APCM Glossary
Plain-language definitions for terms used across the APCM, BHI, and broader Medicare value-based care literature. Each entry is comprehensive, primary-source-cited, and links to related content.
What is ACO REACH?
ACO REACH (Realizing Equity, Access, and Community Health) is CMS's most advanced full-risk Accountable Care Organization model, succeeding the Global and Professional Direct Contracting Model in 2023. Participating ACOs receive capitated PMPM payments and bear professional or global financial risk for aligned beneficiaries, with health-equity benchmarks built into the model.
What is APCM (Advanced Primary Care Management)?
APCM is the CMS care-management reimbursement framework introduced in the CY2025 Physician Fee Schedule Final Rule, consolidating prior care-management codes into a tiered per-member-per-month payment structure under three HCPCS codes: G0556, G0557, and G0558.
What is BHI (Behavioral Health Integration)?
BHI is the Medicare reimbursement framework for delivering behavioral health services integrated into primary care, encompassing the Collaborative Care Model (CoCM) and general BHI. With CY2026 PFS, new APCM-aligned BH add-on codes G0568-G0570 enable PCPs to bill behavioral health alongside APCM under the same TIN.
What is CCM (Chronic Care Management)?
CCM is the Medicare reimbursement framework, established in 2015, for managing patients with multiple chronic conditions through non-face-to-face care coordination activities. Its activities are now substantially consolidated into APCM under the CY2025 Physician Fee Schedule, though CCM codes remain billable.
What is HEDIS (Healthcare Effectiveness Data and Information Set)?
HEDIS is the National Committee for Quality Assurance's standardized performance measurement set, used by more than 90% of US health plans across Medicare Advantage, Medicaid, and commercial markets. HEDIS measure performance drives plan accreditation and Medicare Advantage Star Ratings, and APCM care-management activities directly improve performance on multiple HEDIS measures.
What is MEI (Medicare Economic Index)?
MEI is the index CMS uses to track year-over-year changes in the input costs facing physician practices — clinician compensation, practice expense, and professional liability insurance. It is a primary input into the annual update of the Medicare Physician Fee Schedule conversion factor, which determines APCM PMPM rates.
What is the MSSP (Medicare Shared Savings Program)?
MSSP is the largest Accountable Care Organization program in Medicare, established by the Affordable Care Act in 2010. Participating ACOs take responsibility for the quality and total cost of care of attributed Medicare fee-for-service beneficiaries and share in savings — and, in some tracks, losses — against a financial benchmark.
What is PMPM (Per Member Per Month)?
PMPM is a payment-per-attributed-patient-per-month model used by Medicare for care-management reimbursement and across value-based contracts. APCM uses a PMPM structure: practices bill once per enrolled patient per month at the tier-appropriate rate, differing fundamentally from fee-for-service per-encounter billing.
What is the Quality Payment Program (QPP)?
QPP is CMS's umbrella value-based payment program for Medicare Part B clinicians, established by the 2015 Medicare Access and CHIP Reauthorization Act. It has two pathways: MIPS (Merit-based Incentive Payment System), a pay-for-performance program adjusting baseline fee-for-service payment, and Advanced APMs, which exempt qualifying participants from MIPS in exchange for risk-bearing participation.
What is value-based care?
Value-based care is the broad shift in healthcare payment from fee-for-service per-encounter reimbursement toward arrangements that tie payment to outcomes, quality, and total cost of care. APCM with the CY2026 BH add-on codes sits at the intersection: it pays fee-for-service rates for activities that also improve performance under value-based contracts.