Payer solutions using digital health technologies such as remote patient monitoring (RPM) are standing out for achieving the triple aim of healthcare: improving the patient experience, improving population health, and reducing per capita costs. With continuous, real-time monitoring of members outside of traditional clinical settings, advanced payer solutions such as RPM allow health plans to transition from reactive care to proactive. through data-driven management of member populations. This shift in strategy is vital for success in today’s value-based care landscape.
How Remote Patient Monitoring Drives Payer Solutions for Cost Containment
The core appeal of RPM is its ability to significantly impact financial performance and drive effective payer solutions for cost containment. Implementing robust RPM programs helps health plans lower overall costs by enabling preventative care and the proactive management of chronic conditions. As a result, reductions in expensive, avoidable episodes of care such as emergency department visits and hospital readmissions are occurring.
For example, According to a new study, the Patient Monitoring at Home program at U-M Health had a $12 million return on investment due to avoided hospitalizations. Hospital admissions fell by 59% among patients enrolled in their remote patient monitoring program. The program uses remote monitoring devices and clinician support teams that check daily vital signs and symptoms.
Reduction in high-cost utilization
RPM provides a continuous stream of real-time data on member vital signs (blood pressure, glucose levels, and weight), that allows care teams to detect subtle declines in health status before they become critical events. For instance, A Mayo Clinic study have reported a cost savings for 1,128 patients engaged in their RPM program was about $1.4 million.
By moving monitoring and some aspects of chronic disease management into the member’s home, payer solutions utilizing RPM reduce the high costs associated with inpatient services and clinic visits, which is a major driver of cost-efficiency.
The Mayo Clinic provided an in-home technology package at no cost to patients. The researchers found that those who engaged with the RPM program experienced a significantly lower cost of care than the non-engaged patients. This resulted in an average cost savings of $1,259 during the 30-day follow-up period. It was due primarily to lower rates of hospitalization and shorter lengths of hospital stays.
Payer Solutions That Enhance Value-Based Care & Quality Measures
For health plans engaged in value-based care models, payer solutions that incorporate RPM are improving quality measures and maximizing reimbursement. Success in these models is directly tied to a plan’s ability to improve patient outcomes and quality scores.
Improved Quality Metrics
RPM platforms provide the data and insights needed to positively impact quality scores, particularly those tied to measures like HEDIS (Healthcare Effectiveness Data and Information Set) and Star Ratings. Better management of conditions like diabetes, hypertension, and congestive heart failure directly leads to enhanced outcomes, which are rewarded in value-based arrangements.
Driving Member Engagement
Every day, more than 8,400 discharged consumers complete the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey. The HCAHPS Survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. A feature of effective RPM programs is their ability to increase member satisfaction and health literacy.
When members are empowered with easy-to-use tools and real-time data, their adherence to care plans improves. Ultimately this can lead to better clinical results. Increased patient satisfaction scores in successful programs, also contribute directly to higher quality ratings.
Proactive Population Health Management Through Data and Analytics
Modern payer solutions rely on sophisticated data analytics to manage population health effectively, and RPM is a fundamental source for intelligence such as those outlined below.
Risk Stratification and Targeted Intervention: RPM platforms provide payers with access to real-time, secure health data. This information can be analyzed to better understand member populations, proactively identify high-risk, high-utilizer individuals, and stratify risk for targeted interventions. Predictive analytics, a key component of leading RPM platforms, can alert care teams before a crisis occurs, allowing for timely outreach and care coordination.
Deep Interoperability and Transparency: Effective payer solutions offer deep interoperability with existing payer platforms, promoting data transparency and centrality. This seamless data flow ensures that care management teams have a holistic view of the member’s health journey, enabling streamlined care coordination responsibilities.
Stronger Provider Partnerships with RPM Payer Solutions
Successful deployment of any payer strategy requires strong, collaborative relationships with provider networks. RPM payer solutions act as a catalyst for this collaboration by providing a shared platform for longitudinal care management.
Greater Collaboration and Transparency: The real-time data shared through RPM creates a new level of transparency between payers and providers. This shared information fosters greater collaboration on treatment plans and encourages the development of stronger referral networks and contracts that align incentives around quality outcomes.
Simplified Care Transitions: RPM solutions simplify care transitions, especially for members discharged from the hospital. By ensuring continuous monitoring and coordinated follow-up, RPM minimizes gaps in care, which is crucial for preventing readmissions and improving overall clinical, operational, and quality-related outcomes.
The Member Journey: Remote Monitoring in 5 Easy Steps
A seamless member experience is essential for the high utilization and success of payer solutions. Remote monitoring supports members through a straightforward process:
- Eligibility: Member is identified as eligible to receive telehealth or remote monitoring as a part of their benefits plan.
- Enrollment & Customization: Member is enrolled into the program with a customized, dynamic care plan based on their condition, acuity, and specific needs.
- Engagement: The RPM platform provides the member with user-friendly tools (devices, tablets, apps) to actively engage with their care team and track their health.
- Real-Time Monitoring: The member is monitored in real time, with data securely transmitted to the care team, often supported by 24/7 clinical support to ensure no critical alerts are missed.
- Program Completion & Continued Support: At the end of the intensive program, the member has the option to remain on low-touch monitoring for ongoing self-management and continued support.
Payer Solutions & Return on Investment Outcomes
The American Hospital Association (AHA) forecasts a 3% increase in inpatient utilization over the next decade, moving to 31 million annual discharges. Within that same period, it is projected that inpatient days will rise by 9% to 170 million. These trends will significantly impact patient throughput.
Ultimately, the goal of any advanced digital health offering is to demonstrate a clear return on investment. RPM-enabled payer solutions are consistently shown to deliver high ROI outcomes by:
- Reducing Total Cost of Care — By avoiding costly hospitalizations and emergency department use.
- Improving Utilization — Through proactive intervention and better chronic condition management.
- Optimizing Member Engagement —Leading to improved adherence and healthier populations.
With the potential for high return on technology and staffing investment being reported for effective RPM programs, the shift toward these digital payer solutions is now a clearer financial imperative. Are you interested in calculating your potential ROI for RPM?
Try our Tracker >> and you’ll receive an estimate in seconds.
