Harry Soza

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 has named remote patient monitoring (RPM) as one of healthcare’s 

-and with good reason. Numerous advances, including a move from telephonic to mobile RPM (mRPM), have made the technology much more feasible and effective for patients, health plans, and providers.

Few healthcare stakeholders, however, have extensive experience with RPM. That means some dated misconceptions about RPM still linger in the industry. In particular, these views often fail to consider how to leverage mobile technology popular with Americans of all ages for efficient and cost-effective RPM programs.

With that, the following are five interesting updates about RPM that you may not know:

1. RPM can be delivered on a convenient schedule

RPM is often associated with phone calls from the doctor’s office to the patient, with many missed connections, or with live, video-based virtual visits that require the provider and patient to be sitting at their computers or mobile devices at the same time. Synchronous encounters can be useful in some circumstances, but are not always effective or efficient for ongoing patient monitoring.

Instead, when it is convenient, a patient can be prompted on their mobile device to check in with their physician approximately once a week, or whenever deemed clinically relevant, and answer a short series of subjective and objective questions (including 

), and enter biometric data such as blood pressure readings. The provider can then review the requested patient-reported data before it is entered into the EHR.

This type of asynchronous, automated mRPM does not require both parties to be available at the same time, nor does it require configuring any telemedicine software, ensuring there is an adequate internet connection, or any of the other technical requirements of a live video-based encounter.

Like a virtual visit, mRPM offers higher quality monitoring and patient-reported data than other RPM modalities, such as a phone call, text message or email. The latter two methods also typically require the patient to log in to a separate patient portal, which can be an RPM adherence obstacle. Using a disciplined, clinically-relevant communication schedule integrated into a prescribed care plan, mRPM also prevents providers from being deluged with non-meaningful patient-reported data-data that does nothing to improve outcomes. The focus is on identifying clinically relevant trends or red flags that are actionable and may require an intervention to improve outcomes.

2. RPM isn’t just for chronic care management 

In our value-based care era, RPM is often utilized for 

 (CCM), which is an excellent application of the technology and has been recognized with increased reimbursements by public and private payers.

However, RPM-particularly mRPM-can be highly useful for a wide range of other use cases, including oncology, non-chronic cardiology applications, and monitoring members post-procedure-especially in bundled care payment scenarios.

Post-surgical monitoring of members who receive a total hip or knee replacement, for example, is an ideal application of mRPM. From their homes, members can answer questions about healing, pain, medication and mobility, and even take photos of the incision site. This approach saves members from making an inconvenient and uncomfortable trip to a medical facility when it is not necessary, and it gives providers important progress information, including identifying issues that may need intervention to improve outcomes and prevent readmissions.

With mRPM, providers can place members on a highly structured and carefully scheduled surgical recovery journey, so members are automatically contacted more often following discharge and then at less frequent intervals as recovery advances.

3. RPM can benefit a wide range of members

RPM can benefit a wide range of members, not just those who are higher risk. mRPM is applicable to the vast majority of health plan members, even those who simply need to be reminded about appropriate preventive care, adhering to care plans, and making healthier lifestyle choices.

Four Ways Mobile Remote Patient Monitoring Can Improve Star Ratings

Repeated contact can be subconsciously interpreted as “health coaching,” although it is not direct instruction at all. Reminders, inputting data, and receiving feedback from a provider can prompt members to think positively about what is possible with their health. As a result, members often exhibit new positive health behaviors such as better dietary, activity and therapeutic choices.

4. Yes, seniors will use mobile devices and apps for RPM

Of course, if your health plan rolls out an mRPM program, it’s essential to engage providers so that they adopt the technology. Some providers may be skeptical about whether their patients will participate in mRPM, particularly their senior populations, because they are worried they may be technology luddites.

However, recent figures from Pew Research show that 

 (46%) of seniors aged 65 years and older own a smartphone, while 41% 

, and 40% use YouTube. Those adoption and usage rates jump dramatically for the demographic group immediately younger than seniors, ages 50 through 64 years. Nearly three-quarters (73%) of this group own a smartphone, while 65% use Facebook and 68% use YouTube.

The high adoption rate of these social media platforms among these age groups, who tend to have chronic conditions or medical procedures that would benefit from mRPM, indicate that they would be receptive to a doctor-prescribed app to manage their health.

The 50- to 64-year-old demographic is also often the age when chronic conditions begin. Starting these members on a preventive and proactive CCM program early using mobile technology is a step toward preventing issues in the future.

5. You don’t need to swallow the apple whole

Implementing mRPM is not an all or nothing proposition-not for health plans, and not for providers. The technology is highly flexible, so physicians do not need to monitor all their patients immediately. Instead, they can start with a small group of 10 or 20 patients who have chronic conditions or are undergoing medical or surgical procedures requiring recovery at home.

The provider can begin with this pilot group and learn from that experience before the mRPM program is expanded across larger populations. Providers can tailor their mRPM management for certain high-risk patients or conditions, or for post-surgical recoveries.

Due to its minimal upfront investment and ease of use, conducting mRPM with even small populations delivers an ROI in terms of high-value relevant data capture, lower high-cost care utilization, improved care-plan adherence and healthier patient behaviors.

RPM has come a long way in recent years, especially since smartphones and mobile devices have become so widely adopted across all demographics. With this cultural change, it’s an opportune time to reconsider the approach to RPM. Thanks to the near-ubiquitous adoption rate of mobile devices, mRPM is an ideal way to stimulate patient engagement and encourage members to take more responsibility for their own health while giving providers a contextually meaningful and highly controlled way to receive actionable information.

Health plans that arm provider organizations with an mRPM technology solution are giving them an innovative tool to manage chronic and acute conditions, surgical recoveries and care transitions between face-to-face appointments.

, a Silicon Valley tech company that partners with health plans and providers to advance population health management by enabling physicians to leverage the power of mobile-enabled remote patient monitoring that engages them and leads to improved outcomes and lower costs. He can be reached at 

Articles

Five surprising updates about one of healthcare’s top trends.

What You Don’t Know About Remote Patient Monitoring

In an increasingly competitive Medicare Advantage (MA) marketplace, Star Ratings have become more crucial than ever before.

Higher Star Ratings not only demonstrate care quality to current and potential members, they mean additional financial incentives from CMS in the form of bonus payments and rebates for superior quality and member/beneficiary service.

 shows that increasing a plan’s Star rating from 3 to 4 can result in an 8% to 12% increase in enrollment. With that bump in enrollment, an MA plan could potentially bring in millions of dollars in additional revenue in the form of bonuses and rebates. And, CMS now incentivizes high-performing MA plans with 

 starting at 4 stars, with additional 5% bonuses once the plan hits the higher premium 4.5- and 5-Star Ratings.

Improving Star Ratings can be challenging, especially because many of the metrics that comprise the ratings are contingent on patient behavior, which can be difficult for plans to influence. Despite these complexities, healthcare organizations that administer MA plans can now directly address patient behavioral change by partnering with their providers to implement mobile-enabled remote patient monitoring (mRPM).

Through patients’ smartphones or other mobile devices, physicians can leverage mRPM to automatically check in with them to manage chronic conditions, or to monitor their progress when recovering from a procedure such as orthopedic surgery. mRPM also allows physicians to learn more about patients’ social determinants of health that may be hindering care plan adherence.

How mRPM can move the dial on behavior and adherence

By offering mRPM technology to providers, health plans can have a more immediate and direct influence over patient behavior and adherence. Whether it is Star ratings, HEDIS measures or any quality metric, managed care organizations can strengthen their financial performance while improving outcomes of their members.

Four ways that mRPM can be leveraged to improve performance and quality metrics such as Star ratings include:

1. Changing behaviors through consistent reinforcement

Star Ratings criteria can essentially be grouped into three distinct categories:

. These include helping patients resolve disputes, answering questions and offering benefits and services based on beneficiaries’ needs.

. This category includes one-time annual screenings or tests, such as mammograms, flu shots, colorectal exams and BMI assessments.

 By far the most difficult category to influence, these metrics involve patients’ medication adherence, obtaining prescription medications, monitoring physical activity and overall management of chronic conditions.

Most MA plans have systems and resources in place to achieve high scores in the first two categories. For the third category, however, the majority do not offer a solution for network physicians to effectively communicate with patients, nor data collection methods that will move the needle positively on adherence and improved metrics.

My personal experience is one clear illustration of this issue. Recently, I received a form letter in the mail from my health plan reminding me to refill a specific medication before my prescription runs out. The letter, however, arrived at my home more than a week before I was permitted to get a refill. What action could I take? I did what the thousands of other health plan members likely did who received a similar reminder: tossed the letter in the recycling bin and forgot about it.

Improving care plan adherence needs to be “in the moment”-not an ill-timed paper reminder, a 10-minute office checkup, or a hospital discharge directing the patient to schedule a follow-up visit. Patient behaviors must be periodically and consistently influenced so that they will be engaged in healthier lifestyle behaviors, care plan adherence, preventive care and proactive communication with providers. To do that, insurers and providers need to consistently support patients in managing their chronic conditions at home and safely manage their care transitions.

Offering education, seeking feedback, and answering questions while patients are at home reminds them to adhere to their provider’s care plan, while also fostering greater engagement that motivates patients to take ownership of their health and improve their own outcomes.

The smartphone offers tremendous opportunities in this regard. According to Pew Research, 

 of adult Americans own a smartphone, including 46% of those aged 65 years and older. In addition, 73% of Americans aged 50 to 64 years own a smartphone, indicating that even more beneficiaries will have the devices for the foreseeable future.

3. Tapping into CMS’ Chronic Care Management program

Enhanced RPM of Medicare patients is already paying dividends for CMS through its 

)  service program launched in 2015. The program allows physicians to earn additional reimbursement for non-face-to-face management of patients with two or more chronic conditions.

Adoption of the CCM program has been slow so far; in its first two years, only 684,000 beneficiaries received the service, according to a November 2017 

. . However, CMS still saved $74 per beneficiary per month (PBPM) in the “18-month cohort” of the study, thanks to the enhanced monitoring and patient support. Surveyed patients also reported that they appreciated the CCM service and felt more engaged in their own health.

Six Factors Holding Payers Back from Improving Star Ratings

In fact, some patients who were interviewed by researchers reported they were unaware that they should be concerned about their multiple chronic conditions until being offered the CCM service from their physician. Greater mindfulness of patients’ health was amplified through the periodic contact with their practices’ providers through the CCM service, as well as better coordination with other practices throughout the care continuum.

Room for improvement in the CCM program exists, particularly for making the monitoring and patient-data capture and analysis more efficient and automated for providers. Fortunately, when compared to telephonic RPM, mobile-enabled RPM technology greatly reduces the labor demands of providing CCM-or any similar population health management program-without sacrificing care quality or patient engagement benefits.

Earlier this year, CMS unbundled the CPT 99091 code so that providers can now bill separately for the service’s benefits. In this instance, the use of mRPM would not only improve CMS’s financial performance, but also increase providers’ bottom lines. This lesson could be applied to any pay-for-performance program where both providers and insurers benefit.

  4. Influencing heavily weighted criteria tied to Star ratings and HEDIS measures


mRPM addresses numerous Star rating and HEDIS measures tracked by MA plans, as well as other health insurers. For example, the heavily weighted medication-adherence measures for chronic conditions such as diabetes, hypertension and cholesterol could be boosted by one Star point or more through mRPM.

Other major Star and HEDIS measure opportunities in that more difficult category of patient behavior and adherence include:

Diabetes care – blood sugar controlled (HEDIS)

Medication reconciliation post-discharge (HEDIS)

Multiple “care for older adults” measures (HEDIS)

mRPM is an effective, efficient tool to empower providers to directly address these criteria with patients and to engage them so that they have more ownership in improving their own health. The technology works well for patients, who can answer a few short condition-specific questions via a patient-facing app when it’s convenient for them; and it fits with providers’ workflows, since the focus is on clinically meaningful information that may require early and/or immediate intervention-not a data deluge.

Compared to manual outreach and education by a clinician, mRPM costs less per patient than mailing a letter each month or sending a survey-while allowing providers to capture in-depth data on quality measures in real-time, which is when interventions need to occur.

With very little additional effort, but tremendous benefits, MA plans, other types of health plans, and provider organizations can reap the rewards of mRPM: more engaged patients, better outcomes and lower costs.

, a Silicon Valley tech company that partners with health plans and providers to advance population health management by enabling physicians to leverage the power of mobile-enabled remote patient monitoring that engages patients and leads to improved outcomes and lower costs

Mobile technologies offer opportunities to engage members, improve chronic care management, and prevent avoidable hospital admissions and readmissions.

Author | Harry Soza

Articles

What You Don’t Know About Remote Patient Monitoring

Four Ways Mobile Remote Patient Monitoring Can Improve Star Ratings