Improving Hypertension Care for Underserved Populations with Remote Patient Monitoring

2023-10-30

AHA会议

Hypertension is a growing concern in the U.S. Today, it’s estimated that about 122 million adults – more than half the population over age 20 – have high blood pressure. Yet data suggests that only one in four have their hypertension under control, despite doctors recommending prescription medications and lifestyle changes to decrease their risks. Furthermore, at least 14 million more individuals may not even realize they have hypertension and thus are not taking the necessary steps to control their blood pressure. Underserved populations – such as those who don’t have access to quality healthcare because of where they live, lack of health insurance, racial or ethnic disparities, or socioeconomic factors – make up the vast majority of those who are either unaware of their hypertension or not properly addressing it to minimize the chance of strokes, heart attacks, and kidney and eye problems. Such inattention to hypertension is costly. Adults with hypertension face healthcare costs of nearly $2,000 more per year compared to those with normal blood pressure. And the total cost of healthcare services, medications to treat high blood pressure and loss of productivity from premature death is estimated to be as much as $198 billion annually. Reaching underserved communities through remote patient monitoring To overcome the health risks and costs associated with hypertension, the healthcare community must find new ways to reach these underserved populations. Regular doctor visits are important. Yet for many, this step is a challenge. Fortunately, there are ways to better reach these individuals where they are, breaking down the barriers and making healthcare more accessible. One effective way is through digital health technologies, such as cellular-enabled blood pressure monitors and remote monitoring platforms. Leveraging such offerings, patients are provided with connected devices and are instructed to take daily readings in the comfort of their own homes. The data is transmitted via cellular networks to their care providers, who, through the help of insights from remote patient monitoring (RPM) platforms and electronic health records (EHRs), can determine if medication or lifestyle changes are needed – all without the patient stepping foot in the office. Gaining momentum and achieving results for patients with hypertension RPM is gaining considerable momentum for as a tool for managing hypertension across populations. An analysis of Centers for Medicare & Medicaid Services codes show that 51% of all RPM claims in 2021 were related to the diagnosis of primary hypertension, with another 5.4% for blood pressure diagnosis, hypertension with complications and secondary hypertension. More importantly, there are measurable results from using RPM to manage hypertension. Take, for example, the experience of a Federally Qualified Health Centers (FQHC) in California launched an RPM program in March 2021 because many patients were missing blood pressure readings and having problems controlling their hypertension. At the onset of the RPM pilot program, NEVHC patients reported a 38% control rate of their high blood pressure. By providing technology they could easily use at home to provide regular blood pressure data to their doctors, these patients increased their control rate to 70% within just five months. RPM is also benefiting new mothers, who are at high risk of complications from postpartum hypertension, a leading cause of postpartum hospital readmissions and severe maternal morbidity. A private, not-for-profit academic medical center in the northeast that serves a diverse, safety-net population, implemented RPM for its new mothers. By collecting patient data from cellular-connected blood pressure cuffs used at home, this intervention provided an important safety net since blood pressure spikes often happen three days to six weeks after birth, well after most women are released from the hospital. In an abstract published in the American Heart Association Journal, Circulation, the medical center reported success ascertaining multiple BP measures in the postpartum period for more than 500 patients. This included nearly 9,000 total BP readings, 914 high blood pressure alerts and about 800 messages between the care team and patients that enabled them to address significant health changes, to provide better postpartum care and to answer important questions. Funding is required for equity in healthcare These pioneering examples of hypertension management show how RPM can be effectively used to provide high-quality care to underserved populations. Yet, unlike at most hospitals and health systems, there is no reimbursement code that FQHCs, rural health clinics (RHCs) or community health centers (CHCs) can use to pay for these services. These facilities – which are dedicated to some of the populations most impacted by hypertension – rely on grants to support RPM programs. And when pilot programs serving a small slice of patients show promising results, they seek out additional grants or other funding mechanisms to scale and make an RPM program sustainable for all who can benefit from it. Given the impact that RPM can have in addressing chronic conditions like hypertension, there is a distinct need for more funding to ensure all people have access to proven, digital health interventions. Regulations must be revamped so FQHCs, RHCs and CHCs are able to bill for RPM, much like other hospitals and health centers. Doing so will provide an effective way to ensure that those with hypertension receive the care they need, reducing the costs and health complications that result when left untreated or poorly managed.