### MD Revolution is now CoachCare.

**The same trusted platform and care teams, now unified under one connected care brand.**

# APCM Assessment Request

CoachCare can help you assess your organization’s readiness for Advanced Primary Care Management and Chronic Care Management (CCM). This is a no-obligation assessment – please complete the fields below so we can better understand your organization’s capabilities, patient demographics, and goals.

## CoachCare - APCM Assessment Request

"*" indicates required fields

### Organization Information

- Name*
  - First Name
  - Last Name
- Company Name*
- Job Title
- Email*
- Phone Number*
- Organization Type*
  - Choose
    - ACO
    - CAH
    - FQHC
    - RHC
    - Health System
    - Health Plan
    - Private Practice
    - Specialty Group
    - Multispecialty Practice
    - Other
- If "Other", please specify*
- Number of Licensed Providers (MDs, NPs, PAs)
- Total Number of Active Medicare and Medicare Patients Served

### Current State

- Are you currently working with an ACO or an alternative payer model? If so, which one? (e.g., ACO Reach, Making Care Primary, CPC+ etc.)
- What ACOs or alternative payer models have you worked with in the past?
- Are you currently doing traditional CCM? If so, number of enrolled patients?
- Are you currently offering RPM? If so, number of enrolled patients?

### Technology and Data Infrastructure

- Current EHR
  - Choose
    - athenaOne
    - athenaPractice
    - Azalea
    - Cerner
    - ClinicalWorks
    - Elation
    - Epic
    - Greenway
    - NextGen
    - Veradigm (formerly Allscripts)
    - Other
- If "Other", please specify
- Do you currently have access to or the ability to stratify patient risk?
- Are you currently completing HCC coding on your patients?