… is just not sustainable. That’s why we believe that this care delivery model supported with a Virtual Office and CAREMINDr is not just the future of our practice—but all of healthcare.”

Although its services are steadily diversifying, Reliance is focused on family primary care throughout New Jersey’s Atlantic coast. As primary care physicians, the bulk of their time is spent managing patients’ chronic conditions—and for good reason, considering diseases such as hypertension, diabetes, heart disease, asthma and others consumes 90% of the nation’s $3.5 trillion in annual healthcare spending.

“Using CAREMINDr’s mRPM solution helps our patients with chronic conditions stay adherent to the right medications and nutrition, and it also helps us identify and prevent potential emerging medical issues,” says Regis. “By detecting the signs of a worsening condition earlier, we can keep more patients out of the emergency department and hospital—which is what Medicare and other payers want us to do, but it’s also better for our patients.”

Regis adds that the questions that patients answer on the CAREMINDr app also help clinical coordinators identify and address social determinants of health (SDoH) obstacles that are contributing to poorer outcomes. For example, a survey question may ask patients if they were able to refill a medication. If they answer no, the app then asks for a reason, which could be cost or transportation difficulties. Based on the responses, the clinical coordinator can help patients find solutions to adhere to their medication regimens sooner—which keeps patients healthier, and also creates efficiencies for the physicians at the practice.

“If we’re going to change the dynamics in healthcare and move the needle on some of these chronic conditions, it has to start in the patient’s home,” Regis says. “There are so many conditions, both medical and behavioral, that are suitable not just for monitoring, but overall management from the home. With the capabilities available today through CAREMINDr and other technology, the opportunities to improve outcomes and reduce costs are enormous.”

It is no wonder then that 88% of hospitals and health systems surveyed have invested or plan to invest in RPM solutions to help manage complex high-risk patients with chronic conditions.

The choice to partner with CAREMINDr as the technology foundation of the Virtual Office concept has emerged as an early success. Onboarding patients into mRPM through the mobile app is simple. They receive a Reliance Medical Group-branded bag called “The Red Bag” with their blood pressure cuff or another home device, along with information about their chronic condition and CAREMINDr. A medical assistant then shows patients how to enroll in a “journey” specific to their condition and use the app to follow the highly structured and carefully scheduled path where they “check in” at pre-determined intervals determined by the practice and dependent on their conditions and treatment plan.

At each check-in, the patient answers a short series of subjective and objective questions and enters requested biometric data, such as a blood pressure reading. The clinical coordinator can then review the requested patient-reported data before it is entered into the EHR. This type of asynchronous and automated mRPM does not require both parties to be available at the same time, nor does it require any clinician to remember to follow up with a patient to answer the survey questions, because they are sent via CAREMINDR’s push notifications, and answers are collected automatically. If patients don’t answer, CAREMINDr sends a reminder.

“One of the essential ingredients to make this Virtual Office model work is patient engagement,” Regis says. “CAREMINDr delivers that through the repeated contact and clinically relevant, but easy to understand, questions. Patients feel that someone cares about their health and their success in managing their condition. It’s a tremendously powerful tool.”

Since CAREMINDr is simple to use and intuitive, patients rarely make a mistake using it, according to Reliance’s leaders. If they do, the clinical coordinators can quickly recognize and correct the error after a brief phone call with the patient.

“What’s crucial to our Virtual Office model is that our clinical coordinators are knowledgeable about CAREMINDr, but also all the other devices that we give to patients,” Papaccio says. “They are familiar with the potential mistakes that patients may make while using the equipment. This ensures readings are accurate and clinical coordinators do not launch interventions based on false alarms.”

Clinical coordinators at the Virtual Office are the first to review responses, and they escalate it to the patients’ physicians when needed. Simply having another set of eyes on the data helps the team initiate more effective and efficient interventions and reduces the risk of overlooking an important metric. Likewise, clinical coordinators can effectively resolve some of the non-critical issues that are flagged without involving physicians or their staff, saving them time and disruption.

Improving clinical outcomes is Reliance’s primary goal, but there is a significant financial benefit from the Virtual Office model as well. Under value-based care payment programs the practice is involved in, reducing high-cost ED visits, readmissions and expensive imaging positively impacts its bottom line. More specifically and significantly, however, the Centers for Medicare and Medicaid Services (CMS) has recently expanded chronic care management (CCM) and what it calls remote physiologic management CPT codes, which enable the practice to earn additional reimbursement that will support its Virtual Office’s operations and growth.

In 2015, CMS created the first CCM codes, which compensate physicians for more of the care they deliver to patients with chronic conditions between scheduled appointments. Since then, CMS has updated these codes, added new remote physiologic monitoring and transition care management codes and loosened telehealth requirements, all of which offer physicians greater flexibility to earn additional reimbursement. One of the new remote physiologic monitoring codes released for 2020, for example, covers Reliance’s Virtual Office structure. It allows clinical staff to operate “under general supervision of the billing provider” to monitor patients, such as its clinical coordinators are doing, to earn reimbursement.

“This code is a major recognition from CMS that remote patient monitoring, particularly delivered by clinical support staff, is essential to value-based care success,” Papaccio says. “It also shows that CMS believes providers cannot effectively solve the chronic condition challenges facing the healthcare industry with outdated practice workflows that have not significantly changed in decades.”

Following an initial pilot, Reliance Medical Group is now actively enrolling tens of thousands of patients with diabetes, hypertension, asthma and other chronic conditions in CAREMINDr’s mRPM care journeys specific to their health needs.

Fortunately, patient and technology trends are on their side. The results from a 2020 AARP survey show 53% of adults age 50 and older say they “would prefer to have their healthcare needs managed by a mix of medical staff and healthcare technology”—another reason Reliance’s leaders are confident their mRPM program powered by CAREMINDr will be a clinical and financial success.

“Our reimagined practice structure is still new, but we are confident it will have a profoundly positive impact on care quality and financial performance—and most importantly, patient outcomes,” Regis says. “In a short time, we will demonstrate through quantifiable evidence that the foundational changes we have been making have been worth the effort.”

 For more information about CAREMINDr contact: Info@CAREMINDr.com 

Call / Text: 408.915.7274 

CAREMINDr, founded in 2018 in Silicon Valley, is driven by a team of executive leaders and physicians with collectively more than 250 years of experience in health insurance, practice management, wellness, health systems and hospitals, pharmacy management, government, and population health.

CAREMINDr’s focus on “mobile-enabled RPM,” or mRPM, is a game-changer. When you hear the term RPM, you may think of old-school RPM focused on phone calls and inconsistent collection of one-off patient data and information, with a low benefit-to-cost return on investment. With CAREMINDr, that model is no more.