Remote Patient Monitoring is a Wise Investment for Payers

MilsteadRecently, Geneia announced the results of a year-long remote patient monitoring pilot program, which compared the experience of Capital BlueCross members diagnosed with heart failure (HF), who enrolled and actively participated in Geneia’s @Home remote patient monitoring program, to a control group of non-monitored members with statistically similar pre-program risk scores. The study evaluated clinical, utilization and cost outcomes, and patient experience.

In short, the heart failure patients in our study fared much better than the control group:

• Their risk score stabilized – a 2 percent increase in the study group compared to a 31 percent increase in the control group – indicating a slowing of disease progression for participants.

• With a net 45 percent reduction in acute hospital admissions, they spent far less time in the hospital.

• Their quality of life improved as did their satisfaction with their healthcare experience.

The results were gratifying and yielded a savings of $8,375 per monitored patient per year. To put this into context, accounting for program costs and expected participation rates, a typical one-million-member payer could save about $1.1 million per year. You can read more about the results of the pilot program here.

At Geneia, we know payers have the resources and care management expertise to invest wisely in remote patient monitoring (RPM) programs to benefit their participating physicians and chronically ill patients. As such, they also are positioned to drive improvements in the Triple Aim, which is to improve patient health outcomes, their experience of care and the associated costs. That is especially true in programs like the Comprehensive Primary Care Plus (CPC+).

The Centers for Medicare & Medicaid Services (CMS) is moving quickly to implement CPC+, a five-year, multi-payer model intended to strengthen primary care practices. The program was announced in April, and in the months since then, CMS has selected 14 participating regions based on density and interest shown by payers and primary care practices. Primary care practices in the selected regions had to apply for the program by September 15, 2016.

Next: RPM needs will increase

The benefits to participating physician practices are significant.

Under CPC+, CMS and participating payers will pay physicians a monthly fee for patient primary-care visits. Depending on the number of patients participating, providers can earn an additional $100,000 to $250,000 per year under the model, according to Lynn Barr, chief transformation officer at Caravan Health, a healthcare consulting firm.

Another benefit is that CPC+ counts as an alternative payment model as outlined in the Medicare Access and CHIP Reauthorization Act (MACRA).

Payers also are expected to provide financial resources for practices to change their delivery systems and to support the comprehensive and ambitious patient goals for the program, which are to:

• Help patients with serious or chronic diseases achieve their health goals

• Give patients 24-hour access to care and health information

• Deliver preventive care

• Engage patients and their families in their own care

• Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care

Given CPC+ and other CMS programs intended to strengthen the connection between payers and primary care practices and ultimately provide truly coordinated patient care, there is a significant role for RPM. At Geneia, we believe that the overwhelmingly positive results of our year-long study of RPM indicate payers should invest in RPM technology and programs on behalf of their primary care partners.

Dawn Milstead is vice president, clinical solutions, at Geneia.