From acute care to managed care – 1970’s and 1980’s
Prior to and through the 1970’s most healthcare was delivered and paid for using the traditional acute care model – treating patients for ailments and symptoms of acute illness as they occurred. By the early 1980’s medicine saw a significant shift from decades of acute care to a managed care model.
The effort to adapt and increase managed care initially was intended to develop models for improving health status and health outcomes. Health plans were the main driver of managed care, and spearheaded this shift in the structure of care and how it was provided and paid for. With this shift and health plans in charge however, the focus became less about patient care or health improvement, and instead primarily financial and cost control driven. Because managed care was developed and implemented by the health plans, and not the providers themselves, the care was not truly coordinated, nor did it address the complexity of chronic conditions.
Disease management and health outcomes research – 1990’s and 2000’s
As a result of many of these issues, by the 1990s, Disease Management programs were developed as a way to try to incorporate long-term management of chronic diseases. These programs were developed and managed by a range of stakeholders – clinics, health centers or sometimes insurers. Though at times still health insurance driven, these programs showed an effort to establish protocols to help proactively treat and manage chronic conditions like diabetes, asthma and heart disease. The intent and focus on chronic care management, upfront investment and improving health outcomes was moving in the right direction, but was not yet widespread.
While Disease Management programs were growing on the patient care side, throughout the 1990’s and 2000’s, health services research was looking at the impact of chronic conditions on health outcomes and health status – and how to improve those measures. Research occurring during these years was critical in the further shift towards greater chronic care management. This decade of research findings showed the impact that patient care management programs and value based care could lead to improving the quality of care, improving health outcomes, and having more integrated systems – while reducing waste and costs, but still making care more personal and impactful.
Chronic disease and conditions are among the most expensive, common and preventable health issues in the United States
Chronic disease is the public health challenge of the 21st century.
90% of US healthcare dollars are spent on people with chronic conditions.
> ½ of all Americans have a chronic condition. > ¾ of all Americans over 65 do.
Reimbursement for CCM and RPM – since 2015
CMS recognized managing chronic disease as a critical component of primary care. As the research trended further in this direction, CMS got on board and helped further shift the practice of care towards CCM and Remote Patient Monitoring (RPM), and more integrated patient information, monitoring and relationships. In 2015 Medicare (CMS) made CCM a reimbursable service – to improve the quality and effectiveness of care – and to reduce unnecessary costs in the Medicare population. As Medicare determined the importance of remote patient care management and value based healthcare, clinics began to develop programs to incorporate remote patient monitoring services into their practices and systems. The dual incentives of better health outcomes – as well as more effective and efficient care, combined with the potential revenue increases moved practices in this direction. Each year since, CMS has introduced additional CPT codes to further cover and address the complexity of chronic care management, and to expand the scope of remote patient monitoring and management that supports patient care as well.
Historically one of the greatest challenges has been coordination of care – even once Medicare added reimbursement – the coordination and monitoring of care remains a huge task – leaving many providers feeling left out to provide successful remote patient management supports. Successful remote patient monitoring programs help patients truly manage their conditions, take stress off the systems providing care and allow practices to have care truly coordinated.
Once reimbursable, (remote patient monitoring reimbursement has expanded greatly among private payers as well as Medicare) medical practices were further incentivized to add more remote patient monitoring, patient engagement and support to their organization. This was great news in theory, but there remained many pros and cons to implementation for medical clinics. Remote patient monitoring is very challenging to implement when already stretched for staffing, time and resources. Medical practices know it’s the right thing to do and incorporate, but many need, and continue to need, external help and expertise to make it easier on the practice, and to improve the care and health outcomes of the practices’ patient population.
Medsien helps practices and health systems take all the important pieces of remote patient monitoring services – and make it easy, efficient and impactful – for the practice, the providers and the patients – using our unique, sophisticated platforms and dedicated programs. Programs like Medsien offer the powerful technology (and staffing support) to help practices improve their remote patient services by improving health outcomes, patient satisfaction and increasing revenue. We do this by providing services and software that seamlessly incorporate patient information from different EHRs and provide highly trained staffing support to handle the care. Medsien’s unique software and staffing model helps medical practices increase the efficiency, effectiveness and the quality of patient care; increase the health status, health outcomes and satisfaction of patients (and providers); and makes all remote patient monitoring platforms work well for medical practices and patients. Our scalable remote patient monitoring platforms, helps expand the scope and quality of care practices can provide.
Medsien is the leading provider of scalable remote care management for a quality patient experience. Hundreds of organizations trust Medsien’s unparalleled technology solutions to implement exceptional remote care management programs, personalize every interaction, and improve the lives of the people who need it most. Based in San Francisco and venture-backed by top-tier investors, Medsien was founded to reimagine remote care management. Visit medsien.com for more information.
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We could not reach her primary care team for days, and could not get anyone to make referrals, advocate or communicate with her doctor. Throughout the entire experience, I kept thinking if the practice had had robust remote patient programs in any way, this would not have been such an awful, dangerous experience - and I would not have felt complete disillusionment with the healthcare system - and the care she was unable to receive.