DIME PROJECT

Aging in Place of Choice with Connected Health Technologies

From AgeTech innovation to sustainable implementation

HEALTHCARE PROVIDER: BUSINESS CASE

Building the AgeTech business case

This section guides healthcare providers through identifying where AgeTech creates financial value based on your business model and reimbursement strategy.

Connecting AgeTech directly to clinical performance and financial sustainability helps clinical practices scale technology successfully and sustainably for older adults.

WHAT IS YOUR CLINICAL PRACTICE?

Identify your clinical practice model & potential motivations for adopting AgeTech

Your business case for adopting AgeTech depends on how your organization delivers and pays for care. For some organizations, technology can create value by supporting billable services. For others, the value may come from avoiding costly hospital visits, improving quality performance, or reducing the total cost of care.

Before evaluating any opportunity or reimbursement pathway. Identify your clinical practice model and potential AgeTech motivations below.

Clinical practice model & description	What value can AgeTech potentially provide?
Home health providers and personal care Delivers direct in-home clinical or personal care	Help prevent avoidable hospital visits, intervene earlier, and extend care partner reach
Solo and small group practices Primary care or geriatrics operating under fee-for-service models	Support billable services and help manage patients with chronic conditions between visits
Multi-specialty group and health systems Larger employed physician groups, often risk-bearing entities	Help manage population health, reduce emergency department use, and support achieving quality benchmarks
Accountable care organizations (ACO) A group of providers (hospitals, physicians) that accepts financial accountability for patient costs	Reduce avoidable acute care use and support shared savings
Federally Qualified Health Centers (FQHC) Safety-net clinics serving low-income / uninsured populations using cost-based reimbursement. Funded by Medicaid and federal grants	Support individual billing services codes, plus non-behavioral distant site telehealth and permanent behavioral telehealth billing
Program all-inclusive care for the elderly (PACE) and dual-eligible special needs plan (D-SNP) PACE: fully capitated Medicare and Medicaid programs for nursing-home-eligible older adults living in the community. D-SNPs: Medicare Advantage plans for older adults eligible for both Medicare and Medicaid, which often build connected technology into supplemental benefits	AgeTech that reduces total cost of care, since these plans absorb all medical costs

FINANCIAL OPPORTUNITIES

Consider financial sustainability as a criteria for implementation success

A strong clinical or operational case for AgeTech is not enough to support long-term adoption. Before implementing a solution, consider how it will create financial value for your organization and whether that value is sufficient to support the costs of adopting and sustaining it.

Exercise: In the previous section, you considered three questions to determine whether AgeTech could address a meaningful need. Here’s a fourth question for you to consider, related to assessing the financial feasibility and sustainability of incorporating AgeTech into your practice.

How would AgeTech create value for your organization?

Consider whether AgeTech could generate new revenue, reduce costs or avoidable utilization, improve care team capacity, support quality goals, or contribute to other organizational priorities. What would need to be true for the investment to be financially sustainable over time?

Your answers will help you identify where AgeTech is most likely to support both better outcomes and a sustainable business model.

Examples of where AgeTech can help improve patient care & support reimbursement goals

In our research, a few consistent priorities appeared consistently across payer policy: improving outcomes, preventing avoidable utilization, supporting care transitions, and expanding access to care. The five addressable challenges below are the areas where those payer priorities and the needs older adults described to us overlap.

The examples below connect patient and care team value to potential reimbursement and payment opportunities. We have organized these opportunities by payment model: fee-for-service and risk-bearing or capitated care.

Potential patient value from using AgeTech	Improved management of chronic conditions and prevention of hospitalization
Potential value for fee-for-service practices	Direct New Billing Revenue Generates recurring practice revenue by billing Medicare RPM codes (99453, 99454 or 99445, 99457 or 99470, 99458, and 99091) for device supply, data review, and care management.
Potential value for risk-bearing, capitation, or outcomes-based practices	Medical Expense Avoidance Detects early clinical decline to prevent expensive emergency room visits and inpatient admissions, directly protecting capitated budgets. Innovative payment programs like CMS ACCESS Model focus on improvement of specific chronic disease outcomes. See ‘alternative and emerging payment models’ for more info.

Potential patient value from using AgeTech

Improved management of chronic conditions and prevention of hospitalization

Potential value for fee-for-service practices

Direct New Billing Revenue

Generates recurring practice revenue by billing Medicare RPM codes (99453, 99454 or 99445, 99457 or 99470, 99458, and 99091) for device supply, data review, and care management.

Potential value for risk-bearing, capitation, or outcomes-based practices

Medical Expense Avoidance

Detects early clinical decline to prevent expensive emergency room visits and inpatient admissions, directly protecting capitated budgets.

Innovative payment programs like CMS ACCESS Model focus on improvement of specific chronic disease outcomes. See ‘alternative and emerging payment models’ for more info.

Insights from our interviews: Value for older adults & care partners

Caring for an older adult living with severe congestive heart failure and undergoing dialysis, the care partner interviewed relied on technology to help manage multiple chronic conditions:

“I have two medication schedules, food time schedules… I use my technology for everything. And if I have to talk to their nurses or anything, we video call.”

Potential patient value from using AgeTech	Safe healing at home
Potential value for fee-for-service practices	Short-Term Billable Care Pathways Pairs Transitional Care Management (TCM) codes with 30-day monitoring to capture higher reimbursement during intensive follow-up periods.
Potential value for risk-bearing, capitation, or outcomes-based practices	Readmission Penalty Reduction Prevents costly 30-day hospital readmissions that trigger direct health system penalties and spike episode-of-care costs.

Potential patient value from using AgeTech

Safe healing at home

Potential value for fee-for-service practices

Short-Term Billable Care Pathways

Pairs Transitional Care Management (TCM) codes with 30-day monitoring to capture higher reimbursement during intensive follow-up periods.

Potential value for risk-bearing, capitation, or outcomes-based practices

Readmission Penalty Reduction

Prevents costly 30-day hospital readmissions that trigger direct health system penalties and spike episode-of-care costs.

Insights from our interviews: Value for older adults & care partners

A care partner recalls when their father returned home severely weakened:

“He was hospitalized for a month in December… coming out of that, obviously, it was really weak… given that he has fallen previously… I would definitely look into [fall detection technology].”

Potential patient value from using AgeTech	Access to care without long travel
Potential value for fee-for-service practices	Expanded Billable Reach Combines remote monitoring codes with standard telehealth billing to treat patients across wider geographic areas without adding physical clinic space.
Potential value for risk-bearing, capitation, or outcomes-based practices	Infrastructure & Transport Cost Reduction Reduces expensive home visits, paramedic dispatches, and long-distance patient transport while keeping rural patients stable at home.

Potential patient value from using AgeTech

Access to care without long travel

Potential value for fee-for-service practices

Expanded Billable Reach

Combines remote monitoring codes with standard telehealth billing to treat patients across wider geographic areas without adding physical clinic space.

Potential value for risk-bearing, capitation, or outcomes-based practices

Infrastructure & Transport Cost Reduction

Reduces expensive home visits, paramedic dispatches, and long-distance patient transport while keeping rural patients stable at home.

Insights from our surveys: Value for older adults & care partners

In a nationwide survey where 56% (n=50) of older adults and 74% of care partners (n=54) lived in rural areas or small towns, the majority preferred a health plan that offered support to help an older adult stay safe and live at home longer, compared with a plan without this support.

Potential patient value from using AgeTech	Preserve mobility, safety, and independence while aging at home
Potential value for fee-for-service practices	Therapeutic Monitoring Reimbursement Bills RTM codes (98975, 98977, 98980) to capture revenue for monitoring exercise compliance, gait stability, and functional movement.
Potential value for risk-bearing, capitation, or outcomes-based practices	Catastrophic Event Prevention Avoids major acute costs, such as emergency care and surgeries from falls, where a single prevented fall delivers direct savings.

Potential patient value from using AgeTech

Preserve mobility, safety, and independence while aging at home

Potential value for fee-for-service practices

Therapeutic Monitoring Reimbursement

Bills RTM codes (98975, 98977, 98980) to capture revenue for monitoring exercise compliance, gait stability, and functional movement.

Potential value for risk-bearing, capitation, or outcomes-based practices

Catastrophic Event Prevention

Avoids major acute costs, such as emergency care and surgeries from falls, where a single prevented fall delivers direct savings.

Insights from our interviews: Value for older adults & care partners

“One of the things that my [smartwatch] also does… in conjunction with the Health app on my phone,… it gives me reminders of when I’m unstable as far as walking. It’ll track how many days I was maybe not as stable as I could be. And so that gives me a reminder to pay a lot of attention to how I’m moving.”

– Older adult

“When I wear my smartwatch, and if I, there’s two times that it… notified me and said, ‘Oh, it looks like you fell. Are you okay?’… afterward I felt kinda like, ‘Oh, good, well at least something, if I fall or something happens, you know, I, I won’t be alone.”

– Older adult

Potential patient value from using AgeTech	Enhance connection and support
Potential value for fee-for-service practices	No standalone fee-for-service code reimburses routine cognitive or isolation monitoring itself. Adjacent pathways can carry some of the cost, including cognitive assessment and care planning (99483), Community Health Integration and Principal Illness Navigation services for health-related social needs, and care partner Training Services (96202, 96203, 97550 to 97552, plus the G0539 to G0543 codes added in 2025, all now telehealth-eligible). Each pays for the clinical or support activity around the technology, not the monitoring.
Potential value for risk-bearing, capitation, or outcomes-based practices	May support Medicare Advantage plan Star ratings plan quality performance, including measures tied to patient experience and care coordination, where your contract shares that performance with you. May also reduce non-clinical call volume that consumes care manager capacity.

Insights from our interviews: Value for older adults & care partners

Uses digital brain games to proactively protect their parents from Alzheimer’s risks:

“my grandmother on my dad’s side passed away from Alzheimer’s and just kind of worried about them also being predisposed to that and so just want to keep their brain activity in tip-top shape and so… some games or just like brain teasers…”

– Care partner

*We reviewed 154 sources on AgeTech reimbursement published between January 2018 and March 2026, including CMS payment rules, CMMI model documentation, and peer-reviewed evaluations of remote monitoring programs.

CMS REIMBURSEMENT

Match AgeTech investment with CMS reimbursement pathways

Use the table below to see how the use of AgeTech products potentially align with CMS reimbursement pathways available today and on the horizon.

Status	Pathway	How could AgeTech work in this pathway?
Billable today under fee-for-service (FFS) Medicare	Remote physiological monitoring (RPM) CPT codes include initial setup code 99453, device supply and transmission codes 99454 or 99445 (data day thresholds), and clinical treatment management codes 99457, 99458, 99470 (staff time threshold). Note that the 2026 additions give practices flexibility for lighter-touch monitoring, but the codes are alternatives rather than additions. 99445 (2 to 15 days of data) and 99454 (16 or more days) cannot both be billed in the same 30-day period, and 99470 (10 minutes) is billed instead of, not alongside, 99457 (20 minutes). This matters for revenue modeling: enrolled older adults who transmit data intermittently generate a lower monthly rate, not necessarily the two rates cannot be combined. You can combine RPM codes with chronic care management (CCM) codes to build a sustainable care model, provided staff time is tracked separately. (The same minute of clinical staff time cannot be counted toward both remote monitoring management and chronic care management.)	Enroll patients with chronic conditions into a routine RPM pathway. Note that FFS RPM, the technology being used must meet the FDA’s definition of a medical device. Clinical staff review transmitted data and spend at least 20 minutes in the calendar month on management services, including at least one live, interactive conversation with the older adult or their care partner. Asynchronous messaging does not satisfy the interactive communication requirement for this code.
Available now through Medicare Advantage and D-SNP contracts	Special needs plans offer supplemental benefits that cover connected technologies directly. These benefits remove cost-by-code billing barriers for complex populations.	Target high-risk or dual-eligible older adults who face financial or technical barriers to health management. Leverage plan-covered supplemental benefits to issue connected tools without charging copays.
Alternative and emerging payment models	CMS ACCESS Model (application-based, 10-year program). Program of All-Inclusive Care for the Elderly (PACE) and Home and Community-Based Services (HCBS) waiver technology provisions vary significantly by state and require direct engagement with your state Medicaid agency or PACE organization.	Embed technology into interdisciplinary care management for high-cost, complex older adult populations. Use passive continuous monitoring to track functional decline, fall risk, and mobility changes.

*As of October 2026. For the most updated CPT codes and billing requirements, refer to the CMS physician fee schedule.

DEFINITIONS

Remote physiologic monitoring

⚠ Proposed Rule: CMS 2027 Physician Fee Schedule – potential changes

A draft rule proposed in July 2026 would restrict Medicare RPM and RTM billing to clinical staff directly employed by the billing practice, effective January 1, 2027. If finalized, third-party vendor billing arrangements would no longer qualify under Medicare fee-for-service.
The same proposed rule would also require a separately reportable initiating visit before monitoring begins, extend the established-patient requirement to RTM, and revise how these services are valued. CMS is additionally considering bundling the existing RPM and RTM codes into new HCPCS G-codes. If finalized, the specific code numbers referenced throughout this page would change, though the underlying pathway would remain. CMS has specifically requested comment on how the staffing restriction would affect access in rural areas.
The rule is not yet final. The comment period closed September 14, 2026, and legislative pushback is active. Monitor the final rule expected November 2026, and model alternative pathways (CMMI ACCESS strategy, MA supplemental benefits, PACE capitation, HCBS waivers) in parallel. View DiMe’s comment on the proposed rule

Alternative payment models: the CMMI ACCESS Model

The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year voluntary CMMI model whose first cohort launched in July 2026, built around Outcome-Aligned Payments (OAPs) rather than fee-for-service billing. It covers four clinical tracks: early cardio-kidney-metabolic disease, advanced cardio-kidney-metabolic disease, musculoskeletal conditions, and behavioral health.
The mechanism that matters for your business case: CMS pays participants monthly at one-twelfth of the annual OAP, but caps cumulative monthly payments at 50% of the annual amount. The remaining 50% is withheld and reconciled after a 12-month care period, based on whether the participant’s Outcome Attainment Rate meets a defined threshold (set at 50% for the initial performance period). That means half of your expected ACCESS revenue is conditional and deferred by design. If you are modeling ACCESS participation against your success-definition, your operational threshold and clinical outcome target need to be documented precisely, since undocumented outcomes are treated the same as unmet outcomes.

High-need population pathways

For patients whose care needs justify comprehensive technology deployment beyond what standard RPM billing supports, three pathways offer more room:

Program of All-Inclusive Care for the Elderly (PACE). Full Medicare and Medicaid capitation for nursing-home-eligible adults. Technology cost is absorbed inside the capitated rate, which removes the code-by-code billing question entirely and replaces it with a straightforward cost-avoidance calculation.
Special Needs Plans (D-SNPs). Medicare Advantage plans for dual-eligible populations, which often build supplemental benefits (including connected technology) directly into the plan design rather than requiring separate billing.
Medicaid Home and Community-Based Services (HCBS) waivers. State-administered, allow technology to be positioned as a substitute for in-person aide hours in a managed Medicaid long-term support services (LTSS) contract.

BUSINESS CASE

Define your business case

Use the following to estimate the value of AgeTech for your practice, based on cost savings or revenue from Medicare billing. Healthcare providers championing AgeTech in their clinics should have a good enough grasp of the economic and financial case for implementing the technology in their organization, so they can effectively advocate to key decision-makers in their organization about the feasibility of adoption. Use this as a structured thinking prompt, not a full financial model.

If you bill Medicare fee-for-service

Revenue

(reimbursement per enrolled older adult per month) x (number of enrolled older adults) x (share of enrolled months that meet billing requirements)

Note that 99454 requires 16 or more days of transmitted data in a 30-day period, and 99457 requires 20 minutes of management time including a live conversation. Months that fall short may qualify for a lower-rate code or may not be billable at all.

Cost

Technology cost per older adult per month + staff time overhead

What determines your break-even point: how many older adults you can enroll, how much clinical staff time each patient requires per month, and whether you can consistently hit the documentation requirements each code demands.

If you are a risk-bearing entity (ACO, MA plan, capitated group, PACE):

Revenue

Step 1: Gross avoided cost
(baseline readmission or ED rate, adjusted for expected regression to the mean − achieved rate due to tech) × (cost per avoided event) × (attributed population)

Step 2: What you actually keep
(Gross avoided cost) × (shared savings percentage, applied only to the current agreement period, since the benchmark rebases each year, plus any quality bonus your payer contract passes through to you, including performance tied to Medicare Advantage Star ratings where applicable)

Cost

(one-time implementation cost) + (recurring technology cost per older adult per month) + (technology logistics like shipping, replacement, loss) + (clinical and non-clinical staff time, including onboarding and ongoing support)

For risk-bearing entities, revenue reflects avoided cost, not billed cost. Step one shows the total value your program created, but part of a baseline drop in a cohort selected for high utilization is regression to the mean rather than a technology effect, so the baseline should be estimated from a comparison group or a longer trend line rather than a single pre-period snapshot. Step two shows how much of that value you actually capture, since your contract determines your split with the payer, and because this year’s savings become next year’s benchmark under MSSP style rebasing, this revenue stream should be modeled as front-loaded and declining across the agreement period rather than as a flat, recurring annuity.

What determines your break-even point: the size of your attributed older adult population, how far your baseline event rate is from best-practice benchmarks (a population already performing well has less room to generate avoided-cost revenue), and how much of any shared savings or bonus your contract lets you keep versus split with a payer.

Sources for calculations:

PRO TIP

Capture the difference between brick-and-mortar, virtual, and hybrid delivery in your own model

A virtual-first rural telehealth and RPM combination carries lower facility overhead but higher technology and connectivity cost per patient than an in-clinic hybrid model. That tradeoff changes your break-even math independently of the clinical opportunity.

CASE STUDY

Reducing avoidable acute care through passive in-home sensors

Sensorum demonstrated that combining fully-passive in-home sensors with remote nurse triage effectively reduces acute care utilization, achieving a 34% reduction in hospital admissions and a 28% drop in ER visits in its partnership with Intermountain Health. This approach strengthens the business case for risk-bearing clinics by allowing them to scale continuous senior care without ballooning per-patient costs while directly aligning financial incentives with patient outcomes through fees-at-risk contracts.

KEY TAKEAWAYS

Putting it all together

Scaling AgeTech successfully requires aligning clinical priorities and financial incentives early.

An AgeTech product that delivers clinical benefit is more likely to succeed at scale when it also fits your practice’s payment model. Consider how the AgeTech product could support your business model, whether through new reimbursable services, improved care team capacity, reduced avoidable utilization, or better quality outcomes.

1. Organizations with a fee-for-service model: consider whether the technology supports eligible reimbursable services, such as remote patient monitoring and chronic care management
2. Organizations with risk-bearing or capitation models: consider whether the AgeTech product can help improve quality, prevent avoidable hospitalizations and other costly utilization, or generate savings under programs like ACO and PACE.

You’ve reached the end of the Healthcare Provider Playbook

Through this playbook, we’ve explored how to select the right technologies and define your business case for implementing them sustainably to meet the needs of older adults you care for. Navigate to the main page to read through our case studies, which highlight examples of how these AgeTech products are being used in the real world.

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