.
The Small Health Care Provider Quality Improvement Program makes up to $250,000 available per budget period across four 12-month periods, roughly 20 awards from $5 million. It requires three things. This service line delivers all three — and the billing revenue it generates is what makes the program survive the end of the award.
Four documents, drafted so the work left in front of North Caddo is review and completion rather than authorship. Download all four below.
The full project narrative in HRSA's required order — abstract, need, approach, work plan, performance management, sustainability, organizational information and budget narrative — each section labeled with the criterion and point value it feeds. Includes draft Attachments 4, 6 and 8 and a status-tracked attachment checklist.
Download .docxFour budget periods by object class against the $250,000 ceiling, the contract fee schedule, the program revenue model behind the sustainability claim, and the post-award steady state with breakeven. Every period sits under the ceiling.
Download .xlsxEvery CoachCare fee classified as chargeable or not chargeable to the award, with the allowability reasoning for each, per-location detail, and a rural-eligibility contingency if a Bossier Parish site does not qualify.
Download .xlsxThe Attachment 13 agreement letter: scope, deliverables, the fixed fees charged to the award, and what CoachCare contributes at its own expense. Ready for countersignature.
Download .docxThese are working drafts prepared by CoachCare to save time. CoachCare is not the applicant. Bracketed items are placeholders only North Caddo can fill: organizational identifiers, audit history, census-tract determinations and actual pay scales.
| Required strategy | What delivers it | Where the evidence is |
|---|---|---|
| 1. Develop and implement QI strategies; train staff to sustain a culture of quality | A funded Remote Care Program Coordinator owning a chronic disease measure set, with implementation training, monthly performance reviews and a dedicated client success advisor | Service line & escalation sections |
| 2. Strengthen data collection using EHRs, health IT, AI or other technology tools | The bidirectional Veradigm integration, continuous physiologic capture, patient reported data, and risk stratification across the eligible population | Veradigm section |
| 3. Implement billing and coding strategies and training to drive revenue from new services, for financial sustainability | Automated care-management claim creation inside Veradigm, billing staff training, monthly reconciliation and denial-trend management on the CY2026 code stack | The 2026 shift & value analysis |
Criterion 3 (15 points) explicitly requires “developing and implementing a monthly data dashboard to track quality measures” — that is the monthly reporting already built into full service. Criterion 4 (15 points) asks what happens after the money ends, and points applicants at chronic care management as the answer. Reviewers score 100 points across six criteria, in order: Need 20 · Response 25 · Performance management 15 · Impact 15 · Resources and capabilities 20 · Support requested 5. The draft narrative is built against that map, section by section.
Year one is the Vivian pilot alone, because grant-funded activity is confined to HRSA-designated rural areas. The expansion clinics come on in year two — at North Caddo's own cost, as intended.
| Grant year | Period | Sites | Net reimbursement | CoachCare fees | Net to North Caddo | Margin |
|---|---|---|---|---|---|---|
| Y1 | 09/30/2026 – 09/29/2027 | 1 | $220,263 | $131,026 | $89,238 | 40.5% |
| Y2 | 09/30/2027 – 09/29/2028 | 6 | $822,594 | $466,203 | $356,391 | 43.3% |
| Y3 | 09/30/2028 – 09/29/2029 | 6 | $1,085,808 | $605,764 | $480,044 | 44.2% |
| Y4 | 09/30/2029 – 09/29/2030 | 6 | $1,085,808 | $605,764 | $480,044 | 44.2% |
| 4-year | 09/30/2026 – 09/29/2030 | 6 | $3,214,473 | $1,808,757 | $1,405,716 | 43.7% |
The budget funds workforce, training, evaluation and data infrastructure — the three things the program is designed to pay for. Every budget period sits below the ceiling; an application that breaches it in any period is not reviewed at all.
| Object class | Year 1 | Year 2 | Year 3 | Year 4 | 4-year |
|---|---|---|---|---|---|
| Personnel | $127,000 | $138,947 | $129,217 | $97,909 | $493,073 |
| Fringe benefits (28%) | $35,560 | $38,905 | $36,181 | $27,415 | $138,061 |
| Travel | $2,400 | $2,472 | $2,546 | $2,622 | $10,040 |
| Supplies | $5,500 | $6,000 | $5,000 | $4,000 | $20,500 |
| Contractual — fixed CoachCare fees | $6,800 | $14,300 | $1,800 | $1,800 | $24,700 |
| Other — QI training, dashboard, evaluation | $30,000 | $14,000 | $20,000 | $22,000 | $86,000 |
| Indirect (15% de minimis) | $31,089 | $32,194 | $29,212 | $23,362 | $115,857 |
| Total federal request | $238,349 | $246,818 | $223,956 | $179,108 | $888,231 |
| Headroom under the $250,000 ceiling | $11,651 | $3,182 | $26,044 | $70,892 | — |
Salary lines are placeholders, flagged for replacement with North Caddo's actual pay scales. The sustainability conclusion is not sensitive to moderate changes in them.
EHR integration setup at $2,500, charged once. Integration maintenance at $150 a month, every year of the period of performance. Implementation and training at $2,500 per location, in the year that location goes live — Vivian in year one, the five expansion clinics in year two. One-time or flat-rate, each tied to a defined deliverable, none of it varying with how many patients enroll.
The per-active-patient-per-month fee covering the clinical care team, the connected devices and their logistics, and the platform is paid by North Caddo out of the revenue the program generates, not from federal funds. Devices are furnished, never purchased. The on-site enrollment specialist through the Vivian launch, the launch session, the care management SOPs and a named client success advisor are contributed by CoachCare at its own expense.
Program income. Medicare revenue generated by services delivered under a federally funded project can be treated as program income under 2 CFR 200.307 and deducted from the federal share unless the award terms say otherwise. Keeping the fee attached to the billable service off the award limits that exposure — but North Caddo's finance leadership and the HRSA project officer should still agree the treatment in writing before submission, and the budget narrative should state it. This is a real audit risk and an easy one to miss.
Equipment. The notice warns that equipment above 5% of the award may be unallowable. This budget acquires no equipment at all: monitoring devices are furnished under the recurring service fee and fall below the 2 CFR 200.1 threshold in any case. They should not be reclassified into an equipment line during budget review — it creates a cap problem that does not otherwise exist.
Care management is separately payable on top of the Rural Health Clinic all-inclusive rate, so the program generates recurring reimbursement. The federal request steps down while the service line picks up its own staffing — which is the strongest answer available to the sustainability criterion.
| Year 1 | Year 2 | Year 3 | Year 4 | |
|---|---|---|---|---|
| Federal request | $238,349 | $246,818 | $223,956 | $179,108 |
| Position cost absorbed by North Caddo | $0 | $0 | $17,789 | $63,361 |
| Net program margin available | $89,238 | $356,391 | $480,044 | $480,044 |
| Margin coverage of absorbed cost | n/a | n/a | 27.0× | 7.6× |
Federal request from the draft budget above; every budget period sits below the $250,000 ceiling.
Every position returns to the full FTE the service line actually needs, including the clinical champion time North Caddo contributes today. Revenue is held flat at the year 3–4 steady state with no escalation while salaries escalate 3% — the conservative direction on both sides.
Net program margin at steady state, after the recurring service fee
Total annual cost North Caddo carries alone — loaded payroll, integration, QI upkeep, supplies
Margin coverage of that full annual cost. Loaded payroll alone is covered 2.24×
Still contributed to North Caddo's operating result, after the program funds its own staff
The step from year four to year five is the number a reviewer looks for. Total loaded project payroll is $208,379 in year four and $214,628 in year five — the difference is salary escalation and nothing else. What moves is North Caddo's share of it: $83,055 to $214,628, a step of $131,573 in a single year. Program margin covers that step 3.6 times over. The more useful test is how far enrollment can fall before North Caddo is subsidizing the program:
| Census against the model | Enrolled Patients | Net reimbursement | Annual cost to North Caddo | Net to North Caddo |
|---|---|---|---|---|
| 100% — modeled steady state | 900 | $1,085,808 | $228,428 | $251,616 |
| 75% — enrollment 25% below model | 675 | $814,356 | $227,428 | $132,605 |
| 60% — enrollment 40% below model | 540 | $651,485 | $226,828 | $61,198 |
| 47% — breakeven | 424 | $511,897 | $226,314 | $0 |
Breakeven sits at 424 Enrolled Patients against the 900 modeled, and 552 Enrolled Services against 1,358. Enrollment would have to fall by more than half, and stay there, before the service line stopped paying for its own staff. No credit is taken here for the national Rural Health Clinic rate basis, for Louisiana Medicaid, or for Medicare Advantage coverage of these code families — all three would raise every figure above.
Two attachments are eligibility requirements rather than scored content, and one is free ranking benefit that applicants routinely leave unclaimed. With the deadline on August 6, these come first.
| Attachment | Why it matters | Owner |
|---|---|---|
| 3 — State Office of Rural Health | An eligibility requirement. Documented notice of intent to apply must go to Well-Ahead Louisiana (wellahead@la.gov, 225-342-9513); attach the email and any response. If it has not been sent, the application fails regardless of quality — send it today. | North Caddo |
| 1 — Proof of rural eligibility | Determines how large the eligible service area is, and therefore the size of the pilot. See the note below. | North Caddo |
| 2 — Proof of public or nonprofit status | A public-entity statement as a hospital service district and component unit of Caddo Parish — not an IRS nonprofit letter. | North Caddo |
| 8 — Funding preference | The Vivian clinic's automatic facility HPSA designation, scored 19, qualifies under Qualification 1. A screenshot from the Shortage Designation site is the whole requirement, and a preference moves a fundable application up in ranking. | North Caddo |
| 11 — Prior funding history | All HRSA awards in the last five years with grant numbers, and non-duplication for anything current. It also confirms no prior award under this program for a similar project, which is an eligibility bar. | North Caddo |
| 12 — CMS Rural Health Transformation Program | Mandatory if North Caddo participates in or benefits from Louisiana's RHTP, and it must explain how the HRSA-funded work is non-duplicative. Reviewers do not score it; omitting it when it applies is a compliance problem. | North Caddo |
| 13 — Agreements with other entities | The CoachCare letter of agreement, drafted and downloadable above. Add letters of support from any network partners. | CoachCare draft |
Appendix A of the notice lists 270 counties holding census tracts that lost HRSA rural status in the September 2025 definition update, and says HRSA still treats those tracts as eligible for FY2026. Caddo Parish is named on that list. Three North Caddo clinics sit in Caddo Parish — Vivian, Oil City and Blanchard — so the eligible FY2026 service area may be larger than Vivian alone even if the Eligibility Analyzer returns “not rural” for some of them. Plain Dealing, Benton and South Bossier are in Bossier Parish, which is not listed. Run all six addresses through the Rural Health Grants Eligibility Analyzer and cross-check the Caddo results against the formerly-designated tract spreadsheet. A larger eligible service area strengthens the application and enlarges the pilot.
The model above is one set of assumptions. Move them and watch the whole 24-month picture recalculate — this runs the same enrollment engine as the Value Analysis, calibrated to North Caddo's own rates.
Hospitalizations avoided under this scenario: ~0 over 24 months.
The explorer reproduces the Value Analysis exactly at the modeled settings. It holds pricing, per-program eligibility, attrition, and the enrollment ramp constant.
Pull the real Medicare panel, the chronic-condition counts, and the dual-eligible and QMB share. Confirm the certification status that sets your rate basis. Every figure on this page gets replaced with one of yours.
Integration build and validation: enrollment flags, chart-attached documentation, and automated claim creation into Practice Management. Escalation routing defined per clinic site.
Launch at one or two clinics — Vivian and one satellite — with the on-site enrollment specialist. Prove the workflow, the escalation path, and the first clean claims before scaling.
Roll out to the remaining sites on the schedule your providers set. The model reaches its enrollment ceilings around month 12; the pace is a choice, not a constraint.
Remote care programs fail on operations, not on clinical intent. This is the operating history behind the model on this page.
Across more than 400 managed conditions.
Clinicians running remote care programs day to day.
Successful in-market program launches.
Care plan coding and billing generating over five million claims.
At a scale that makes protocol, not improvisation, possible.
Enabled across the patient population.