Provider Data, Remote Care Management (RCM) and Telehealth

Whether we call it integrated care management, person-centered care, or the like, in healthcare we have universally agreed on the need to better coordinate care around patients.

What’s yet to be determined in such whole-person care? The role and true value of remote care. We’re still grappling with the tools and data needed for successful outcomes using telemedicine and remote care management (RCM). Ensuring that providers and payers have accurate data to deliver the right care using the best modality for each patient is the right place to start.

What is remote care management? 

In recent years, more healthcare providers and organizations have adopted an integrated—rather than episodic—approach to patient care. The difference between the two is simple: episodic care primarily focuses on getting a patient healthy by fixing whatever is wrong with the patient right now, while integrated care focuses on keeping a patient healthy. 

The key to integrated care is care management, defined as the “activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminating duplication, and helping patients and caregivers more effectively manage health solutions.” Chronic care management (CCM) helps ensure that patients with chronic illnesses or complex comorbidities are better-equipped to manage their conditions, which often means fewer ED visits, fewer specialist referrals, lower costs, and better overall outcomes. 

Advances in telehealth made remote patient monitoring (RPM) easier, but RCM hasn’t always been widely used. Until recently, most providers and healthcare organizations operated under fee-for-service care/payment models that only reimbursed physicians for in-office patient visits, so remote care management was largely ignored. 

That’s changed as more providers and organizations shift to a value-based approach to care. Value-based payment and care models recognize that continuous patient monitoring and support play a crucial role in educating patients about their health, which helps facilitate early intervention and improve medication and treatment adherence. These factors, in turn, lead to better overall patient outcomes and lower overall costs in the long term. 

New CMS reimbursement rules for RCM, CCM

Regarding reimbursement, the Centers for Medicare & Medicaid Services (CMS) added coverage for remote therapeutic monitoring services in its 2022 Physician Fee Schedule final rule. This action underscores the continuing trend of expanded Medicare reimbursement for remote care monitoring. There are five new “remote therapeutic monitoring” (RTM) codes, all of which are live as of January 1, 2022.

How do remote care management and telehealth work? 

Once a patient develops a chronic condition or a complex comorbidity, they are often at an increased risk of rapidly deteriorating health. Before remote care management, providers had only sporadic contact with their patients and limited access to patients’ clinical data. With RCM, providers can use telehealth technology to continuously monitor patients and collect health data on an ongoing basis. Examples of the telehealth technologies and software used to deliver care virtually include:

  • Live video conferencing
  • Interactive voice response (IVR) systems
  • Mobile health apps
  • "Store and forward” electronic transmission
  • Remote patient monitoring devices

Remote care management and telehealth can be used in various ways. Some devices automatically record and send patient data (e.g., blood pressure readings) to providers at regular intervals throughout the day. Others require the patient to record and securely send medical data two or three times daily. 

Once the data is collected, medical providers review it to determine whether to make any recommendations to the patient. In some cases, that could mean something as simple as a medication adjustment. In others, a trend in the data could indicate that more significant intervention is needed and that the patient must be seen in person by a physician or other provider, typically at the physician practice office, before a more serious medical issue occurs. 

Benefits of remote care management and telehealth 

The benefits to remote care management and telehealth for patients and providers include the following: 

Less overhead (and potentially increased revenue) 

With episodic care, it’s difficult for providers to determine what’s been going on with a patient’s health between visits—especially when it comes to patients with chronic disease. As a result, these patients must undergo a physical examination by a provider to determine the best course of action. 

With remote patient monitoring and telehealth, providers already have the up-to-the-minute patient data they need to effectively treat or manage their patients’ conditions. This reduces the need for in-office visits, which in turn decreases overhead costs per visit and lowers no-show rates, allowing providers to maximize their revenue and scheduling without a drop in the quality of patient care. 

Better control over infectious illnesses 

COVID-19 highlighted the need for effective remote care management and telehealth in a major way. For many patients who require chronic care management, in-person visits during the pandemic meant having to choose between potential exposure to a disease that is far more dangerous to them than to the general population or risk their chronic conditions spiraling out of control because they missed their appointments. Remote monitoring care management and telehealth allow providers to continue caring for their most vulnerable CCM patients without putting them in danger. 

Fewer barriers to care 

It’s not uncommon for patients with chronic conditions to need appointments with multiple specialists, and the burden of having to attend various in-person appointments can be too much for patients to manage. Remote patient monitoring and telehealth can eliminate transportation, scheduling, and other barriers by decreasing the number of necessary in-person visits—and that can make all the difference regarding prevention and cure. 

Lower patient costs 

As the saying goes, “an ounce of prevention is worth a pound of cure.” In-person visits can discourage patients from showing up for follow-up or routine appointments. But these visits play an important role in early detection and proactive treatment adjustment: Without them, a health concern that might have been spotted and easily addressed could go unchecked. Issues that spiral out of control not only create health problems that are more difficult to manage or treat effectively, they also increase costs for patients and members. That’s where RPM comes in.

Better performance and quality metrics 

It can be difficult to measure provider performance and quality of care, especially when care is sporadic or episodic. The continuous stream of data provided by remote care management, RPM, and telehealth makes it easier for healthcare organizations to get a clear picture of what action(s) should have been taken and when, which in turn allows them to more accurately assess and review provider performance and quality when it comes to patient care. 

Improved patient engagement and outcomes 

Patient outcomes are inextricably linked with the patient’s level of engagement in their care—especially when it comes to chronic care management. The reality is, providers can only do so much on their own. They can prescribe the right medications or treatments and suggest the right lifestyle changes, but it’s up to the patient to carry out that treatment plan. 

The more engaged a patient is, the better they’ll understand the "why" of their treatment plan. The better their understanding, the more likely they will be to stick with it—and the better their long-term outcomes will be. Remote care management, RPM, and telehealth are crucial tools for keeping patients engaged and up-to-date with their own health and treatment plans. 

Why patient data accuracy matters for healthcare providers

More efficient daily routines 

Healthcare providers have too much on their plates as it is. Healthcare organizations are working to reduce provider burnout rates by implementing effective workforce management strategies, and part of that includes ensuring provider workflows are as efficient as possible. 

Remote care management, RPM, and telehealth give providers a more complete and accurate picture of patient health. That means less time spent getting up to speed on a patient’s current condition and increased confidence that care decisions made are the right ones. 

Improved patient education and support 

Outside of helping patients avoid worst-case scenarios, RPM and telehealth can also be incredibly useful tools for patient education and support. 

Continuous monitoring reassures patients that their provider is keeping a close eye on their health—and the variety of data points captured help patients connect the dots between the CCM treatment and their health. The data can also help providers clearly demonstrate to patients that the treatment is working as expected, which can drive home the value of medication and treatment adherence in a way that counseling alone often can’t. 

Sometimes patients need additional support from their providers: maybe a prescribed medication has side effects and they don’t like taking it, or maybe their schedule makes it difficult to stick to the medication timetable and they’re worried about bringing it up with their provider. With the data provided by RPM and telehealth, providers can identify opportunities to support patients and make the necessary adjustments to ensure the best possible outcome. 

How data management technology can improve remote care management and telehealth 

When properly implemented, remote care management and telehealth can capture valuable patient data that helps providers most effectively manage their patients’ health. But this data is only as effective as the software supporting it: Without effective data management, it can be difficult for providers and healthcare organizations to maximize the benefits of remote care management and telehealth.  

symplr offers a range of solutions that can help providers and organizations navigate the complexities of data management. To learn more about what we can do for you or to request a demo, get in touch with us today.


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