Utilizing Technology in Pharmacy-led Remote Patient Monitoring Initiative

Remote Patient Monitoring (RPM), a relatively new concept, has the potential to change the way we manage chronic diseases. It involves the supervising of patient data between appointments, allowing the team to address issues in a timely manner, more effectively manage medication dosages, and to provide as-needed disease state education. Our practice incorporated remote monitoring of blood glucose and blood pressure in mid-2019. It was a manual process where the patient called and verbally transmitted values or they provided physical logs. The clinical pharmacy team would review the data and assist the provider team with dose titrations, getting patients to their goals more quickly while also monitoring for side effects. The service was a success, but was time consuming and the data somewhat unreliable.

The COVID-19 pandemic hit, and the demand for RPM increased drastically as we needed to keep an eye on our sickest patients without exposing them to the virus at in-person appointments. To meet this demand, our practice investigated some of the newer devices that allowed data to be transmitted automatically. The incorporation of this technology has completely revolutionized the program.

The devices we utilize have a cell chip embedded. A smart phone is not required, which is helpful in caring for our elderly and low-income patients.  As the patient checks their blood pressure, blood glucose, oxygen level or weight, the data is transmitted to a dashboard integrated in our EMR within five minutes. Any out-of-range values create a follow-up on a list that our clinical pharmacy team works daily. Patients are contacted via HIPAA-compliant electronic messaging or by phone, depending on their preference. Once contacted, our team typically alters doses per provider signed protocols, but has done everything from answer questions about diet to advise patients to seek care immediately.

Patient charts were audited at enrollment in the program and at three months post-enrollment. For the diabetic patient population, we saw an average decrease in A1c of 1.8%. We hypothesize that this is due to the efficient titration of medication dosages, specifically insulin. Instead of titrating at appointments bi-weekly, alterations were made every three days when needed. We also noticed a decrease in the hospitalization rate of the patient population, likely due to the constant contact and the early detection of issues and side effects. Patient retention has also improved with the new technology. Once in range, most patients requested to be discharged from the program because manual submission was time consuming. Automatic submission removes that barrier and allows us to continue to monitor patients and limit the potential to backslide that we have unfortunately observed.

The medical providers at our clinic who have bought-in to the program have expressed experiencing higher job satisfaction as they are receiving assistance in managing some of their more complex patients. Time between appointments can be lengthened, addressing the provider shortage in our coverage area. Improved patient outcomes are reflected in star-ratings and increase the amount of quality-related funding that our clinic receives from third parties. Not only that, but billing codes for this service have the potential to generate significant revenue. The average claim generated per patient per month is $88.25.

Our in-house pharmacies are utilizing the relationship they develop with the patients to improve patient satisfaction. Many patients state during our calls that they feel as if our company truly cares about them. Without being pressured, this relationship often results in the patient transferring their prescriptions to our pharmacy. The revenue generated by our RPM patients in 2021 increased by 28% over the previous year due to new patient additions as well as improved compliance and increased fills.

In closing, data is showing that this service is truly a win-win-win for PrimaryPlus. Current efforts include working to expand the program to include more patients, more disease states, and more types of devices. We can’t wait to see what future technological advancements in this field can do for this service and ultimately our patients.

 

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