By Dr. Paul Helmuth, MD
Over the past few months, my colleagues and I have been trying to discern the ideal mix of in-person and virtual care as we move into yet another phase of the COVID-19 pandemic. How do we balance the requirements for quality of care with patient convenience and even staffing challenges? How do we expect to deliver care in the next year? In five years?
In the midst of these discussions about the future, I cannot help but reflect on the past few years and on the unexpected yet transformational changes we have all witnessed in healthcare technology. I’m reminded of a patient of mine, whose access to medical care was complex even prior to the COVID-19 pandemic, but whose experience of care actually improved with the addition of virtual care technology and services.
“Alex” is a 70-year-old Puerto Rican man with hypertension and coronary artery diseases, who speaks little English and has low literacy in his native Spanish. Although we included a Spanish interpreter during all his in-person visits to our office, he continued to have problems with understanding and adhering to his medication regimen. His blood pressure was never consistently controlled. At the onset of the pandemic, our office arranged audio-only telehealth visits for Alex with a bilingual nurse practitioner to manage his hypertension. However, since he did not have access to a home blood pressure monitor, the visits were not very productive.
By enrolling him into a chronic care management program with a Spanish-speaking care manager, we were able to maintain meaningful contact with Alex to encourage adherence to his medication regimen. Adding remote monitoring with a cellular-enabled blood pressure measurement device gave his care team the data to titrate his medications. For Alex, his blood pressure control, access to services and experience of care improved dramatically during the pandemic despite barriers of literacy, language and access to technology.
This is just one example of how tech-enabled services can transform patient care and outcomes.
The combination of remote patient monitoring (RPM) and chronic care management (CCM) can improve clinical quality and care team efficiency, as well as the financial performance of an organization. Transformative stories such as Alex’s can be enabled by allowing practitioners to make time for everyone in their care.
Our approach to virtual care management will be presented in three parts:
- Part 1: Despite the rapid expansion of mobile health technologies during the pandemic, clinicians find themselves with too much to do and not enough time in the day. Most providers still practice a traditional model of care delivery. Remote monitoring technology, while extremely valuable, is not a silver bullet for improving patient outcomes and engagement. Incoming data from devices needs to be leveraged properly and not be seen as an additional burden for medical staff.
- Part 2: Technology-enabled clinical services delivered via a remote patient management approach (CCM and RPM) represent a powerful combination that finally enables practitioners to provide truly proactive and preventive care. Chiefly, it can facilitate increased patient engagement, better outcomes, reduced rates of clinician burnout, improved access to healthcare and improved financial performance.
- Part 3: What features does a CCM and RPM enabling platform need to have? Three fundamentals include ease of use, integration and connectedness, and scalability.
Part 1: Too Much to Do, Not Enough Time
Healthcare practices and systems across the United States are under immense strain. The pandemic has added enormous pressures, and although the worst impacts of the virus appear to have passed, the fallout continues to hamper the efficient delivery of services.
Clinicians are not only under enormous time pressure to catch up on delivery of services and see growing numbers of patients, but also in danger of burnout, which further threatens patient care.
Indeed, for many healthcare providers, there is too much to do and not enough resources to do it well. No matter how many extra hours are put in, next week the pressure will be even more unsustainable.
Let’s paint a picture:
- You have a growing list of patients with chronic conditions and only 24 hours in the day.
- You know you should be looking for ways to keep chronic care patients out of the emergency department, but the acute conditions in front of you are taking all your attention.
- You recognize the need to expand your clinical team, but your budget is stretched already, and you cannot just pass your patients on to anyone.
- You keep turning to technology to take some of the pressure off, but implementing and managing the new technologies just puts more pressure on your team.
There is a damaging cycle at play. Patient care is worsening due to a lack of clinicians’ time, but practice schedules are remaining full — this is adding an even greater burden on medical staff, who continue to suffer from growing instances of burnout.
With increasing burnout, we know that patient experience and patient safety in healthcare settings will suffer. Mistakes will start to slip through. Medication can be incorrectly taken, community support can fall behind, conditions can worsen and lead to hospitalization and, in the worst-case scenario, patients can die.
And the most difficult part of it all? The people who suffer the most are patients. Vulnerable individuals like my patient “Alex” are the very people whose health (and, in many cases, lives) depend on the effective delivery of care.
According to a 2020 survey from Mental Health America (MHA), 93% of participating healthcare workers were experiencing stress, 86% reported feelings of anxiety, 77% reported frustration, 76% reported burnout and exhaustion, and 75% said they felt overwhelmed.
As a result, practice employees are physically and mentally exhausted, with more than half of the MHA survey respondents (55%) stating they were questioning their career path. Should more workers exit healthcare, the impact on patient care could be disastrous. However, despite how difficult it may seem to give the most vulnerable patients the attention they need, we believe it is possible to create more time for providers and patients alike.
Part 2: How Tech-Enabled Services Allow Time for Everyone
A vast array of technological solutions is already in use or coming to market now, with systems such as telemedicine and RPM becoming more widely adopted during the pandemic. Ideally, such health technology programs represent tactical point solutions as part of a broader strategy for engaging patients meaningfully between office visits that enables patient engagement, program enrollment, conditions management, monitoring of biometric data and closed-loop provider communications.
However, technology can only truly benefit the patient experience and outcomes when it is used in harmony with practitioners — otherwise, the deployment of smart, data-heavy solutions can actually add an extra strain on medical teams.
This is where CCM and RPM form a powerful combination. While CCM provides continuity of and coordination of care, RPM supplies the care team with tangible, actionable data that enables real-time intervention to prevent avoidable hospitalizations and help to manage chronic conditions such as uncontrolled hypertension, diabetes, heart failure or COPD.
Specifically, this approach to tech-enabled services offers five major benefits that will positively impact not only patient outcomes but also their experience of care.
1. Boosting Patient Engagement and Satisfaction
We know the demand for telehealth services exists. According to a State of Telemedicine Report published in 2022 by Doximity, the number of patients with chronic conditions who said they would use telehealth beyond the pandemic has increased to 80% — up from 60% in 2020.
Meanwhile, around two in three (67%) patients without chronic illness said they would continue using telemedicine after the pandemic. This represents another significant rise — up from 55% in 2020.
These are important insights, not least because by having more highly engaged patients, healthcare providers can focus on more critical tasks and experience less burnout from repetitive, time-sapping menial work.
What’s more, physicians are calling for it, too. According to a DHC survey, the majority (54%) of physicians want help connecting to patients before and after their visits, with those surveyed reporting an interest in using a variety of technologies to connect with patients outside of their premises.
2. Improving Patient Outcomes
Furthermore, by engaging more with patients between office visits and in community settings such as home, our care teams can also focus more on assessing and intervening to address social determinants of health (SDOH), those risk factors important to our patients where people live, learn, work and play.
Leveraging remote patient monitoring and chronic care management services more effectively will also help tackle the problem of medication nonadherence. Nearly a quarter (23%) of patients say there have been times when they forgot to take some of their medications or took the wrong ones – however, fewer than one in 10 (8%) patients reported medication adherence as a concern.
My patient, “Alex”, became more adherent to his medication when he was able to see the clear correlation between taking his medications for hypertension consistently and his home blood pressure readings. Because of the frequent telephone contact, his care manager was able to continue reinforcing the importance of taking his medication and following his blood pressure readings consistently.
By improving these intermediate health outcomes like blood pressure and blood sugar control, lower utilization rates including reductions in hospitalizations and emergency department visits will follow.
When compared to fee-for-service patients, CCM beneficiaries generally require fewer hospital visits. Regarding cardiovascular and diabetes issues specifically, emergency department visits and hospitalizations are reduced on average by 23 and 47 per 1,000, respectively. Meanwhile, separate studies also show that patients making use of RPM services require fewer inpatient hospital stays.
In combination, CCM and RPM can reduce the strain on frontline and emergency healthcare services, which in turn will enable them to provide superior care to those patients who are in greatest need.
3. Reducing Clinician Burnout
The COVID-19 pandemic affected the healthcare industry at every level, including both providers and the patients they serve. The American Medical Association’s Coping with COVID survey revealed that out of the more than 20,000 healthcare workers who participated, 38% reported experiencing anxiety and/or depression, 43% experienced work overload and an astonishing 49% suffered from feelings of burnout.
As a result, healthcare professionals are leaving the industry en masse, further complicating problems and compacting feelings of burnout for those who remain. Clinician burnout costs healthcare organizations and providers in many ways, including:
- Financial: According to a 2019 study published in the Annals of Internal Medicine, provider burnout costs the American healthcare industry an average of $4.6 billion per year. The researchers state that this loss is mostly the result of clinician turnover and reduced clinical hours.
- Personal: Burnout can damage one’s physical health and mental well-being. Physicians suffering from burnout may experience low energy, insomnia, compassion fatigue and a general lack of purpose.
- Professional: Clinicians experiencing burnout are more prone to making mistakes, increasing the risk of poor quality care and malpractice.
While there’s no one solution that will reduce clinician burnout, care management technology can alleviate many of the major causes by making it easier to access critical patient data quickly. This provides more time during in-person appointments to address patient concerns. Plus, when clinics and hospitals are able to make a difference in reducing burnout, patients will benefit from higher-quality care.
4. Increasing Access to Care
According to the National Academies of Sciences, Engineering, and Medicine, economic instability is one of the most significant factors determining an individual’s ability to access quality health care. Patients living in low-income areas, both rural and urban, are far less likely to regularly visit their primary care providers for a variety of reasons.
For example, patients who lack access to reliable transportation — or patients who must drive long distances to reach the nearest clinic — are more likely to miss, cancel or reschedule their in-person appointments. Without the ability to monitor these individuals between appointments, any changes in their conditions are likely to remain hidden until they escalate into serious consequences.
The limited availability of important resources is another significant barrier to access for many people. Clinics suffering from staffing shortages may have to reduce office hours, or their patients may need to wait for longer periods of time to see their provider in person.
Tech-enabled patient services such as CCM and RPM provide physicians with a way to keep tabs on their patients even when they’re unable to make it into the office. As a result, more people will be able to receive the care they need regardless of their socioeconomic status.
5. Boosting Financial Performance
Patients are also more likely to benefit if their practice is performing better financially.
This is another key consideration when it comes to deploying tech-enabled services — do it right, and practitioners can help to secure a sustainable financial future.
In general terms, costs relating to patients with uncoordinated care are 75% higher than those with joined-up medical service provision. Strikingly, among fee-for-service Medicare beneficiaries, people suffering from multiple chronic conditions account for 93% of total Medicare spend.
In stark contrast, patients in CCM programs account for lower hospital, nursing home and emergency department costs.
A Centers for Medicare & Medicaid Services (CMS) study reviewed data from every Medicare patient who received CCM services over a two-year period. It found that the CCM program reduced CMS’s costs by $74 per patient per month for patients who were enrolled in the CCM program for 18 months or longer. And for every 500 patients enrolled in CCM + RPM services, practices could see around $1 million in new revenue annually.
The upshot of improved financial wellness is clear. By operating with a more secure budget and efficient cost base, there is greater scope for healthcare practices to invest in what really matters — improving patient care.
Part 3: Making It Happen
Combining the best of chronic care management and remote patient monitoring, while no small undertaking, is more accessible and attainable than practitioners may realize. Software platforms have been developed specifically to enable CCM and RPM to join forces. When exploring potential solutions, there are several critical factors to consider: keep it simple; keep it connected; keep it going.
Keep It Simple
An effective program will enable practices to deliver chronic care management and remote patient monitoring on a single platform, and likewise be simple for any member of practice staff to onboard and use.
Patients should be enrolled easily, with the platform partner able to identify, contact and obtain consent from eligible patients while staying Medicare-compliant, allowing practices to increase revenues without adding to workloads.
Keep It Connected
Successful CCM and RPM programs need all salient clinical data, and integrating with electronic health records will help to offer a full picture of the patient during each encounter.
Meanwhile, the platform provider should provide dedicated clinical staff who connect with patients to coordinate their care. The coordinators should have medical experience, receive thorough training and be regularly audited for quality assurance – all helping to ensure patients are in the best possible hands.
Keep It Going
Finally, an ideal program will offer a flexible and scalable model with its own care coordinators, the customer’s own, or a mix of the two. Practices could start with an outsourced or co-sourced model and adjust based on staffing needs.
Such flexibility in program design requires a responsive platform partner able to provide quick answers to questions and help problem-solve long after the contracting paperwork has been finalized. Such a partner will ultimately help practices design a CCM + RPM program with a profitable operating model that will see a return on investment within the first month of initiating services.
Leveraging Technology to Transform Patient Experiences
For complex individuals like my patient “Alex,” health outcomes and the experience of care can be transformed almost immediately by onboarding onto a platform that enables the merging of CCM and RPM programs.
Common care scenarios experienced right across the United States, where there is too much to do with too little time to do it, can become a thing of the past. Indeed, through tech-enabled services that combine chronic care management and remote patient monitoring, there can be time for everyone:
- Time for Mr. Jones to get a ride to his next appointment.
- Time for Sra. Rodriguez’s blood sugar levels to be checked more frequently.
- Time for Ms. Patel to ask questions about her care regimen.
- Time for practitioners to get all the reimbursements they are owed.
- Time for physicians to see the problems before they see the patient.
- Time for patients to get issues resolved at home instead of in the emergency department.
The time has come for preventative care to become a reality across the United States, a country that is home to almost 10 million world-leading and incredibly dedicated healthcare professionals.
Learn More About Tech-Enabled Patient Solutions From TimeDoc Health
Since 2015, we at TimeDoc Health have strived to provide healthcare organizations with effective virtual care management solutions for patients with chronic conditions. Our integrated solution creates patient-centric solutions by combining a leading SaaS platform with care coordination services, including chronic care management, behavioral health integration and remote patient monitoring.
From facilitating uninterrupted preventative care to improving in-office efficiency, our end-to-end solution empowers providers to improve patient outcomes through comprehensive, continuous and accessible care.
Take the first step. Get in touch with TimeDoc Health to schedule a live demo today.
About the Author
With more than 25 years of experience as a primary care physician in a private practice setting, Dr. Paul Helmuth holds board certifications in internal medicine and pediatrics. Previously, he served as Medical Director of Quality & Population Health for the largest healthcare organization in western Massachusettes and has interests and expertise in clinical quality, value-based care and virtual care.