Advancing meaningful engagement through remote patient monitoring

By Jessica Hylander

A patient’s active involvement in their healthcare, also known as patient engagement, can result in better outcomes, improved care and lower costs. Motivated by this trifecta of results, plans, payers and providers have launched a variety of engagement strategies with varying amounts of success. From gamification to incentives to wearables, the healthcare industry continues to search for ways to engage patients in meaningful and sustainable ways. While a single answer to patient engagement remains elusive, existing paths such as remote patient monitoring (RPM), could be further leveraged to fill an important piece of the engagement puzzle.

RPM use is on the rise among individuals, health plans and providers because it makes healthcare more accessible. Importantly, RPM fulfills patients’ desire for convenient in-home care. The number of RPM users in the U.S. will “more than double between 2020 and 2025 reaching to 70.6 million,” according to Insider Intelligence. RPM programs are already in place using devices such as blood pressure and glucose monitors, electrocardiography and heart rate monitors, smart scales, medication monitoring and personal emergency response systems.

RPM helps strengthen health

Reports continue to support the premise that RPM keeps patients healthier, improves outcomes and reduces overall costs. A study in the Journal of Patient Safety suggested that routinely monitoring hospitalized patients with continuous pulse oximetry and heart rate devices were associated with reduced mortality. Mayo Clinic researchers publishing in the journal Nature recently studied the effects of using RPM on those suffering from an acute illness, in this case, COVID-19. The group monitored more than 7,000 participants, whose RPM device usage rate was nearly 79% and found “emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%.” This research found RPM was “feasible, safe and associated with a low mortality rate” and supported further expansion of RPM programs.

RPM is both effective and accessible for at-risk populations because of the straightforward design of the devices. While we live in a technology-driven society, one study reported older age, lower education level and income are often associated with a lower likelihood of owning or using a smartphone to use a health app. Simple RPM devices and supportive services can break down that barrier by bringing care right into the home. Researchers publishing in TELEMEDICINE and e-HEALTH noted that RPM “appears to be an accessible tool for minority racial groups and for the aging population.” Additionally, “home monitoring and hospital-at-home models offer the potential to transform care and potentially allow a substantial proportion of hospitalized patients to receive care from home,” according to a recent JAMA Viewpoint essay by Peter J. Pronovost, MD, PhD, Melissa D. Cole and Robert M. Hughes, DO. During the current period of understaffed hospitals, providers and personal care providers, RPM could help fill a much-needed gap.

Sustainable, friction-free engagement

An additional untapped benefit of RPM is its ability to create sustainable patient engagement and drive behavior change. Behavior change is complex. However, a simple framework of friction and fuel, as described by psychologist and behavior economist Dan Arierly, Ph.D., gives valuable insight. “Think about behavioral change in the same way that we think about sending a rocket to space. When we think about sending a rocket to space, we want to do two main things. The first one is to reduce friction. We want to take the rocket and have as little friction as possible so it's the most aerodynamic possible. And the second thing is we want to load as much fuel as possible, to give it the most amount of motivation, energy to do its task. And behavior change is the same thing,” Arierly said  in his TED talk “How to change your behavior for the better.”

Successful RPM programs can both reduce friction and increase motivation for engagement and behavior change.

RPM programs offer convenience, create a cadence of care and build trusted relationships between an organization and the individuals it serves. Unlike office visits or prescheduled telehealth appointments, RPM allows patients to take readings on their own timetable, when and where it’s convenient. Patients repeatedly and consistently interact with strong RPM providers through readings or even regular device testing. Rather than relying on a separate app or outbound phone campaigns, a well-run RPM program is built with a regular cadence of care at its foundation. Those regular and repeated touchpoints could be used to promote patient engagement.

In one of our studies with a national health plan, we found that 87% of patients were open to engagement opportunities during our interactions.

Developing trusted relationships

The cadence of care created during RPM programs provides more than just an opportunity to engage, it can create a trusted relationship with the patient. Whether it’s a high blood pressure reading or a personal emergency response service alert, RPM organizations that provide personalized, responsive and timely care establish a foundation of trust and support. We are all more open and receptive to messages, directions and advice from a trusted relationship versus a stranger or acquaintance. Patients are the same: they are more likely to take positive actions in response to input from a trusted relationship. We found that to be the case in our recent study of RPM patients.

These highly engaged RPM participants took more health-related actions compared to a control group:

• 36% took gaps-in-care closing action
• 40% more gaps were closed
• 80% more had colorectal exams
• 56% more had breast cancer screenings

To be impactful, the patient must have tremendous comfort with the timing of communications and engagement. A well-run RPM program with a forward-thinking provider achieves just that. An excellent RPM program may give plans, providers and payers a greater opportunity to increase patient engagement and drive meaningful behavior change with a population that is growing every day.

Jessica Hylander is Chief Operating Officer of Modivcare Monitoring and Meals.