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Mobile technologies offer opportunities to engage members, improve chronic care management, and prevent avoidable hospital admissions and readmissions.
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.
For example, one study 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 Quality Bonus Payments of 5% 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:
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.
2. Meeting patients where they are
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, 77% 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 Chronic Care Management (CCM) 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 two-year retrospective study. . 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.
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:
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.
A cost-benefit analysis that makes sense
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.
Harry Soza is president and CEO of CAREMINDr, 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.