Of the recent developments in health insurance in the past twenty or thirty years, few have had the impact that Medicare Advantage plans have had. Medicare Advantage plans – more formally referred to as Medicare Part C – are private pay plans that offer a broader range of services than traditional Medicare Fee for Service plans. As a result, these plans are the fastest-growing type of healthcare plan in the market today. And it’s easy to see why: they offer more benefits (vision, dental, wellness, etc.) and often cost less than traditional Medicare.
Get more; Pay less? Sign me up. But there’s gotta be a catch. First, all providers want a piece of this fast-growing patient population, estimated to be approximately 28 million in 2022 and representing almost half of the Medicare population. But to get in on the action, providers need to be comfortable accepting outcomes risk. In addition, because MA plans are capitated – providers can’t simply bill for additional procedures if those procedures “shouldn’t” have been required under acceptable care guidelines.
So to play medicare advantage ball with confidence – which can be a lucrative new revenue channel for a provider – you need to understand how your patients are doing even when they aren’t receiving direct care. Ideally, you’d know your patient’s health while they’re in between visits – and in fact, you’d try to reduce visits as long as they were stable and not decompensating – to avoid unnecessary utilization. In addition, you’d need a way to understand basic vital and non-vital information while they were doing their daily chores, resting, and having lunch.
That’s where remote patient monitoring (RPM) can be indispensable – it gives the provider information as if they were with the patient without requiring face-to-face visits, phone calls, or healthcare journals. It’s easier, better, and more convenient than legacy engagement and monitoring methods. And it gives your patients their autonomy back. Do they prefer to measure at 8 am? Great. 4 pm? Fine.
So how does RPM aid in the management of Medicare Advantage patients? RPM can help a provider identify which patients have deteriorating health by monitoring vital and non-vital signs in a patient population and alerting if a submission is out of range (high, low, present, not present, etc.). Monitoring and alerting RPM allows the provider staff to stop making phone calls to voice mails and start focusing on decompensating patients. With this more significant focus, the provider staff can spend time with patients that truly need care. In any patient cohort, a small minority of patients are unstable – most are fine. The challenge is identifying those that need help and doing that efficiently. And by managing those patients closely, the provider can stop deterioration before it requires an office visit, ER visit, or hospitalization, avoiding unnecessary utilization. In an IRB-approved clinical study with Medicare Advantage, Harmonize Health was able to reduce ER visits by more than 40% and admissions by more than 60% in 600 chronically ill patients.
RPM platforms can be deployed at scale to provide population health insights, improve treatment protocols and stabilize health in chronic care and post-acute discharge. In addition, the flexibility and efficiency of the platforms make them valuable tools in various clinical conditions where recurring patient information and a monitoring schema are helpful.