Scaling Remote Monitoring Programs: Strategic Imperatives for Health System Leaders

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Introduction

Remote monitoring technology and programs have proliferated over the past five years, accelerated by the continued miniaturization of medical-grade sensors; improvements in device accuracy, validity and pricing; and new reimbursement models such as coverage for remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) codes. Remote monitoring programs, when well-designed and broadly deployed, can accelerate progress toward the triple aim of improved health, a better patient experience and lower cost.

Health systems across the country are actively implementing or considering remote monitoring for a wide range of conditions and levels of acuity, ranging from population health management to episodic care to hospital-at-home. Remote monitoring technology can support a fundamentally different care model—digitally enabled care1—that is centered in the home, enables continuous patient-provider connectivity and empowers patients to manage their own health. There is opportunity for health systems, and academic medical centers (AMCs) in particular, to lead in designing these models. This article shares strategic imperatives for health systems to advance their remote monitoring programs.

Strategic Imperatives

1) Invest in Remote Monitoring Programs That Align With Health System Strategic Goals

Remote monitoring programs are most successful when viewed as a means to advance enterprise strategic goals and needs, such as:

  1. Optimizing hospital capacity: Home-based care programs that leverage remote monitoring are an opportunity to enable hospitals to preserve precious inpatient bed capacity for their sickest patients and to support patients. Examples of conditions that hospitals are often able to monitor and support at home are congestive heart failure, urinary tract infection, acute kidney disease and chronic obstructive pulmonary disease (COPD).
  2. Improving population health and individual health outcomes: Remote monitoring has shown to improve outcomes for patients with chronic diseases such as hypertension, diabetes, hyperlipidemia and COPD. Improved outcomes may include reductions in avoidable emergency department (ED) visits or admissions, reductions in inpatient hospital days, and improvements in disease-specific measures such as blood pressure and blood sugar.2
  3. Enhance financial results for patients in risk-based arrangements: By improving population health outcomes, health systems can improve their financial results by deploying remote monitoring programs for high-risk and high-cost patients and lowering the total cost of care.
  4. Alleviating staff shortages and improving provider well-being: Remote monitoring programs can provide an opportunity for clinicians and staff to work remotely. With staffing shortages and COVID-19 surges continuing to impact the health care system, enabling clinicians to work from home can reduce burnout and staff turnover and prioritize care for patients who need it, thereby easing staffing challenges.3

2) Develop a Diversified Financial ROI Model for Remote Monitoring Programs

A return on investment (ROI) can be achieved several ways.

Though the reimbursement potential for remote monitoring programs is improving through the adoption of RPM and RTM codes, revenue from these codes alone do not reflect the full ROI potential of remote monitoring. Though these codes should be well understood and utilized when possible, they are not covered by all payors and are often challenging to use due to onerous code-specific requirements. Health systems should look to other sources of revenue, such as direct contractual revenue from employers, health systems and customers, as well as indirect cost savings, such as lower spending on employee health and lower total cost of care for at-risk populations, to get a full view of the ROI of remote monitoring.4

In our experience, though health systems that operate in predominantly fee-for-service environments can realize a positive ROI from remote monitoring through the use of RPM and RTM codes, payor, and employer contracts, health systems managing populations in value-based arrangements are best positioned to realize the greatest ROI of remote monitoring.

3) Match the Organizational Model for RPM to Your Overall Organizational Structure

Organizing RPM programs at scale requires thoughtful organization; it’s too soon to tell what the best model is, but it is critical that organizations carefully consider models for governance, operations and clinical program development that best fit their organization and stage of RPM program development.

The following chart highlights the range of organizational models, which range from fully local (managed at the department or service line level) to fully centralized (managed at the enterprise level).

  Option 1:
Fully Local
Option 2:
Hybrid
Option 3:
Fully Central
Description
  • All programs are developed, governed and operated at the department or service line level
  • Some functions are centralized; others are local
  • Some have centralized governance and infrastructure, while some clinical programs are still developed, managed and operated locally
  • Programs are governed and operated fully centrally
Considerations
  • Supports innovation at the local level; programs starting RPM will benefit from local champions
  • Often leads to duplication and confusion for providers and patients
  • Could lead to diffusion of resources and subscale programs
  • Enables streamlining of core infrastructure that can be scaled across multiple clinical programs
  • Enables scaling of high-performing programs
  • Supports innovation at the local level while ensuring consistency for core services and a consistent patient experience
  • Typically works best in organizations with a strong culture of central programs
  • May stifle innovation at the local level
    There are a range of RPM organizational models pursued by health systems, but high-performing organizations are evolving toward more-centralized enterprise models with dedicated enterprise governance and operations teams with flexibility at the department and program levels for certain functions. We believe that most organizations would be best served by deploying a hybrid RPM organizational model.

Typically, a hybrid model will centralize certain functions (e.g., vendor selection, billing, device management) and distribute others (e.g., clinical program design, quality oversight). As systems’ RPM programs grow and scale, they expect that more functions may become centralized over time. As a guiding principle, functions that are more routinized and can be shared across programs will be centralized and those that are more variable/customized will be local.

4) Remoting Monitoring Can Support an Expanding and Broad Range of Clinical Needs

Health systems are innovating and experimenting with various use cases to see which create value for the organization and improve care for patients. In launching and managing an RPM program, flexibility and a portfolio management strategy are key—e.g., investing in multiple programs, scaling those that show promise and ending those that don’t meet the organization’s needs. Historically, RPM programs have focused on chronic disease management, with well-documented examples and successful clinical and operational models. As remote care and technologies become more common, health systems and clinical areas are seeking opportunities to expand to additional clinical areas, such as joint replacement, prenatal care and mental health care.

Some considerations for how to choose which RPM programs to invest in may include clinical value, logistics/workflow, technology need, financial impact, organizational impact (e.g., bed capacity) and where there are clinical champions.

Different clinical programs will demand different staffing and oversight models. Typically, chronic disease management programs with standard treatment protocols can be implemented at an enterprise level, while episodic and home-based programs, at this point, are more likely to be managed and implemented at a department level while leveraging enterprise resources.

5) Remote Monitoring Programs’ Execution Benefits From Patient Support Tools

Successful RPM program implementation, adoption and ongoing engagement can be realized by using design approaches that proactively address barriers to care, reduce friction and encourage ongoing engagement.

Health systems have implemented a range of strategies to ensure that RPM programs are designed in a way to consider patients’ needs with respect to social, behavioral, environmental and clinical factors. Ochsner Health, for example, offers the O Bar, staffed by a full-time technology specialist who helps patients get set up with equipment and apps for its RPM programs.5 Other organizations have developed RPM programs that leverage Bluetooth or cellular service (texts and phone calls) to circumvent Wi-Fi or app downloads. Often, health coaches will work with patients on goals that consider their unique social circumstances and help integrate other care needs (e.g., nutrition). It is important that RPM programs meet patients where they are.

Conclusion

RPM offers health systems and AMCs the opportunity to innovate and lead; the accelerated and widespread adoption of digital tools opens new doors and approaches to solving some of our greatest health care challenges. As organizations advance their programs, it is important to invest in areas that advance organizational needs, organize governance and operations thoughtfully, and implement programs in a way that reflects the needs of the population.


1 American Medical Association. Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care. 2021.

2 https://www.ochsner.org/io/work/digital-medicine

3 https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0031

4 American Medical Association. Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care. 2021.

5 https://www.ochsner.org/shop/o-bar

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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