Elevating Care & Revenue: The Provider's Guide to RPM and CCM Success

For executive leaders, the pressure is on: How do you deliver a higher standard of care while navigating increasingly tight budgets and complex patient needs? The answer isn't just about working harder, but working smarter. This fundamental shift in how we approach care delivery is a strategic transformation powered by Remote Patient Monitoring (RPM) and Chronic Care Management (CCM), which are rapidly becoming the essential pillars for success. Health Recovery Solutions (HRS) is your partner in this journey, empowering providers to turn these powerful concepts into tangible value for your organization.

The Accelerating Growth of RPM and CCM in Ambulatory Care

The growth of RPM and CCM programs, particularly within the ambulatory setting, presents a significant strategic imperative. While Hospital-at-Home programs are growing, the highest growth rates in RPM adoption are observed among specialty-focused physicians in the ambulatory space.

• Significant Opportunity: CCM and RPM services remain underutilized relative to the eligible patient population but continue growing steadily none the less, indicating substantial room for expansion. CCM was utilized by only approximately 4% of eligible Medicare Fee-for-Service (FFS) beneficiaries in 2022, but approximately 1.3 million patients received CCM services in 2023. According to CMS data, RPM also shows a strong trajectory, with the number of beneficiaries receiving RPM services growing tenfold from 2019 to 2023, suggesting considerable opportunity for continued enrollment.

• Consistent CMS Support: CMS has consistently demonstrated its support for these remote care programs, expanding coverage over the last decade by introducing a range of codes. This sustained support reflects CMS's conviction that continuous care between office visits profoundly improves healthcare quality and outcomes.

• Strategic Financial Trends: While Medicare reimbursement for RPM services has generally remained flat, CCM reimbursement rates saw a meaningful increase in 2022 and have largely remained stable. RPM exhibits a significantly higher growth rate (203% Compound Annual Growth Rate in aggregate claims volume compared to CCM's 25% CAGR between 2015-2022), as reported by Definitive Healthcare. RPM claims volumes saw a 29% increase from 2022 to 2023, while CCM billable services rose by 23% in the same period. This indicates a broadening landscape for remote care, with specialists increasingly adopting CCM while RPM maintains a consistent presence across primary care and specialty practices.

Unlocking Strategic Value: Patient Experience, Clinical Outcomes, and Financial Opportunities

Embracing RPM and CCM offers profound, multi-faceted value across the entire healthcare ecosystem, benefiting patients, provider organizations, and payers.

For health systems and hospitals with an ambulatory presence, these programs deliver enhanced patient experiences through higher-touch management and expanded access to care. They lead to improved clinical outcomes by facilitating earlier interventions, leading to fewer hospitalizations and lower readmission rates. Financially, they create a billable revenue stream, improve performance in critical value-based programs, and help achieve a lower total cost of care.

For ambulatory healthcare organizations, RPM and CCM enable personalized treatment plans and proactive care, fostering better health outcomes for patients with chronic conditions. They also create new, sustainable revenue streams and allow practices to access greater value-based care incentives. While some view RPM as a cost center, it can be a profitable program when considering reimbursement offsetting licensing, hardware, and labor costs.

For Payers and Payviders, these programs provide significant advantages in managing population health and financial risk.

• Reduced Total Cost of Care: RPM and CCM help reduce overall costs through a scalable in-home member monitoring platform. This is achieved by preventative disease management, improved care transitions, and closing care gaps, leading to significant cost avoidance.

• Improved Quality Measures: These programs positively impact payer quality measures that influence reimbursement, contributing to better performance in value-based programs.

• Enhanced Population Health Management: They support proactive risk stratification and the ability to improve population health across a cohort with actuarial scale, leading to healthier populations and long-term cost reduction.

• Strategic Partnerships: By demonstrating commitment to longitudinal care, providers become more reliable partners in value-based care arrangements, which can enhance referral networks and access to preferred contracts benefiting payers.

Addressing the Challenges of Remote Care Implementation

Despite these significant opportunities, executive leaders understand that providers often face major hurdles in implementing and scaling RPM and CCM programs. These operational and financial pain points can quickly derail even the most promising initiatives:

• Operational Burden: The day-to-day work of managing device logistics, enrolling patients, and continuously monitoring data adds a significant burden to already resource-constrained clinical staff.

• Reimbursement Complexity: Navigating the intricate and ever-changing landscape of RPM and CCM billing codes and ensuring compliant documentation requires specialized expertise, creating a hurdle for many organizations.

• Patient Engagement and Enrollment: Securing patient consent and maintaining long-term engagement requires a strategic and ongoing effort to educate patients on the program’s value, which can be challenging and resource intensive.

• Siloed Initiatives: RPM programs often remain isolated within health systems, viewed as individual use cases rather than a unified, enterprise-wide strategy, limiting their widespread impact and ROI.

These barriers underscore a critical need for a solution that not only provides the technology but also a full-service partnership to overcome these challenges.

PatientFirst Pinnacle: Your Comprehensive Solution for Remote Care Excellence

At Health Recovery Solutions, we understand these challenges. We recognize that executive leaders need solutions that not only promise strategic value but deliver it through seamless execution and reduced operational burden. That's why we designed PatientFirst Pinnacle—a full-service, turnkey remote care model that empowers your organization to achieve value-based care goals, maximize patient outcomes, and optimize financial performance.

PatientFirst Pinnacle is built on a Full-Service Reimbursement Model, providing a robust infrastructure to address the broad spectrum of remote care opportunities, including not only RPM and CCM but also Principal Care Management (PCM) and Transitional Care Management (TCM). This extended support is key to ensuring continuity of care beyond episodic monitoring, which helps prevent re-hospitalizations, improves patient self-management, and enhances performance in value-based metrics. Here's how it provides a comprehensive advantage by directly alleviating the burdens we identified:

• Turnkey RPM Program with Comprehensive Monitoring: HRS manages all device ordering and logistics, while our HRS-led Remote Patient Onboarding (RPO) ensures a smooth and effective start for patients, significantly reducing your team's operational load. Our provider partner provides active alert monitoring, offloading this critical responsibility from your internal teams to ensure comprehensive oversight.

• Simplified Billing to Address Reimbursement Complexity: Our provider partner is responsible for all billing and collections. This streamlines financial operations by offloading the complex and time-consuming responsibility of reimbursement, allowing your organization to benefit from the program's overall financial contribution without the administrative burden.

• Seamless EMR Integration: We ensure seamless EMR integration for efficient data flow, enhancing clinical decision-making and reducing redundant documentation. HRS offers out-of-the-box integrations with every EHR platform, helping to unify remote care initiatives across the enterprise.

• Robust Portfolio and Analytics: PatientFirst Pinnacle leverages the full potential of HRS PatientConnect and ClinicianConnect platforms for data collection and analytics to gain valuable insights for program optimization and ROI demonstration. This helps break down silos and provides a strategic, enterprise-wide view of success.

PatientFirst Pinnacle is an ideal solution for a variety of organizations, including Health System Affiliated Home Health, Palliative Care Organizations, Health Systems and Hospitals, Federally Qualified Health Centers (FQHCs), Physician Practices, and Payers and Payviders.

Why Choose HRS? Your Trusted Partner in the Evolving Landscape

HRS is a recognized leader in RPM, consistently earning accolades since 2020, including from KLAS, Frost & Sullivan, Newsweek, and Avia. Our proven track record demonstrates clinical and financial outcomes, supported by robust integration capabilities with major EHR systems. We provide a full suite of solutions with 24/7 technical support for both patients and clinicians, backed by a fully supported partnership model that includes clinical advisory, logistics, support, reimbursement, and marketing expertise.

Partnering with HRS means gaining access to comprehensive support and resources, ensuring the long-term success of your remote patient monitoring and chronic care management programs by reducing operational burden and optimizing financial opportunity. Let us help you transform care delivery, enhance patient well-being, and drive clinical and financial excellence in the ambulatory space.

Ready to transform your remote care delivery and seize strategic opportunities? Connect with a Digital Health Advocate today to design your program and explore the full potential of PatientFirst Pinnacle!