Key Strategies for Sustaining an RPM Program

UnityPoint Health is scaling its remote patient monitoring program out to new populations. Here’s its game plan for success.

For many health systems, remote patient monitoring (RPM) Is still a challenge. It’s not easy to find the right patient population, match those patients to the right devices, and develop a process that meets clinical goals and doesn’t put a strain on clinician workflows.

Health systems like UnityPoint Health are addressing those challenges by partnering with digital health companies who act as the middleman. The Iowa-based, three-state network has collaborated with HealthSnap over the past two years to build out RPM and chronic care management (CCM) programs that now collectively serve more than 25,000 patients through 94 primary care clinics and involving more than 400 physicians.

“Logistics are not something that healthcare organizations are typically good at,” says Dawn Welling, chief nursing officer at UnityPoint Clinic. By partnering with someone to handle the technology, she points out, the health system can focus on care management and clinical oversight.

Outsourcing the Tech

That strategy, of course, involves careful planning on the part of healthcare leadership. Executives have to balance the cost of outsourcing against the financial and clinical outcomes of the program.

“There is a financial play in this,” Welling says. While the short-term benefits, such as identifying unhealthy trends and reducing hospitalizations offer “bread-and-butter fee-for-service crisp ROI,” she says, the long-term benefits should also come into play, especially as the industry moves toward value-based care. A program that reduces hospitalizations now is great, but one that encourages healthier trends and cuts down the chance of many more healthcare events down the road is even better.

“Are we keeping people healthier?” she asks. “That takes longer to figure out. You definitely see fee-for-service [benefits] faster, but that’s not the only [measurable outcome.]”

Reimbursement is also important. The Centers for Medicare & Medicaid Services (CMS) has been slow in embracing RPM, which it calls remote physiological monitoring and remote therapeutic monitoring, but does offer some codes for Medicare coverage of data capture at home. Recently CMS expanded that coverage to include rural regions.

“That was big,” says Welling, who notes UnityPoint is moving quickly to expand its RPM program to rural communities in Iowa. “You have to have that up-front investment for those long-term gains I think we all know will come.”

Identifying the Right Tools for the Right Patients

CCM and RPM are in fact two different programs, each addressing a different patient population (though some patients are enrolled in both programs at the same time). CCM is more selective, focusing on patients with chronic health conditions and relying on a patient’s ability and willingness to manage their care at home. RPM, meanwhile, matches a patient’s health concern with a specific device aimed at tracking a key metric and relaying that data back to the care team.

According to Welling, UnityPoint developed its RPM program by creating a protocol to match patients with certain health concerns with a specific device that would be sent to them (unless they were using a device on their own). For patients living with more than one health concern, the clinician must choose what device that patient gets.

This process, she says, needs to be integrated with the patient flow process, so that patients get their devices at the appropriate time at home, along with whatever training is needed. Without that structure in place, patients could get their devices before they’re ready to use the technology, in some cases even affecting their willingness to use the devices.

“If you don’t do that well, you will frustrate your care teams,” she says.

Healthcare leaders also have to plan ahead for more complex patients. In some cases, Welling says, a physician could prescribe more than one device for a patient if the physician felt that strongly about multiple devices, even though Medicare reimbursement is limited to one device per patient.

“We didn’t automate that in any way, shape, or form,” she says. “There isn’t an algorithm for that. That is truly a physician and patient decision.”

That type of exception could become more commonplace as more patients present with multiple health concerns. Welling says this could also lead UnityPoint Health to develop more intricate and integrated RPM programs, adding resources such as behavioral health and home health care.

Episodic Vs. Continuous Care

Welling says it’s also important to understand how data from devices reflects a patient’s health. A single reading can capture a patient’s health at a specific moment, but it doesn’t accurately capture the patient’s continuous health journey. For that reason, the RPM program charts seven readings at the beginning of monitoring, allows some time for the patient to get used to the program, then captures seven more data points.

“It takes some time to get into [a] normal lifestyle,” she points out. And while that information is gathered by HealthSnap and included in quarterly reports, a physician can ask to look at a specific patient’s data at any time.

Understanding how that data is used goes a long way toward determining the ROI for an RPM program—and helping reluctant physicians buy into the program.

“This is not easy – it’s a big change,” she says. “Some [physicians] run towards it; they love it. Others see it as relinquishing control.”

And both physicians and patients have had concerns about having a technology vendor in the loop. Both are used to the concept of episodic care, where a patient visits a doctor for treatment, everything is done in that visit or in subsequent follow-ups, and that’s it. RPM, on the other hand, understands that a lot of healthcare happens outside the doctor’s office, with patients and doctors connecting via the device to keep patients on a care path.

Welling says the health system is still learning the intricacies of RPM, and that should be the strategy for the program that needs to adjust continuously to the ebb and flow of its patients. It’s important, she says, for the physicians in the program to know they can check on their patients at any time, guiding each patient rather than waiting for the next scheduled doctor’s visit. And patients in the program are encouraged by knowing that a care team is monitoring them, helping them get through the ups and downs of healthcare management.

She expects both the RPM and CCM programs to continue evolving. She also sees the platform branching out to address behavioral health concerns, which play a role in many care pathways. As well, the program could link in pharmacies.

“In time, we will think that what we’re doing before was just silly,” she says.