CCM / RPM Outcome Studies
According to CMS, chronic care management (CCM/RPM) programs are a critical component of primary care and are essential for reducing healthcare costs, improving outcomes and increasing patient satisfaction. Additionally, CCM/RPM programs lead to:
As payers transition from the fee-for-service (FFS) model, which ties payments to the quantity and types of services provided, to value-based care (VBC) and population health management (PH) arrangements that connect payment amounts to the outcomes of patient services, healthcare providers must adopt solutions that help them keep patients healthy while reducing costs.
This is where remote patient monitoring (RPM) and chronic care management (CCM) come into play.
Numerous studies over the past 15 years have demonstrated the extensive benefits of implementing CCM, RPM, and PCM (Patient Care Management) programs for clinics, practices, ACOs (Accountable Care Organizations), IPAs (Independent Practice Associations), health systems, and particularly for patients.
Please see below some additional studies and articles for your review.
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An estimated 129 million people in the US have at least 1 major chronic disease (e.g., heart disease, cancer, diabetes, obesity, hypertension) as defined by the US Department of Health and Human Services. Five of the top 10 leading causes of death in the US are or are strongly associated with, preventable and treatable chronic diseases. Over the past 2 decades, prevalence has increased steadily, and this trend is expected to continue. An increasing proportion of people in America are dealing with multiple chronic conditions; 42% have 2 or more, and 12% have at least 5. Besides the personal impact, chronic disease substantially affects the US healthcare system. About 90% of the annual $4.1 trillion healthcare expenditure is attributed to managing and treating chronic diseases and mental health conditions.
Any efforts to reduce total healthcare costs in the U.S. must address these chronic health conditions. CDC: Chronic Disease Prevalence
Another study found that patients with chronic diseases contributed to 60% of all ER visits, and 4.3 million visits were likely preventable. Avoiding these preventable visits would save $8.3 billion yearly in healthcare costs. Chronic Disease Costs a Lot: How Care Management Can Help
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KLAS Research partnered with the American Telemedicine Association to examine the success factors of remote patient monitoring programs at different healthcare organizations, including hospitals, payers, and home health agencies. As part of the report, KLAS Research spoke with 25 organizations using products from seven leading remote patient monitoring vendors about their experiences. RPM programs offer multiple clinical and financial benefits, including reduced hospital admissions among patients.
Here are eight clinical and financial outcomes, ranked by how frequently respondents said they improved during remote patient monitoring programs (Click here to see article):
38 % reduction in hospital admissions
25% increase in patient satisfaction
25% reduction in re-admissions
25% reduction in Ed visits
17% reduction in quantified costs
13% improvement in medication compliance
13% improvement in patient health
8% decrease in A1c levels
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Medical Economics published a report entitled “Remote patient monitoring: A win for both providers and patients”. It says that RPM offers patients a clear return on investment ROI over time, with an estimated range of $1,390 to upward of $7,000 per individual, depending on healthcare needs. This extends beyond initial healthcare savings, including money associated with transportation, time, and energy to visit their doctors; prescription, laboratory, and imaging costs; and hard and soft expenses if a hospital stay or emergency department visit is required. However, the return on RPM is not limited to financial measurements. It also improves health outcomes, eliminates communication barriers, facilitates faster access to providers, reduces hospital re-admissions, shortens hospital stays and enhances patient education. Click here to see article.
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According to Jessica Jones, population health project lead with the Accountable Care Organization, re-admissions and emergency room visits among the home-monitored patients significantly reduced after 90 days. Jones said that using RPM, the 90-day readmission rate dropped by 63 percent, and emergency visits dropped by 48 percent. Please click here to see the article.
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The CPSTF’s recommendations for telehealth interventions are based on the findings of four systematic reviews, which are described in more detail in Table 1. Click here to see article.
The CPSTF found the use of telehealth interventions can improve:
Medication adherence, such as outpatient follow-up and self-management goals.
Clinical outcomes, such as blood pressure control.
Dietary outcomes, such as eating more fruits and vegetables and reducing sodium intake.
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Several recent studies documented how RPM prevented avoidable hospital readmissions and improved patients’ recovery from the COVID-19 virus. For example, a recent Mayo Clinic study documented how its RPM program prevented avoidable hospital readmissions and improved patients’ recovery from the virus. The analysis of data from more than 7,000 patients across 41 states reported that its two-tiered RPM program with nursing support was safe, effective and led to positive outcomes, including (Click here to see the study):
High patient engagement levels.
Low hospitalization rates.
Low 30-day mortality rates.
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CCM is a huge source of untapped healthcare cost benefits. Mathematica Policy Research developed a study in 2017 discussing the impact of chronic care management services on the costs of healthcare. See graph below entitled “The Impact of CCM on total expenditures” Source: Medicare 2014-2016 enrollment and FFS claims data.
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→ A 76% reduction in the risk of hospital readmission was achieved through the implementation of RPM,
according to the University of Pittsburgh Medical Center report.→ A 38% reduction in hospital admissions was achieved by implementing RPM,
according to the University of Pittsburgh Medical Center report.→ A 51% reduction in emergency room visits, according to the University of Pittsburgh Medical Center report.
→ CCM leads to a 25% reduction in hospitalization and a 35% reduction in ED visits. Click here for article.
→ RPM reduces healthcare costs by 53%, resulting in cost savings of approximately $8375 per patient over six months,
according to a study published in the Journal of Medical Economics. Refer to Market.us Media.→ With regular RPM monitoring, patients were found to have a 10 mm/Hg reduction in systolic BP,
as per the Journal of Clinical Hypertension. See Journal of the American Heart Association→ With regular RPM monitoring, patients were found to have a 1.7% reduction in HbA1c. See AACE Endocrine Practice.
→ 88% of healthcare providers reported that RPM improved patient outcomes, according to a survey conducted by Spyglass Consulting Group.
→ 80% boost in patient engagement, a 70% rise in compliance, and a 90% increase in satisfaction. Click here for article.
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Eligible CCM patients will have multiple (2 or more) chronic conditions that are expected to last at least 12 months or until the patient’s death or that place them at significant risk of death, acute exacerbation or decompensation, or functional decline. These services aren’t typically face-to-face and allow eligible practitioners to bill at least 20 minutes or more of care coordination services monthly. Check Medicare eligibility.
Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (like number of illnesses, number of medications, repeat admissions, or emergency department (ED) visits) or the typical patient profile in the CPT prefatory language.
CCM services can also help reduce geographic and racial or ethnic health care disparities. Examples of chronic conditions include, but aren’t limited to:
Examples of chronic conditions include, but aren’t limited to:
● Alcohol abuse
● Alzheimer’s disease and related dementia
● Arthritis (osteoarthritis and rheumatoid)
● Asthma
● Atrial fibrillation
● Autism spectrum disorders
● Cancer (breast, colorectal, lung, and prostate)
● Cardiovascular disease
● Chronic kidney disease
● Chronic obstructive pulmonary disease (COPD)
● Depression
● Diabetes
● Heart failure
● Hepatitis (chronic viral B & C)
● HIV and AIDS
● Hyperlipidemia (high cholesterol)
● Hypertension (high blood pressure)
● Ischemic heart disease
● Osteoporosis
● Schizophrenia and other psychotic disorders
● Stroke
● Substance use disorders
Although patient cost sharing applies to the CCM service, some patients have supplemental insurance (Medigap) to help cover CCM cost sharing. Also, CCM may help avoid the need for more costly services in the future by proactively managing a patient’s health, rather than only treating severe or acute disease and illness.
A chronic disease, as defined by the U.S. National Center for Health Statistics, is a disease lasting three months or longer. Per CMS, the chronic conditions are "expected to last at least 12 months, or until the death of the patient" and "place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline" Link: cms.gov MLN909188 – Chronic Care Management Services