Care programs — setup & enrollment

Manage ongoing care between visits

Open Value-Based Care from the toolbar to bring enrollment, consent, care plans, confirmed time, quality review, and claims together. The tabs are Today, Programs, Remote monitoring, Quality & ACO, Month-end & claims, Reports, and Settings. Your practice’s features and your permissions determine which appear.

Enrollment and time totals do not establish that a service can be billed. Hero checks consent, care plans, qualifying conditions, overlapping programs, staff roles, and other supporting evidence before releasing a claim.

Turn on the hub and choose your workflow

1. Enable the hub. A practice administrator or staff member with feature-management access opens Admin → Additional Features and turns on Value-Based Care. It starts off. Enable APCM and Remote Patient Monitoring separately if your practice uses them.
2. Open Value-Based Care → Settings. This requires care-program administration access. The five setup steps are Programs, Staff profiles, Timer behavior, Eligibility, and Claim policy. Press Save settings after changing the shared settings.
3. Choose enrollment recommendations. In Eligibility, turn on Check eligibility and suggest programs, then set Population, Insurance rule, Require an established patient, and any excluded payers. Program-specific requirements still apply.
4. Assign timer profiles. Under Staff profiles, use Add staff profile. Set Timer behavior to Off — show progress only, Offer — let staff start, or Auto — capture while working in the patient chart. Choose the programs, default activities, and Profile members, then Save profile. Each person has one profile in the practice; unassigned users keep Offer mode.
5. Configure optional assistance. Timer behavior includes Pause after idle minutes, Offer the timer instead of starting automatically on face-to-face visit days, Suggest time from my calls and patient messages, Suggest activities from recorded chart work, and Polish draft time notes with AI. Suggestions and automation start off and still require review before time is counted.

Advanced settings contains Refresh care-plan drafts each month and Deliver approved plans to the patient portal. Hero must also enable scheduled background work for your practice — ask support if you want these automatic workflows. Manual review and approval remain separate actions.

Within Programs, APCM automatic enrollment offers Off, Review candidates, and Auto-enroll eligible patients. RPM native billing and RPM code and practice settings require the corresponding monitoring and financial access. Existing APCM and RPM settings keep their saved behavior; opening this wizard does not reset them.

Check eligibility and enroll a patient

1. Open the patient’s Care programs chip. In the drawer, choose Programs and Add program. The Enroll in care programs window checks eligibility and shows the recommended program when recommendations are enabled.
2. Review the care team and conditions. Confirm Program, Qualifying conditions, Billing provider, and the payer shown. Assign me as care manager is available only when you are eligible for that assignment.
3. Choose how to collect consent. Document verbal consent requires reviewing the displayed script, including cost-sharing, and confirming that the patient agreed. Send e-consent to portal uses Enroll & send e-consent. A sent invitation is pending consent, not completed consent.
4. For RPM, also choose Monitoring program. Verbal consent requires the Consenting patient or guardian name. After enrollment, continue to Remote monitoring → Devices to add or order a device.
5. Return to the drawer to follow progress. Programs shows consent and care-manager status and offers Pause or Resume. Pending non-RPM consent can be requested with Send e-consent; use Manage RPM consent for monitoring consent.

From the hub’s Programs tab, filter by program, service month, or My patients/Everyone, and search by name or MRN. Select patients to Assign care manager or Send e-consent. Actions apply to their current enrollments; read the result because a consent batch can contain both successful and failed invitations.

For an eligible patient with a visit today, the care dock can offer the recommended program directly. That shortcut opens the same enrollment and consent review.

Prepare, approve, and deliver a care plan

1. Open Care plan in the patient drawer. Use Draft from chart for the first plan or Refresh from chart for an existing plan. Review problems, goals, interventions, and follow-up; replace bracketed placeholders and save your edits. While any [bracketed] template text remains, the editor reminds you that it still needs to be personalized.
2. Have an eligible clinician review it. Mark reviewed records review of the working plan. Staff can prepare a plan but do not gain approval authority merely by having a timer profile.
3. Prepare the monthly copy. Under Monthly care plans, choose Refresh now. Expand Review changes and sources and inspect Preview patient PDF before Approve revision. Changes appear as labeled Before and After text — each problem with its goals and interventions, and the plan’s narrative — so you can see exactly what changed. The revision keeps the reviewed monthly copy separate from later edits.
4. Deliver the approved plan. Use Deliver, or enable automatic delivery of approved plans in Settings. Check the delivery status and the patient-viewed timestamp; Retry notification is available after delivery. If filing fails, follow the displayed retry instruction.

For a batch, select patients in Programs and choose Prepare plan review. Only unchanged draft plans can be approved together. Changed plans need individual review. APCM uses this shared care-plan editor when Value-Based Care is enabled.

Use Today and the patient drawer

Today groups the next care actions. My patients follows care-manager assignments across programs; Everyone shows the practice. Select an action to open the relevant patient or review screen. Use j/k to move through actions and Enter to open one.

Click a patient in Programs to work in the side drawer. Its sections include Programs, Month progress, Time ledger, Care plan, Episodes, and, with the required access, Devices, Claims, and Time suggestions. Open chart returns to the clinical record.

Month progress shows confirmed minutes and the next threshold. CCM and PCM keep staff and physician minutes separate. APCM shows monthly care without a timer threshold. Monitoring also shows reading-day progress. The selected service month uses the practice calendar.