How Remote Patient Monitoring Supports Chronic Care Management

For patients with chronic conditions such as respiratory illness, heart disease, and diabetes, remote patient monitoring (RPM) can be life-changing. These common diseases are among the leading causes of morbidity and mortality in Americans, and they require continuous monitoring, timely intervention, and personalized care plans. RPM is revolutionizing chronic care management (CCM), which traditionally can be disruptive, time-consuming, and resource-intensive.

Moreover, the Community Preventative Services Task Force (CPSTF) recommends remote interventions to reduce chronic disease risk and manage certain illnesses. These include cardiovascular disease, end-stage renal disease, high blood pressure, diabetes, and obesity. ^[1] Through a proactive, patient-centered approach, RPM improves outcomes enabling providers to deliver more efficient healthcare.

Understanding Traditional Chronic Care Management

CCM strives to provide the necessary support for patients to manage their conditions while preventing complications and reducing hospitalizations. It involves the coordination of regular exams and therapy, medication management, health coaching, and education. Conventionally, these services require substantial time and effort for patients and providers. They include home health services, phone calls, and frequent office visits. Providers receive patient data surrounding a scheduled visit or an emergency, putting them in a reactive position.

Impact of Remote Patient Monitoring on Chronic Care

RPM securely delivers real-time medical data from patients to healthcare providers through digital technology from any location, so patients with chronic conditions can consistently monitor their health metrics at home. Medical devices including glucose meters, blood pressure monitors, and wearable fitness trackers transmit information such as heart rate, heart rhythm, blood oxygen, weight, blood pressure, and blood sugar to an RPM clinical team and the provider. The team reviews the data for abnormalities or concerning trends that could require intervention and escalates to the provider as appropriate. Providers can then make recommendations and adjust the treatment plan or medication early to prevent worsening conditions. Other benefits of RPM include:

• Improved patient engagement— Regular monitoring is critical to effective chronic care and empowering patients to participate in their health management is a major advantage of RPM. Because patients can follow their medical trends, they can better understand their conditions, which leads to increased compliance with treatment plans, prescribed therapies, and lifestyle changes. Furthermore, it can improve overall health outcomes.
• Personalized care—RPM provides insight into individual patient needs and facilitates the delivery of personalized care. Through consistent health metric reporting, physicians can evaluate how patients respond to their medication and treatment plans and adjust accordingly.
• Enhanced patient and provider communication—RPM promotes ongoing interaction between patients and providers. Patients can get the support they need by asking questions and sharing concerns through digital platforms, and providers can reply promptly. Additionally, providers can gauge patient progress through these exchanges. Increased communication builds trust between patient and provider and improves the quality of care.
• Reduced healthcare costs—RPM facilitates early detection and intervention, minimizing the risk of complications and hospitalizations. This proactive medical approach can avert costly diagnostics and treatments, reduce office visits, and optimize resources by enabling provider focus to remain on those most in need.

How Remote Patient Monitoring Works for Chronic Care

The process for RPM for CCM may vary across providers, but generally, these are the basic steps and services a patient can expect.

• Initial consultation and risk assessment—A healthcare provider prescribes a monitoring program with their third-party RPM team after determining whether a patient is a candidate. The provider assesses the benefits and risks of remote physiological monitoring for the patient, which condition(s) qualify, and obtains their consent to initiate a program. Providers must also establish if the patient has coverage (if not a Medicare beneficiary). ^[2] A registered nurse from the RPM team establishes patient goals based on a comprehensive questionnaire and feedback from the provider.
• Device activation—The RPM team arranges for the appropriate medical device and ensures proper activation. The electronic devices transmit health data via Bluetooth or a cellular network. Common RPM devices include weight scales, blood pressure monitors, glucose meters, and spirometers.
• On-going patient support—A registered nurse from the RPM team conducts regular follow-up calls with the patient. Additionally, the RPM group provides patient support 24 hours a day, seven days a week, 365 days a year. They respond to readings, schedule doctor’s appointments, ensure medication adherence, answer questions, and escalate important health matters to the patient’s provider. ^[3]

Considerations of Remote Patient Monitoring for Chronic Care

For RPM to be effective in chronic care management, patients and providers need education about the proper use and implementation of the program. Healthcare providers should integrate electronic health records (EHRs) with the RPM system. This requires technological and infrastructure investment. They should have training and policies surrounding RPM and choose a partner with a secure HIPAA-compliant RPM/CCM platform. Finally, they should have billing solutions that result in clean, seamless claims.

RPM could shape the future of CCM for patients and providers with increased efficiency and a more personalized, proactive approach. Technological advancements offer new opportunities to improve patient outcomes and decrease healthcare costs. RPM represents a paradigm shift in chronic care to achieve better patient health and a more sustainable healthcare system. To learn more about CCM through Nsight Health click HERE to schedule a demo today.  Whether you are a patient or provider looking to learn more about RPM, we would love to hear from you.

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