By now, it is no secret that remote patient monitoring (RPM) can be an effective solution for improving patient care. Not only can RPM provide a streamlined approach, but it can also cut down on financial penalties due to poor hospital performance. By implementing an effective RPM system guided by a care coordinator, healthcare providers can more closely monitor their patients and intervene when needed.

So how can we integrate remote patient monitoring programs into our health systems?

Enable RPM Programs with Strong Care Coordinators

As the accountable care organization (ACO) model of healthcare continues to expand, the care coordinator is becoming a vital role after hospital discharges. Initially, physicians and advanced clinicians, such as nurse practitioners and physician assistants, were the main players in care coordination. However, other healthcare professionals have become valuable resources for care coordination, especially among chronically ill patients.

Care coordinators are responsible for several actions that can help improve quality of care and overall patient satisfaction. They ultimately help reduce hospital readmissions and execute cost saving measures for both the hospital and the patient. In a remote patient monitoring system, these responsibilities can include:

1. Following up with patients after hospital discharge by telephone or health software platform
2. Ensuring patients receive their discharge instructions and fill any new medications
3. Educating patients on their condition and chronic signs and symptoms
4. Monitoring patient quality metrics and measuring them against assigned values
5. Identifying risks for hospital readmission and relaying patient vitals and “alerts” to their physician

Drive Patient Engagement with Coordination of Care

Care coordinators are essential for driving patient engagement in a consistent manner. By providing virtual check-ins and assessments, patients can get the care they need with minimal effort and cost. This way, patients can feel comfortable knowing that supportive resources are available.

Depending on patient conditions, care coordinators typically perform monitoring and assessments on an ongoing basis. In some cases, targeted conditions such as COPD and heart failure, may need additional support such as a 30-day post-discharge check-in and/or a quarterly or annual assessment

Through the use of remote patient monitoring platforms, care coordinators have a direct line of communication to address patient concerns. Patients may sometimes have questions regarding their condition(s), such as appropriate diet or lifestyle measures. Care coordinators can continually review patient vitals and overall health via remote monitoring platforms for quick intervention. These interventions can include recommending a doctor’s visit, referring the patient to a specialist, or providing coaching for self-management.

Care Coordinators Becoming Essential

Care coordinators are becoming an essential part of chronic care management. Because of their growing importance and the flexibility in remote patient monitoring reimbursement requirements, their positions can often be filled without the need for advanced medical degree. While many care coordinators are nurses or medical social workers, these roles can also be sourced from those with bachelor’s degrees in medical, business, or hospital administration.

Depending on the organization utilizing remote patient monitoring services, a care coordinator can be part of the internal team or outsourced as a remote position. Many healthcare professionals can build upon their existing education and experience and be trained to provide the correct level of coordination by their employer or their employer’s remote patient monitoring partner. Utilizing a dedicated care coordinator then allows providers to be more efficient by focusing on patients who are physically present in the clinical setting.

Care coordinators can help providers maintain a higher standard of care on an ongoing basis through remote patient monitoring programs. With little cost and minimal oversight, healthcare providers can supplement patient care with consistent assessments allowing for education and intervention as needed. By providing extensive support for patients and physicians, care coordinators can ultimately improve patient engagement, reduce cost and drive appropriate levels of utilization.  

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