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Care service

Advanced primary care

Whole-panel primary care, tracked by the work performed rather than a time count. Hoss Care turns each requirement into a workflow your team can run, with the record behind it.

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Samuel van Hoogstraten, The Doctor's Visit (The Anaemic Lady), c. 1667A physician at home with a family he knows. Primary care as the home base.
Who it is for

For the practice patients come back to.

Advanced primary care pays the practice that is the patient's home base for the work it already does, across the whole panel.

A good fit

Practices and patients it fits

  • Patients whose home base for care is your practice
  • Patients with one or more long-term conditions
  • Panels you want to follow as a whole
  • Practices that would rather show the work than keep time logs
Not the right fit

Patients better served elsewhere

  • Patients whose care is led by a specialist
  • Patients on another monthly care service this month
  • Patients in their first month after a hospital stay
A better fit for them
Who does what

Your practice does primary care. Hoss Care shows that it happened.

Every requirement becomes a task with an owner and a status, and the evidence lands on the record as the work is done.

Your care team

What your team does

  • Stays the patient's home base for care
  • Runs visits, follow-ups, and care coordination
  • Answers patients when they reach out
  • Reviews, edits, and signs every note
Hoss Care

What Hoss Care does

  • Turns each requirement into a task with an owner
  • Shows which patients still need what this month
  • Keeps the evidence of each step on the record
  • Prepares one monthly claim per patient for billing to send

AI assistance in Hoss Care is advisory. It suggests and flags; your clinicians review, edit, and sign, and your staff submit.

How it runs

A whole panel, month after month.

The panel is sorted once, each month runs as a checklist, and the claim comes from the record.

Steps · 3
  1. 01
    Before the first month

    The panel, sorted patient by patient

    Each patient is matched to the care service that fits, so nobody is billed twice in a month. AI assistance suggests; your team decides.

  2. 02
    Each month

    Each requirement is a task with an owner

    The practice manager opens one screen and sees which patients still need an initiating visit, a shared plan, or a follow-up.

  3. 03
    Month end

    One claim per patient, with the record behind it

    Complexity level and start date roll into one monthly report. Your billing team sends the claims with the documentation attached.

See how it works
Which fits

Advanced primary care or complex-condition care?

Both cover ongoing follow-up. The difference is how the work is tracked and which patients qualify. Many practices run both, for different patients.

We sort the panel with you, patient by patient. Book a demo to walk through yours.

About ongoing care for complex conditions
Ongoing care for complex conditionsAdvanced primary care
How the work is tracked
Follow-up time is recorded each monthThe work performed is tracked, with no time logs
How billing works
Billed monthly on the follow-up work recordedOne monthly claim per patient, set by how complex their care is
Who qualifies
Patients with two or more long-term conditionsAny patient in the panel, including those with one long-term condition
Best fit
Practices with dedicated care coordinatorsPrimary care practices that are the patient's home base
Questions

Questions practice managers ask

How does this fit into our EHR?

Each requirement runs as a workflow inside the patient's chart in Epic, Oracle Health, or athenahealth. The care plan, the follow-up notes, and the monthly report all live in the record your team already uses.

Who does the follow-ups?

Your care team does, working from a list that shows which patients need what this month. If you are short on staff, our clinical team can cover the list until yours is ready. Every action is on the same record either way.

How does billing work?

Eligibility and complexity level are checked before the first month. Notes are written during each follow-up, with no time logs to keep. When the month closes, one claim per patient is prepared with the documentation attached, ready for your billing team to send.

Can we run this alongside ongoing care for complex conditions?

Yes, across different patients. A patient is on one monthly care service at a time, and only the practice that is their home base for care bills for it. Most practices start their primary care panel here and keep ongoing care for complex conditions for patients a specialist leads. We sort the panel patient by patient.

How long does it take to go live?

The EHR connection comes first, then the panel review, then the first month of care. A typical go-live takes about 30 days.

Paid for the practice you already are. Every requirement on the record.

Advanced primary care

Ready to start with your panel?

We will walk through your panel, sort it by complexity level, and map every requirement to a workflow your team can run from day one.

Book a demoSee how it works