Remote Patient Monitoring in Value-Based Care

Medicare, Medicaid, and private pay insurers are beginning to offer providers financial incentives based on patient outcomes rather than solely for a service.

December 16, 2022
Remote Patient Monitoring in Value-Based Care

There have been continuous changes in healthcare in the past decade, and one of the most challenging has been the "risk shift" from healthcare payers to providers. This shift has increased the emphasis on successful healthcare outcomes, which most providers are not typically set up to manage. As a result, remote patient monitoring – or RPM – has emerged as a clinically effective, cost-efficient tool to provide insights into patient outcomes and avoid unnecessary financial exposure for healthcare providers.

Historically, healthcare has been paid for in a "fee-for-service" framework where providers submit for reimbursement based on a procedure (or procedures) performed. To control costs and align providers with payers, Medicare, Medicaid, and private pay insurers are beginning to offer providers financial incentives based on patient outcomes rather than solely for a service. Such value-based care plans – or VBCs – are often associated with Medicare Advantage insurance coverage or the provider's participation in an Accountable Care Organization – ACO. Yes, this can be an alphabet soup of acronyms, but the upshot is clear: providers can improve their financial performance by achieving outcomes benchmarks like readmissions rates.

Well, that sounds great, but it turns out to be a big challenge for most of the healthcare industry because for the past 70-80 years (since the mainstream emergence of health insurance), they have yet to track or manage outcome measures. Instead, providers performed a service, submitted claims, got paid, and moved on – that's how 85-90% of the healthcare market works today. Managing outcomes effectively requires a change in focus from discharge or office visits to managing patients who aren't under a provider's direct care. For example, about 30% of heart attack sufferers will have a second heart attack within a year – and the most significant proportion will have a heart attack within 90 days of discharge. The reasons for this are complex, but there are very effective programs to reduce the chances of a second heart attack. One of these is cardiac rehabilitation, which seeks to introduce a healthy diet, stress, and exercise routine to improve underlying health. Companies such as Moving Analytics are leaders in this approach.

Providers also need to understand better which patients are succeeding post-discharge – and which are deteriorating and posing a greater risk of a second heart attack. Although most providers aspire to create engagement points with discharged patients, few do this regularly or cost-effectively. And the industry standard – a nurse call center reaching out to patients to collect vital and non-vital signs - is inefficient, laborious, and ineffective. Remote Patient Monitoring, or RPM, offers an autonomous, automated system to collect vital and non-vital signs, alert for out-of-range submissions and manage clinical workflows and resolutions. These systems have proven to be effective aids in monitoring chronically ill patients outside the clinical setting. In addition, they can assist providers in achieving clinical and financial goals (such as incentives for readmission rate improvements).

RPM is one of the many new digital tools to improve provider operations and financial results. The platforms are a component of a provider's effective chronic care, post-discharge or transitional care program. They are very RoI positive in value-based care programs and fee-for-service arrangements. You can find more information at Harmonize Health.

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