Contributed Content: How RPM Can Break the Chronic Disease Cycle in Underserved Communities

Two healthcare executives share their ideas on using remote patient monitoring to address critical gaps in care management and access

Editor’s note: Janet Simon is executive director of the New Mexico Podiatric Medical Association and a podiatric physician who has served Native Americans in New Mexico for nearly 30 years. Gary Rothenberg is a board-certified podiatrist, certified Diabetes care and education specialist, and certified wound specialist who currently holds an associate professor of internal medicine appointment in the endocrinology division at the University of Michigan School of Medicine. Rothenberg is also Director of Medical Affairs for Podimetrics.

Remote patient monitoring (RPM) devices are swiftly becoming a mainstay of the chronic disease management toolkit. From continuous glucose monitors (CGMs) for people with diabetes to Bluetooth-enabled scales and blood pressure monitors for those with cardiovascular conditions, smart devices are steadily working their way into the homes and onto the bodies of people who need regular monitoring to ensure their health and well-being.

Healthcare providers and health plans have shown themselves to be all-in on this trend, with one industry survey finding a 305% increase in RPM usage in 2023 compared to 2021. Another recent poll found that 46% of healthcare executives are planning to increase their spending on RPM in the next year to further accelerate the trend, citing measurably improved outcomes and clear financial ROI from remote device utilization.

However, these high-impact devices may not be getting into the hands of everyone who needs them. Equal access to cutting-edge care is a persistent issue among people facing systemic socioeconomic barriers, creating generational cycles of devastating complications, early mortality, and dim hopes for a different future.

For example, in a study of Native Americans living with type 2 diabetes, less than half (42%) reported using any form of RPM that connected them to their care team. Of the Native Americans surveyed who were able to get ahold of these tools, one-third said they did not have access to education or clinical support services to help them make the most of their device — lessening the potential for positive patient outcomes and reducing the financial ROI of the investment for health plans.

The limited access contrasts with strong demand for inclusion in the digital health ecosystem. More than 80% of Native Americans believe RPM devices should be a standard part of diabetes care, and close to half cited remote monitoring as the most-desired strategy for improving their personal health — even beating access to more affordable medications.

This data needs to be top-of-mind for health plan executives investing more dollars into RPM over the next few years, especially if value-based care models are part of the equation.

Breaking the cycle of poor outcomes requires the entire health system to collaborate on equitable distribution of RPM capabilities, with a particular focus on shifting the narrative of chronic disease for groups with longstanding socioeconomic and clinical challenges.

Reframing the ‘generational curse’ of chronic disease with data-driven, proactive care

For people in underserved communities, the “socioeconomic barriers to care” are the deeply traumatic, lived experiences of their parents, grandparents, aunts, uncles, and children. After seeing generation after generation succumb to chronic disease complications, it’s no wonder that younger people may experience feelings of helplessness, futility, or anger when reflecting on their own futures. 

RPM tools can be part of the solution by reducing the perceived paternalism of the healthcare system, connecting individuals more deeply with their healthcare teams and putting health data directly into the hands of patients. When individuals are empowered to monitor their own health, they can more easily advocate for themselves and their loved ones while actively participating in collaborative care decisions with providers who have received timely alerts before complications emerge.

To take advantage of this potential, health plans and clinicians on the front lines need to have open, empathetic, non-judgmental conversations with patients about their experiences with the health system and commit to making changes based on the feedback.

Health plans and clinicians also need to share culturally sensitive advice on lifestyle choices, ideally working with respected members of the community to identify and deploy effective strategies. Device-specific, patient-centered education on leveraging data, such as how to interpret blood glucose fluctuations after a certain type of meal, will also be crucial to reaffirm that it is possible to live an active, productive, joyful life with chronic disease.

Building a physical environment designed for digital equity

Successful chronic disease management requires access to both physical care locations and reliable broadband internet to bridge the gaps between office visits. Many underserved rural communities, including Native American tribal lands, lack both. The Indian Health Service (IHS) lacks the funding to fully meet the scope of need — and even when care options exist, they are often many hours away from residents of remote areas.

Broadband internet is similarly hard to access, further limiting the potential reach of IHS resources. Experts estimate that only two-thirds of tribal lands in the continental US have broadband access, and the majority of that service does not meet the FCC’s “minimally acceptable” standards.

This leads to healthcare “deserts” that cannot fully support basic care, let alone the RPM devices that patients are clamoring for.

While the federal government is continuing to make investments in broadband access for rural regions, healthcare systems seeking equitable RPM deployments should also consider creative solutions for equipping hard-to-reach patients with high-value devices, such as leveraging cellular connectivity, satellite internet, or store-and-forward technologies as alternatives.

Charting a new path for RPM with innovative reimbursement options

The revenue cycle might be the most influential cycle in all of healthcare — and one that needs to catch up with the technology available in the RPM era.

The use of store-and-forward devices is a prime example. While they could aid rural patients, use is currently limited by a lack of clarity around reimbursement guidelines from the Centers for Medicare & Medicaid Services, including how to code for billing and how to manage data transmission.

In other cases, health plans want proof that RPM is effective in specific populations before they will incorporate reimbursement opportunities. But without the financial resources to put devices into the hands of these high-needs patients, providers are unable to generate the evidence required.

This Catch-22 simply perpetuates the inequities both parties are trying to avoid while leaving patients in the lurch.

Providers, health plans, and policymakers will need to work together to break free of the status quo and make RPM financially viable for more people living with chronic conditions. With leaders in agreement that RPM is a sound investment that will return clear ROI, there is a strong argument for reexamining the payment mechanisms for this home-based technology.

Only by addressing these fundamental issues of trust, technology, and reimbursement will our healthcare system be able to deploy RPM devices in an equitable, effective, and empowering manner. It is crucial to act quickly to break free of past patterns for Native Americans — and for others who have a right to equal access to the best possible chronic disease care.