Thanks to its ability to drive better outcomes, cut costs and improve the patient experience all at once, population health management has grown sharply in utilization in recent years. And telehealth technology like remote patient monitoring (RPM) has become the driving force behind this trend, giving more healthcare organizations in more places a powerful tool for implementing effective population health management solutions.
Why Population Health Management Solutions Are Central to Care Delivery Today
The use of population health management solutions has grown steadily in recent years, and not by accident. Designed to improve outcomes by emphasizing certain goals and standards within specific patient segments, population health management is an extension of the value-based (as opposed to fee-for-service) standard of care that’s emphasized by the Centers for Medicare & Medicaid Services (CMS).
But what is population health management, exactly, and how does it help providers meet this new standard of value-based care? As its name suggests, population health management is a system of managing specific patient subpopulations as separate groups. By doing so, it empowers providers to more efficiently treat these populations, while giving patients more targeted services and interventions.
Population health management grew out of — and is sometimes confused with — public health, a term that focuses on addressing social determinants of health (SDOH) to offset large-scale inefficiencies in the healthcare system. But as used today, population health management has become a separate entity, focused on the identification and optimized treatment of specific patient populations.
How does it work? By collecting and analyzing high-quality patient data at the individual level, and then extrapolating those findings to the entire subpopulation, population health management solutions can provide a rich level of benefits to everyone involved in the care continuum:
- Providers can enjoy a higher level of patient data for better decision making (and outcomes), as well as new or improved revenue streams, the reduction of potentially preventable events (PPEs), the foundation for better clinician/patient relationships, and the option of providing a better patient experience.
- Patients can receive more personalized positive behavior coaching, and more opportunities to engage with their own care plan. They may also feel a stronger sense of ownership over their own treatment goals, which can drive engagement and positive outcomes.
- Payers can cut expenses by reducing readmissions and the possibility of comorbidities and other risks, while also lowering the chances of other unnecessary interventions while improving CMS reimbursement.
Done correctly, population health management meets all of these important benchmarks, and in the process, helps realize the “Triple Aim” of healthcare — that is, improving the health of the patient population while increasing overall quality of care delivery and reducing the growth of medical costs.
How Population Health Management Solutions Help Manage High-Risk Patients
Another key reason why population health management has become such a widespread concept in healthcare in the United States is the variety of forms it can take. Depending on the different settings to be used, and the needs of each population in question, population health management solutions can be as extensive or as minimal as needed, to better fit a variety of budgets and operational workflows.
Take, for instance, what’s perhaps the best-established type of population health management, chronic care management (CCM). A care management model designed to treat patients with two or more chronic conditions, CCM offers healthcare providers a set amount or reimbursement dollars for carrying out specific tasks, including:
- CPT code 99490, which reimburses time spent by clinical staff, under the direction of a physician or qualified healthcare provider (QHP), for basic patient coordination services such as arranging follow-up appointments, refilling prescriptions, and requesting and updating medical records.
- CPT code 99491, which reimburses time spent directly by a physician or QHP to manage care for patients, covering 30 minutes of time per patient per month (PPPM).
- CPT codes 99487 and 99489, which cover the same services as 99490 and 99491 but for patients who require “moderate or high complexity medical decision making.”
- HSPCS code G0506, a single-code option covering comprehensive assessment and care planning for patients with two or more chronic conditions, as separate from the above codes.
Since 2015, when the first CCM code was introduced, healthcare providers have been leveraging this model to achieve population health goals for patients with chronic conditions — a comprehensive list of high-risk conditions that includes stroke, heart disease, diabetes, cancer, chronic obstructive pulmonary disease (COPD), kidney disease, multiple sclerosis, depression, and many others.
It should come as no surprise that these chronic conditions are also the costliest to the overall system of care in the U.S. Diabetes alone costs the U.S. health system an estimated $327 billion per year. Taken together, stroke and heart disease cost another $216 billion, with cancer at a comparable amount, according to figures from the Centers for Disease Control and Prevention (CDC).
Those are big numbers, and the government’s desire to bring them down is strong. Population health management solutions like CCM are designed to do just that — and to do so effectively, they rely upon telehealth technology like remote patient monitoring.
How RPM Empowers Population Health Management
How does remote patient monitoring empower population health management solutions like CCM? In short, successfully carrying out a CCM program means going beyond strategic considerations to make the best possible use of today’s available technology. That means not only medical devices, but other tech innovations like analytical tools and EHR integration, too.
As J. Collins Corder, MD explained in Missouri Medicine, to meet its goal of improving group health outcomes “by monitoring and identifying individual patients within that group,” population health management requires “a business intelligence tool to aggregate data and provide a comprehensive clinical picture of each patient.”
Remote patient monitoring helps meet these technological needs by providing not only the basis for monitoring patient data with medical devices, but also a platform that lets doctors and clinicians easily collect and quickly analyze that data.
So, by enabling the regular monitoring and transmission of vital signs and other important physiologic patient information, RPM technology gives doctors and clinical staff the day-to-day data they need to make the best possible decisions. And when it comes to chronic, high-risk patients, having continuous or near-continuous data can make all the difference in preventing escalation or hospitalization.
In addition to helping empower CCM, RPM has served as its own care management model since 2018. Also used primarily to manage patients with chronic conditions, the RPM model of care reimburses providers for coordinating the setup of RPM devices, as well as time spent utilizing that data. As of 2022, the RPM specifically reimburses for:
- Time spent on initial program or device setup, valid just once per episode of clinical care (CPT code 99453).
- Time spent collecting and analyzing RPM data (CPT code 99454).
- Additional clinical time spent with each patient per month, in 20-minute increments (CPT codes 99457 and 99458).
- The collection and interpretation of data, and 30 minutes of clinical time (CPT code 99091, a standalone version that cannot be used in conjunction with the other RPM codes).
So, while the emphasis of CCM is on coordinating care and providing guidance to the patient, RPM focuses on setting up the necessary remote devices needed for at-home care. It also provides reimbursement for staff time that’s specific to the use of these devices, as opposed to the administration of their care plan, which are covered in CCM.
Because the tasks associated with RPM and CCM are complementary to one another, then, many providers “couple” the two. By using both RPM and CCM as a comprehensive model to manage patients with two or more chronic conditions, providers can treat complex patients more efficiently and cost-effectively while driving population-wide improvements, and receiving maximum reimbursement for doing so.
The result can be better patient outcomes, which can drive growth for organizations operating in competitive or otherwise challenging areas. And, over time, the power of RPM technology to drive population management health solutions can also ramp up an organization’s operational capacity to take on higher-risk patients — and the expanded revenue streams that go along with that capability.
Looking for Population Health Management Solutions that Work?
If you’re seeking more info on how to leverage RPM to achieve critical population health management solutions, we’re standing by to help. Contact CareSimple today to connect with an RPM expert.
And if you’re looking for a full rundown of CPT reimbursement codes for CCM and other models of care that are adjacent to population health management solutions, download our CareSimple Reimbursement Tree for a convenient single-page summary.