Most doctors are doing CCM on less than 12% of their Medicare patients & AWVs on 21%  that qualify for it.    Using Chartspan, our clients average 73% of their qualified patients.  See the story of one of our clients below who followed our advice


Saini Medical Associates


Dr. Satinder Saini, the founder of Saini Medical Associates, is a beloved member of the Crowley, LA community. He knows every patient’s name and all about their family, putting in long hours to see as many as three dozen patients a day. 

When Carol Hubbard joined Saini Medical Associates as practice manager in early 2016, she began a mission to relieve some of that manual workload and move the practice from paper to electronic records. Today, the practice uses NextGen EHR and Hubbard works diligently to identify opportunities to create new efficiencies and new revenue streams, so Dr. Saini can continue to expand his services. 

That’s when she decided to proactively pursue annual wellness visits (AWVs) for the practice’s Medicare 

patient population. 

AWVs fit perfectly into the practice’s dedication to providing meaningful and complete care to their patients. According to Hubbard, “That’s what it is all about. Dr. Saini is one of the most caring and giving physicians I’ve ever had the privilege of working with, and anything I can do to help extend his care to more patients in the community, I will do it. When we learned more about the value of AWVs, I knew we had to proactively pursue them for the greater good of our patients. We also thought the additional revenue would help us do more for our patients.” 

Initially, Hubbard and team contracted with a vendor who was solely focused on calling patients and scheduling appointments for them to come to the office and conduct the AWV.   The problem with this approach is that most patients don’t want to go to the doctor’s office if they are not sick.  As a result, the no-show rate was incredibly high. Plus, the service provider was overly aggressive on the phone with patients, which ended up jeopardizing the relationship Dr. Saini had worked so hard to create in his community. 

Turning to ChartSpan 

When one of Hubbard’s peers recommended ChartSpan’s RapidAWV™, Hubbard evaluated the service with a very sharp eye. After reviewing the solution from ChartSpan, the largest care coordination company in the country, she liked what she saw – a tablet-based system that allowed the patients to 

complete the comprehensive health risk assessment while waiting in the practice lobby for an appointment. 

Expanding to CCM 

The implementation of RapidAWV™ went so smoothly, Hubbard felt comfortable with rolling out ChartSpan’s chronic care management (CCM) solution just one month later. “Offering a CCM program to our chronically ill patients is a huge advantage we can now offer our patients,” explains Hubbard. “And I 

have heard positive things from patients about having 24/7 access to ChartSpan’s clinicians. It’s been easy to work with them on medication refills and to schedule appointments.” 

ChartSpan is the largest chronic care management company in the U.S., having served more than 75,000 patients. The company offers a comprehensive outsourced solution, allowing practices to benefit from the revenues and clinical support without having to add staff or increase workloads. 

Hubbard is now eager to work with ChartSpan’s experts when it is time to file the practice’s MIPS attestation. “MIPS can be intimidating to try to do it on our own, so I’m grateful that ChartSpan offers us free access to a MIPS consultant. We are confident that our scores will continue to climb and both our 

patients and practice will experience additional benefits from our quality improvement efforts.” 

“ In just the first six months of using the ChartSpan RapidAWV™ solution, the practice received new gross revenues of more than $100K. And the ChartSpan team has been terrific to work with – there is a real feeling of teamwork.” – Carol Hubbard, Practice Manager 



▪ Breast Cancer Screening: 30 

▪ Controlling High Blood Pressure: 100 

▪ BMI Screening and Follow Up: 76 

▪ Colorectal Cancer: 39 

▪ Diabetes Hgb A1C Poor Control: 2 

▪ Influenza Immunization: 15 

▪ Pneumonia Vaccine: 81 

▪ Screening for Depression: 17

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No more hounding patients to come in for a special AWV appointment. No more no shows, and no more wasted time. 

Less than 20% of Medicare beneficiaries receive an AWV today. With ChartSpan, most practices are seeing an 84% completion rate. Why the big difference? Mainly because the patient does the assessment while they are already in the office. It is easy to follow, and all it takes is for the person at 

the front-desk to hand the tablet to the patient when they check in. It’s as simple as that. 

Hubbard added, “The ability to combine the AWV with an existing appointment is the key to the success of ChartSpan’s service. Most of our patients are pleased to have the iPad while they wait, and some even get a kick out of it. Our receptionist is great about making sure they are comfortable with the technology, and before they know it, they are done.” 

No More Missed Revenue Opportunities 

AWVs are an integral component of Medicare’s preventative patient care programs. Building these annual plans does not require a visit, despite the word “visit” in the name. They are intended to create or update a personalized prevention plan for Medicare patients. In addition, AWVs have a powerfully 

positive impact on a practice’s MIPS and quality scores. 

The plans are a win-win for everyone involved. 

Patients are receptive to AWVs because they get a proactive look at their health, which can lead to better outcomes and lower costs. In fact, a recent study shows that patients who received an AWV had a 5.7% reduction in their healthcare costs.* 

Physician practices receive a boost in revenues from conducting the AWV (billable CPT codes G0438 for the initial visit and G0439 for the subsequent visit), and AWVs have proven to drive up to 22 follow-up screenings for additional practice revenues. They are also able to use the data to identify trends and opportunities in support of population health initiatives. 

Medicare also benefits from the AWVs, with multiple studies showing patients who participate in preventative care programs like AWVs and chronic care management end up costing Medicare much less in the long run. 

According to a recent Porter Research report, only 54% of physician practices are currently offering a CCM program to their patients. Perhaps that is due to the fact that of those actively offering a program, 88% of them are trying to do it with their EHR system and their own resources. As demonstrated with Saini Medical Associates, it takes a lot more operational expertise than most providers expect to optimize the revenue potential and patient reach than many practices expect. 

An analysis of Saini Medical Associates shows that in the first six months of participation in RapidAWV, the practice received new gross revenue of more than $100K, which the practice is using to launch new care services,  such as remote blood glucose tracking for their patients.