Telehealth vs. remote patient monitoring & their impact on CHCs
Community health centers (CHCs) provide vital care for underserved populations, largely in urban and rural communities. As such, they continue to face many challenges.
The National Association of Community Health Centers' Community Health Center Chartbook notes that health center patients are "disproportionately poor, uninsured, and publicly insured":1
- 91% of the patients CHCs serve are "in or near poverty"
- 79% of CHC patients are either uninsured or publicly insured
The report also notes that health center patients suffer from chronic conditions — such as diabetes, high cholesterol and hypertension — at higher rates than the general population.1
On the bright side, telehealth technology can help CHCs make the best of their limited resources while helping improve patient care. And there's potential for community health centers to make an even greater difference with their patients by incorporating remote patient monitoring (RPM) technology, says Rebecca Russell, director of sales and program management for RemetricHealth.
What's the difference between telehealth & remote patient monitoring (RPM)?
First, consider how remote patient monitoring (RPM) fits into a telehealth model.
Russell refers to the term telehealth as "an umbrella term." Telehealth describes the use of technology to provide care to patients from a distance,2 and includes a broad array of electronic and telecommunications technologies and services, including videoconferencing. Telehealth can help reduce barriers that might prevent people in remote or underserved areas from getting the care they need.2
Remote patient monitoring (sometimes called remote patient management) is often just one part of a broader telehealth approach to patient care. "RPM is definitely something that can be used in conjunction with video teleconferencing," says Russell. "But there's so much more than that."
RPM is the use of technology that collects data about a patient's health and securely transmits that data to a doctor or healthcare facility so they can monitor or analyze it.
Examples of RPM technology include:
- Continuous glucose monitors
- Digital blood pressure monitors
- Bluetooth-equipped thermometers & scales
A robust telehealth program can benefit from an RPM component where appropriate because a video conference can't provide objective data, yet remote patient monitoring technology can. The acquired data can enable physicians to monitor their patients' health from a distance and take action if the data reveals any problems. RPM technology can not only track biometric data in real time, it can also help providers track trends over time, which can help improve patient outcomes.
"RPM has been proven time and again to reduce hospital readmissions and improve patient care and outcomes," Russell notes.
How can telehealth & RPM help community health centers?
Prior to the pandemic, the demand for telehealth services from community health centers was already on the rise, but COVID-19 accelerated the situation.
"In total, the number of health centers offering virtual visits grew from 592 in 2019 to 1,362 in 2022, an increase of 130%," the U.S. Department of Health and Human Services noted in a recent statement.3 And the number of virtual visits provided by community health centers skyrocketed from 478,333 in 2019 to 28,550,608 in 2020, an increase of 6,000%.3
- 130% increase in CHCs offering virtual visits
- 6,000% increase in CHC virtual visits performed
But funding is an ongoing challenge for community health centers.
Presently, the primary sources of revenue for community health centers come from the Health Center Program and from Medicaid payments.1,4 Companies like RemetricHealth also help out when possible. For example, Remetric waived software costs for its products for many community health centers during the pandemic, which helped defray some of the expenses. But the community health centers still had to pay for internet connectivity and the clinical staff to oversee the usage of RPM.
Medicare reimbursements could definitely help, according to Russell. But as she also notes, "Unfortunately, the Medicare reimbursements are not there yet. Medicare's position is that RPM is a component of care management under the prospective payment system (PPS) qualifying visit and therefore covered under the PPS payment rate."5
However, telehealth models that incorporate RPM into the community health clinic setting can make good use of limited resources and help improve patient outcomes — while stretching every dollar. It can improve access to care for people living in rural areas, adults with limited mobility and others.
And community health centers have worked hard to use telehealth to expand access.
Here's an example:
Physical access to a clinic or a doctor is a barrier to care for many patients in rural or remote areas. Patients may not have a health center or clinic close by, so in order to see a doctor or a nurse, they might have to take a significant amount of time off work, drive a long distance, or arrange for transportation to a community health center. Those barriers can prove problematic, or maybe even impossible to overcome, for some. The result: They put off care as long as possible.
Delaying care is all too common, according to 2019 research from Gallup, and when people delay care, it tends to get more extensive and more expensive.6 "They don't make that call to their doctor until it's so bad that it's really an emergency," says Russell. Telehealth and virtual visits add a layer of convenience that can help mitigate or potentially remove the delays in care.
RPM technology can also help better manage patients with chronic diseases. For example, research suggests that people with congestive heart failure (CHF) are at an increased risk for frequent hospitalization.7 RPM technology allows CHCs to pick up on indications of decompensation in patients and the data collected may identify problems before they get worse.
"Instead of waiting for the next scheduled office visit or hospitalization, an RPM program and perhaps a simple phone call can pick up on things that could lead to a hospitalization or unscheduled visit," Russell says.
How technological improvements are helping
In the past, a lack of internet access was also an obstacle. Internet connectivity issues and inconsistent (or even nonexistent) broadband access often hampered the robust use of telehealth, including RPM, says Russell. A patient might get a device to use at home but not have access to Wi-Fi or they may have a spotty connection.
Fortunately, that's improving, thanks to funding from agencies such as the federal Health Resources and Services Administration (HRSA) to address gaps in rural telehealth by improving broadband access.8
Additionally, improvements to the RPM technology itself may help. For example, consider data device retention. The devices RPM uses can now collect and retain data even when a patient can't connect to the internet. "Then, once they get into communication, the data will flow at that time," Russell explains. That means that RPM opportunities won't become limited only to people with reliable internet connections.
The future of RPM in community health centers
Looking to the future, funding is going to prove critical to helping CHCs maintain their RPM programs. And there are some bright spots.
In February, HRSA awarded almost $55 million to 29 HRSA-funded health centers to help them use telehealth and RPM to increase access for underserved populations.3 That comes in addition to the $7.3 billion invested in CHCs over the previous year through the American Rescue Plan's funding in response to the impact of COVID-19.3
Russell thinks that community health centers are going to work as hard as they can to provide care to their patients — and RPM is hopefully going to become one key component of their efforts.
"Community health centers are particularly passionate about helping patients using whatever means they have, stepping outside of their comfort area and trying something new, going the extra mile and doing what it takes to help their patients," says Russell. "I think remote patient monitoring and CHCs are similar in that they both help to fill in the cracks in healthcare."
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