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Remote Patient Monitoring (RPM) | Health Plans

Health Plans Play a Critical Role in Remote Patient Monitoring

July 11th, 2023 | 7 min. read

ThoroughCare

ThoroughCare

Content Team

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The benefits of adopting remote patient monitoring are mounting. According to America’s Health Insurance Plans (AHIP), healthcare organizations are seeing evidence of those benefits through reductions in utilization, readmissions, and on-call visits, as well as increases in consumer satisfaction. RPM procedure claims grew by nearly 1,300% over the last three years.

RPM adoption is expected to double to 20% over the next five years. Additionally, 87% of providers believe RPM will become vital to the patient experience, according to a report by Accenture. 

This shift is due to the widening array of available and approved technologies and their proven capabilities for early symptom detection, reducing in-person procedures, and minimizing utilization. 

Remote patient monitoring maximizes a health plan’s engagement strategy

What’s most exciting about the potential of remote patient monitoring is how it supports healthcare payor strengths. Health plans have stayed on the front edge of data analytics, digital health, telehealth, and care management. RPM provides unprecedented access to real-world member health condition data and the ability to use the data to help members make decisions (including signs and symptoms that alert them to the need for care). 

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Payors see multiple benefits from remote monitoring

Alongside telehealth adoption during the pandemic, shifts to outpatient care, home care, and retail channels highlight the need for lower-cost care delivery options, but also the consumer’s need for scheduling and location flexibility.

There are a number of areas where remote patient monitoring aligns well with payor objectives to improve outcomes and decrease cost and utilization.

Value-based care

Remote patient monitoring can not only optimize team-based but be the foundation of value-based care models. RPM can be the driver for early interventions, ongoing monitoring, and triaging member populations more effectively. 

Using remote monitoring tools can support successful transitions among inpatient, ambulatory, skilled nursing, and home, enabling a more continuous cycle of care. The accumulated data can support quality improvement, performance reporting, and quantifying value toward incentive payments.

Chronic care management

Chronic care management becomes more standardized, data-driven, and streamlined from remote patient monitoring

Collecting and sharing biometric and patient-reported data enables care teams to look for concerning trends and shift tactics when necessary. Also, having real-time notifications that clinicians, care managers, and patients can review informs care from daily living, not just periodic appointments or estimates over the phone.

And, when RPM improves chronic care management, aids in preventative services, and supports high-quality, personalized care for members, it can positively impact HEDIS measures, star ratings, as well as member and employer retention.

Population health

Population health management is a point of pride for most health plans. RPM adds new data sources and value to support population health risk stratification, enabling risk alerts and informing utilization and cost analysis. 

Marrying real-time data and analytics with targeted interventions allows plans to improve care quality while reducing unnecessary costs. Armed with RPM data across a population or program, it empowers quality improvement efforts that deliver new levels of efficiency and impact for the entire population. 

Holistic, real-world data analytics

Health plans appreciate rich, robust analytics data from valuable sources. RPM offers new sources of real-world data via more sustainable monitoring over more extended periods. 

With more complete data, payors can have a more accurate and comprehensive member picture beyond claims and any accompanying clinical data. Not only can payors create a more robust and precise view of each member and member population, but they now have benchmarking data to provide a baseline within the context of members’ daily activities.

Payors double down on remote patient monitoring

In just a few years, payors have piloted, launched, and adapted RPM strategies and programs. 

The following examples from three health plans give credence to increased adoption, highlighting their specific clinical, programmatic, or population objectives.

Humana

In 2019, Humana started a partnership with Philips around a remote patient monitoring pilot for select Medicare Advantage members with severe congestive heart failure. Their goal was to support members and their caregivers via in-home support, keeping them engaged and focused on preventing CHF exacerbations. 

Humana equipped select MA members with a telemedicine kit that included an interactive tablet and wireless devices like a weight scale, blood pressure monitor, and pulse oximeter.

Synching regularly with the tablet, the kit brought greater awareness to each member’s daily health needs as well as shared real-time data with care managers who could follow-up or intervene. The data supported Humana care teams in making informed and proactive care decisions and helped reduce unnecessary readmissions.

In 2021, Humana launched a home healthcare service that included remote patient monitoring. 

Partnering with DispatchHealth, their program focused on patients requiring care management for multiple chronic conditions. Humana was one of the first payors to leverage CMS’ Acute Hospital Care at Home program, using RPM and telemedicine tools to reduce hospital inpatient admissions by treating certain acute care patients at home.

UnitedHealthcare

In 2019, UnitedHealthcare launched a pilot with Vivify, which Optum acquired to provide advanced remote patient monitoring technology. Covering seven months and 60 Medicaid members with congestive heart failure, chronic obstructive pulmonary disease, or diabetes, each pilot participant received a Vivify kit to monitor their health status and share data with their care managers in real-time.

The kit included a 4G tablet computer, a blood pressure cuff, an oximeter, and a Bluetooth-connected scale. The RPM technology helped nurses monitor members’ blood pressure and oxygen levels while the tablet supported ongoing engagement that kept patients involved and actively participating.

In 2021, UnitedHealthcare implemented the Babyscripts platform as part of an RPM program for OB-GYN physicians to monitor pregnant patients at home. Launched in Tennessee, the program was one of several US states using telehealth to address perinatal care, particularly targeting hypertension and mental health services for mothers.

Cigna

In 2022, Cigna followed Humana and UnitedHealthcare to unveil its first remote patient monitoring program. In partnership with MDLIVE, Cigna’s virtual care provider, the program became available to all health plans that offered MDLIVE primary care services to their members.

RPM enabled members to track and report biometrics like blood pressure and glucose levels to their virtual primary care providers. This alignment via data between MDLIVE primary care providers, Cigna, and their members provided more significant insights into critical daily health information that can be an early indicator of a serious medical issue.

RPM as a foundation to payor influence

As healthcare payors seek to expand their influence over care and cost, remote patient monitoring offers many valuable benefits. Increased adoption and evidence of value will position RPM as a technology-enabled foundation for many health plan initiatives and partnerships.

How ThoroughCare can support RPM use

Digital care coordination can support patient management, simplify data collection, integrate with electronic health records (EHR), and maximize reimbursement models. 

ThoroughCare takes this one step further by supporting data visualization and analytics to drive actionable insight. Remote vitals can be more easily monitored and interpreted to inform care decisions. 

Paired with comprehensive care planning, ThoroughCare’s RPM solution can help providers motivate patients to address their chronic illnesses as the healthcare landscape continues to shift. 

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