Remote Patient Monitoring for Medicaid/Duals Populations: Closing The Digital Divide | Deloitte US has been saved
By Justin Pasay, senior manager, Deloitte Consulting,
Remote Patient Monitoring (RPM) is a critical component of any comprehensive virtual-care strategy—particularly in chronic-care management—and could serve as an important tool as the health sector shifts from a focus on care to a focus on wellness. While device-based RPM solutions (e.g., connected heart-rate monitors), sophisticated apps, and wearable devices can be effective, they typically aren’t designed with the most vulnerable populations in mind. That could limit access for millions of Medicaid beneficiaries and people who qualify for both Medicare and Medicaid (i.e., dual-eligibles).
In-home, device-based solutions can effectively capture patient health data outside of a traditional clinical setting. However, some Medicaid beneficiaries and duals might not be able to take full advantage of RPM technology due to barriers such as limited access to reliable Wi-Fi at home, an unstable living environment, and patient cost-sharing. Moreover, RPM devices are often designed to monitor a single chronic condition, such as diabetes. They typically do not address rising risks, multiple conditions, behavioral health issues or the drivers of health (also known as social determinants of health), which can be critical to serving this population. Many of these challenges also exist for app-based solutions and wearable devices, which could further complicate adoption due to gaps in digital literacy among beneficiaries.
Deloitte’s 2018 and 2020 Survey of US Health Care Consumers dispelled some misconceptions around Medicaid beneficiaries and their relationship with technology and digital health. Survey results revealed that Medicaid beneficiaries own smartphones at the same rate (86%) as the overall US population. Beneficiaries are also just as comfortable using technology to monitor health issues as people who have employer-based health coverage (30%), according to our survey results. In a recent blog on digital health tools for mobile devices, our colleagues Connie Richie and Bobby Powers outlined some key strategies for designing and building more inclusive digital products to advance health equity.
While there are similarities between Medicaid beneficiaries and the overall population, there are often critical differences in income level, formal education, disease prevalence, digital literacy, and social needs. These differences should be factored into RPM solutions to help ensure health equity and the most appropriate interventions.
Eight strategies for designing inclusive RPM products
Whether designing a suite of RPM products, or evaluating one with a partner, health organizations should ensure a focus on health equity and inclusivity. RPM products should account for some of the unique challenges that Medicaid and duals populations often face.
RPM Case Study4
Some organizations are beginning to focus on making RPM more inclusive and accessible for all patients. Deviceless, condition-specific RPM and engagement solutions offer potential avenues to address many of the barriers seen in Medicaid and duals populations.
For example, text messages and/or interactive voice response (IVR) phone calls can be used to capture patient-reported outcomes for a multitude of chronic, social, and co-existing conditions, including behavioral issues and the drivers of health. These technologies don’t require beneficiaries to download apps, enter passwords, or connect to Wi-Fi or data plans. No training is necessary, and little technical support is needed.
STRIDE Community Health Center, the largest Federally Qualified Health Center (FQHC) in Colorado, recently implemented one such solution. STRIDE was moving to a value-based, proactive care model and faced many of the challenges that we have seen in other FQHCs and Medicaid managed care plans. These challenges include limited financial and staff resources and difficulties engaging vulnerable Medicaid and dual-eligible populations. STRIDE decided to align its clinical quality metrics with its value-based care initiatives. It selected two chronic conditions (diabetes and hypertension) that can have a significant impact on Medicaid beneficiaries and duals (see table, below):
Condition |
Quality Metric |
Patient Inclusion Criteria |
Diabetes |
Reduce patient HbA1C levels to under 8% |
HbA1C above 8% |
Hypertension |
Reduce patient blood pressure scores to under 140/90 |
BP above 140/90 |
Through automated outreach in English and Spanish, enrolled patients answered prompts that sent clinically relevant data to STRIDE’s vendor, CareSignal. At-risk individuals were automatically categorized, and alerts were sent to care Managers in real-time for intervention. Over the first nine months, diabetes patients with a baseline A1C of more than 9% showed a 2.02% decrease, on average. Patients who had hypertension exhibiting a baseline of more than 160 mmHG showed a 10 mmHg average SBP drop.
This case study helps to demonstrate that an RPM solution can be cost-effective, scalable, equitable and clinically actionable.
Endnotes
1. Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, Kaiser Family Foundation 01 January 1, 2021
2. How might internet connectivity affect health care access? Peterson-KFF Health System Tracker, December 14th, 2020
3. Why achieving health equity is so hard in the telehealth age, American Medical Association, October 21, 2020
4. Case study: How the largest FQHC in Colorado prepared for the shift from fee-for-service to value-based care, CareSignal