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Beyond Hospital Walls: consumer empowerment for faster, better and cost-effective care

Beyond Hospital Walls: consumer empowerment for faster, better and cost-effective care
September 23, 2019

Digital healthcare enterprises today leverage data, are experience centric and outcome driven, and are keen on innovating. However, the key element that will determine the future of healthcare is consumer empowerment. The industry has become comfortable referring to clients of healthcare organizations as consumers (as opposed to patients or members). This, combined with explosive transformation consumer technologies, offers an interesting opportunity to bring healthcare solutions closer to the needy. The implementation of consumer centric care delivery mechanisms show that the four critical aspects of healthcare delivery – cost, access, quality, and value, are addressed more efficiently than the traditional care delivery model.

The newer opportunities for overall improvement in healthcare delivery leverage consumer empowerment and enablement. They are made possible by a combination of new care delivery models that are enabled by cutting-edge technology, progressive legislation, healthcare ecosystem partnerships, and most importantly, consumer awareness and demand. Healthcare consumers have many choices now - most of the new care delivery models offer care at consumers’ doorsteps, beyond hospital or clinic walls. These healthcare solutions would also mean more responsibility and accountability for consumers.

In this series of blogs, we will examine various such opportunities for care management for consumer centric care delivery.

Remote Physiological Monitoring (RPM)

RPM is a classic example of how the aspects of care have moved closer to consumers, thanks to technology advancements and accompanying regulations and incentive structures. While self-monitoring of health conditions, illness or wellness, is not new, the sophistication of the devices (read wearables), ease of documentation, integration of measured parameters into care records, the security and credibility of such self-monitored reporting has increased significantly over past few years. Laws and regulatory bodies have also started propagating the mainstream adoption of care models enabled by RPM. From a pure technology standpoint, RPM is Internet of Things (IoT) advances in action with other technologies like web, cloud, analytics, reporting etc. playing enablers.

Remote Physiological Monitoring (RPM) can prevent physician burnout issues, improve patient engagement and satisfaction scores, improve ability of patients to self-triage, and save overall healthcare cost

In the US, many states have been covering RPM as part of Medicaid in some form or the other. But the biggest boost for RPM came from Center for Medicare and Medicaid Services (CMS) recently, in the form of new CPT codes for Medicare reimbursements on RPM. RPM is now encouraged and reimbursed for physicians treating chronic conditions per the new CMS 2019 rule. Multiple Current Procedural Terminology (CPT) codes have been established (CPT 99453, 99454, and 99457) as part of CMS’ initiatives to improve health of the masses and facilitate better and timely care coordination by incentivizing remote monitoring in Medicare population.

Two major aspects of this rule make RPM more physician friendly and suitable for wider adoption as a healthcare solution. One, unlike telehealth related codes, these CPTs are universally available. Another interesting aspect of this rule, issued as a technical correction recently, is that it now covers “RPM treatment management services” conducted by auxiliary personnel “incident to” billing physician’s professional services. Thus, this also enables authorized clinical staff of the treating physician to provide monitoring services, making the physician’s return on time higher. At $123 per enrolled patient per month, potential for additional revenue is one of the best incentives yet for physicians to adopt RPM. This rule is expected to encourage other health plans and employer sponsored plans to adopt remote monitoring as an effective tool in encouraging better care management and disease management in their managed populations.

Included below is a sample end to end RPM solution flow that HCL has put together to help any provider who might want to leverage the latest CMS rule. This is a part of an RPM solution called 454RPM that strives to make the adoption of the care model simple and straightforward, with least possible disruption to the established care settings.


Pic 1. Sample solution flow for RPM in the context of CMS rule 2019

Implications of RPM in mainstream

RPM programs, like the one in the example above, have wide ranging implications. With financial incentives, better care monitoring and management, better patient involvement in care delivery and accountability, and improved population health are obvious gains, there are some critical auxiliary benefits as well. RPM can potentially prevent physician burnout issues by ensuring better utilization of a physician’s time. It can boost consumer empowerment in healthcare, improve patient engagement and satisfaction scores, the ability of patients to self-triage, and save healthcare costs.

In conclusion

As RPM brings digital healthcare to consumers, innovation in consumer technology is getting a boost as well. Medical device manufacturers are already working on more innovative medical and consumer grade technology options to enable RPM. Data sciences and RPM data will make care more real time and personalized, and incorporating RPM into clinician’s workflow will make home-clinic-hospital care pathways more integrated and connected. Similarly, native cloud applications, blockchain enabled care management platforms, and supportive cybersecurity solutions are all coming together to provide better, safer, more secure, easier, and cheaper solutions, to enable RPM for large scale deployments. This is just the beginning of true “self-service healthcare”!