A MORE EFFECTIVE APPROACH TO REMOTE PATIENT MONITORINGNew CPT Codes for Remote Patient Monitoring can enhance outcomes while generating additional revenue

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TABLE OF CONTENTS

The Rise of Chronic Conditions

The Cost of Chronic Care on the American Health System

Monitoring Patients Outside the Exam Room

A Better Solution: Real-Time Remote Patient Monitoring

Financial Incentives

Success in Action

Pilot Participant Testimonial

A Multifaceted Opportunity

About NavCare

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THE RISE OF CHRONIC CONDITIONS

Our population is getting sicker, driven in part by the aging of baby boomers and Gen Xers. It is projected that by the year 2030—just ten years from now—one in five US residents will be 65 or older. By 2035, they are expected to outnumber those in the under-18 age group.¹ The top chronic care conditions for those over 65—heart disease, cancer, stroke, and diabetes—typically result in more costly, acute episodes of care.²

The shift towards an aging population puts greater burden on providers and families to find ways to ensure the best quality of life for those patients.

80% of those age 65 and over have at least one chronic condition

77% of those age 65 have at least two chronic conditions

14M people over 65 in the US live alone

80% 77% 14M

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THE COST OF CHRONIC CARE ON THE AMERICAN HEALTH SYSTEMHealthcare spending in the US reached $3.6 trillion in 2018, accounting for 17.7% of our country’s Gross National Domestic Product. That’s $11,172 for every man, woman, and child. The vast majority of these costs were related to patients with chronic care conditions.

Reducing healthcare costs and improving quality outcomes are the impetus behind value-based care, which incentivizes—and penalizes—providers based on patient outcomes. This is especially challenging for providers managing patients with chronic conditions, especially when those patients are remote.

Managing chronically ill patients can be a daunting task for providers, family members, and other caregivers. Understanding what happens to patients outside the traditional healthcare setting is important for physicians serving this population.

117M adults have one or more chronic health conditions, and 25% have two or more chronic

health conditions7

80% of healthcare costs are related to chronic

conditions8

80% of chronic care costs are from hospitalization or

ED visits9

80% 80%117M

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MONITORING PATIENTS OUTSIDE THE EXAM ROOMWhile Chronic Care Management (CCM) and Transitional Care Management (TCM) programs provide a network of additional support in guiding patients to better health, primary care providers recognize there still remains a lot to be done to consistently demonstrate positive health outcomes for the chronically ill population.

Traditionally, remote monitoring was done over the phone. But this method is costly, time-consuming, and unreliable. Besides the issue of missed calls, phone monitoring falls short when it comes to collecting accurate, real-time information. Patients may not remember that they felt weak a few days ago, that they lost

their balance stepping out of the shower last night, or that they experienced an episode of shortness of breath. Or they may not think those incidents are a natural part of aging and not worth reporting.

While telehealth appointments are an improvement over telephonic appointments, they require the provider and patient to coordinate timing and to have technology with remote video and audio capabilities. For a senior uncomfortable with this type of technology, it can be challenging.

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A BETTER SOLUTION: REAL-TIME REMOTE PATIENT MONITORING

To be truly effective, remote monitoring requires the collection of highly accurate, comprehensive, real-time patient data. This includes vitals such as blood pressure, O2 saturation, heart rate, blood glucose, and weight. These stats can provide greater insight into a patient’s current condition as well as trends over time. Daily monitoring of vitals provides clinical staff with the actionable and timely information they need to make more informed clinical decisions. It also allows for more proactive intervention.

According to the CMS, Remote Patient Monitoring (RPM) is the use of digital technologies to collect health data from an individual in one location and electronically transmit that information securely to a healthcare provider in a different location.

“The benefit of having incoming vitals daily on some challenging patients enables providers to make more timely decisions while helping set a course for better management of care and improved health outcome.” Debora Fisher, RN, MHA, Chief Operating Officer, NavCare

REMOTE PATIENT MONITORING CONTINUUM OF CARE

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FINANCIAL INCENTIVESTo encourage the adoption of remote patient monitoring technology, the CMS has created four new CPT codes.10 If they haven’t already, providers should begin utilizing these codes immediately.

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education for the use of equipment.

$24,000$20/patientper month

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

$78,000$65/patientper month

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes

$62,400$52/patientper month

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes (New for 2020)

$50,400$42/patientper month

99453

CPT Code DefinitionReimbursement

Potential

99454

99457

99458

Providers who fail to adopt RPM are needlessly leaving money on the table and robbing patients of better care.

Annual value per 100 patients

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SUCCESS IN ACTIONIn September 2018, NavCare, an industry leader in care management services, launched a pilot RPM study with Doctor Nicholas Chronos, cardiologist at Cardiology Care Clinic in Eatonton, Georgia. Already using NavCare’s chronic care management service, Dr. Chronos added RPM to the care plan for his most challenging CCM patients.

In one case, the NavCare coordinator noticed a two-day trend of hypotension from the measurements being reported, upon which she quickly notified Dr. Chronos. The patient was seen the next day and medications adjusted accordingly. The patient suffered no injury as a result of the low blood pressure, nor did they require an urgent care or emergency room visit.

PILOT PARTICIPANTS: 40 challenging CCM patients with heart failure and hypertension

AFTER THREE MONTHS• Improved outcomes for all patients• Several patients said they had a better understanding of their health condition• Patients said they better understood the key metrics that indicated clinical changes• Overall, patients showed greater participation in the management of their care• Only 1 ED visit

“It is clear that there is better compliance with medicines and also more rapid response to deviations from the norm.” Doctor Chronos

REMOTE MONITORING TECHNOLOGY PLATFORM The customizable suite of FDA-approved, HIPAA-compliant monitoring devices includes:

• Connect Tablet or Two Button Table-Top Device • Blood Pressure Monitor • Fall-Detector Pendant • Glucometer • Personal Emergency Response Device • Pulse Oximeter • Spirometer• Scale

Powered by NavCare ConnectA secure chronic care management platform that• Tracks• Transmits• Trends every patient encounter

Delivering real-time actionable analytics and insights for better visibility into care compliance and program performance

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PILOT PARTICIPANT TESTIMONIALMr. Byrnes, a patient of Dr. Chronos and participant in the RPM pilot shares his story.

“I started using the NavCare health monitoring equipment at the advice of my cardiologist. The primary driver for its use was to get my blood pressure under control. The monitoring established patterns for when I was high that allowed my cardiologist to adjust my meds and get me in excellent control. A byproduct of using the equipment was that it brought my weight into my focus and I’ve lost ten pounds.

I found the equipment easy to use and not disruptive to my daily routine. I tried to keep a schedule but that’s not always possible. A key component to my success was my interface with the NavCare care team professional who kept a constant eye on my readings and kept my cardiologist informed.

I would unequivocally recommend the NavCare program.”

“The key to RPM is the connectivity to the patient, especially the sick patient who feels safer by virtue of direct link into the practice. We have noticed that patients are much more willing to discuss their condition and have more frequent input as to how to change their medical regimen.” Doctor Chronos

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A MULTIFACETED OPPORTUNITYHelping patients live healthier lives is the ultimate goal of providers and health systems. As our population continues to age, chronic conditions will escalate. Providers can get ahead of the trend now by adopting new technologies that not only improve outcomes, but allow patients to maintain independence while also giving them and their families greater peace of mind.

For providers, the financial incentives available through the release of the new RPM CPT codes presents a timely opportunity to enhance their services, improve outcomes, enhance patient satisfaction, and achieve greater revenue potential at the same time. In addition, providers can gain a competitive advantage over other providers who continue to rely on outdated remote monitoring methods.

Partnering with industry experts like NavCare can help providers quickly benefit from the new RPM CPT codes without investing in new infrastructure or additional resources.

Improving Health

• Daily monitoring

• Timely feedback

• Actionable insight

• Clinical oversight

Ensuring Independence

• Keeping patients safe at home

• Improving patientparticipation in their health

• Enhancing patient confidence

Building Relationships

• Dedicated clinical telephoniccare coordinator

• Routine outreach

ABOUT NAVCARE

The NavCare RPM solution, Navcare ConnectTM, provides:

Navcare ConnectTM includes:

NavCare provides peripherals include:

NavCare is a care management organization founded on more than 30 years of leadership experience serving health systems, private practices, and other healthcare providers. NavCare provides high-quality clinical services that demonstrate a positive impact on the health and wellbeing of patients.

Navcare Connect users take a more active role in their health with the use of our modern telehealth equipment, mobile app and improved communication for caregivers, loved ones, and healthcare providers.

• Daily insight into the care needs of patients

• Greater visibility into trends or health changes, allowing for timely interventions to prevent condition exacerbation or emergent care/visits

• More effective clinical coordination among the care team

• Greater patient engagement through ongoing outreach activities

• Easy-to-use mobile apps for patients, family, and caregivers

• Daily reminders for medication and appointments

• Care team alerts for critical vitals

• Call assessments triggers based on critical vital alerts

• Personal emergency response pendant or watch for fall detection, and automatic call-outs to 911 or designation contact

• Blood pressure monitor• Pulse oximeter• Thermometer

• Glucometer• Scale• Spirometer

Sources¹ https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html,² ahttps://www.ncoa.org/news/resources-for-reporters/get-the-facts/healthy-aging-facts/, ³ ibid., 4 ibid., 5 Administration on Aging, 6 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ NationalHealthExpendData/NationalHealthAccountsHistorical, 7 CMS-Connect 2018, 8 Clinical Health Coach 2018, 9 ibid.

Improving health. Ensuring independence. Building relationships.NavCare 699 Broad Street, Suite 1001 Augusta, GA 30901 • www.navcare.com • ©Copyright 2020 US CareNet