How FQHCs Are Standing Up, Sustaining Remote Patient Monitoring Programs

Remote patient monitoring is growing in popularity in the U.S., especially since the COVID-19 pandemic restricted access to inpatient care. For many large health systems, the rising popularity of RPM has led them to expand or strengthen existing programs. But for federally qualified health centers (FQHCs), it often meant standing up brand-new programs, even amid the financial uncertainty of the public health emergency.

FQHCs, community-based providers that receive federal funding, play a key role in the healthcare system infrastructure. To become qualified for government funding, the centers must meet certain criteria, including providing care on a sliding fee scale based on ability to pay.

Thus, these organizations play a key role in ensuring care access in underserved communities and advancing health equity. Recent data from the Boston University School of Public Health revealed that FQHCs were disproportionately responsible for getting communities of color vaccinated against COVID-19.

As remote patient monitoring efforts have grown amid the pandemic, many FQHCs depended on partnerships with technology companies to implement new programs. But that does not mean the path was free from hurdles.

Remote patient monitoring programs at FQHCs

For Green River Medical Center, an FQHC in Green River, Utah, the impetus to implement an RPM program came on realizing their current system of measuring and gathering blood pressure readings needed improvement.

Initially, the organization was sending patients home with blood pressure cuffs, asking them to keep a log of their readings and then bringing it back to the center, said Tyler Rundell, associate medical director at Green River Medical Center, in a phone interview.

"We needed to have a way to get those numbers without the possibility of the patient interfering with them, for lack of a better word," he said.

As the center began looking into RPM as a way to improve hypertension care, the Health Resources & Services Administration released a three-year, $90,000 grant specifically for that type of care. The health center applied and won the grant.

"That was where we started to see a lot more opportunities for getting in contact with our patients, keeping closer in touch with them, decreasing the frequency that they had to come in visit us at the clinic, but still increasing the number of touch points we had with the patients, which was really nice," Rundell said. "That's kind of why we continued to pursue it."

The health center launched its RPM program last March, supported by Rimidi, a cloud-based software platform that combines patient-generated data with information from the EHR to support clinical decision-making.

Hypertension patients are able to take their blood pressure readings at home and transmit them electronically to Green River Medical Center via the platform provided by Rimidi.

Similarly, Northeast Valley Health Corporation (NEVHC), an FQHC in San Fernando, California, used Rimidi to support its RPM program for hypertension patients.

"Many of our patients had a missing blood pressure [reading] in their charts, which kind of drove down our hypertension control rates," said Alejandra Mata, program manager of chronic disease at NEVHC, in a phone interview. "So, we decided that we needed something that would be very convenient for our staff, as well as keeping our patients safe by checking their blood pressure from home and us having immediate access to those readings."

Biggest hurdles to implementation

The most challenging aspect of implementing the RPM program was developing a workflow that did not overwhelm staff and enabled them to complete their other work as well, Green River Medical Center's Rundell said.

In general, staff is one of the most limited resources in FQHCs. So, the center needed a workflow and technology platform that was easy to use and understand for even non-clinical staff.

"[We were] trying to find something that worked very simply — where it gave us just the information we needed and no more, no less," Rundell said. "[The Rimidi platform] was something where we could just have even one of our front desk [people] run through, give them a workflow saying [for example], 'Okay, this is the third time the patient has read a high blood pressure, create a telephone encounter and move on.'"

Creating an efficient RPM workflow for staff was also a challenge that NEVHC faced. To combat the issue, the center created a new role: RPM project coordinator.

"We did decide that an RPM project coordinator would be most beneficial for really closely monitoring these patients on RPM and providing timely follow up and acting as the liaison between the patient and our clinical care teams," NEVHC's Mata said.

Another hurdle was getting FQHC patients engaged in the program. To drive patient engagement, NEVHC developed a script for recruiting patients, where it outlined what RPM was, what the platform entailed, the follow up that the patient could expect from the care team members, and so on, she added.

RPM program outcomes and what's next

Both NEVHC and Green River Medical Center tout improved hypertension outcomes as a result of their respective RPM programs.

NEVHC's pilot program includes 50 patients, who had a 38 percent control rate last March, as compared with its overall hypertension patient population that had a control rate of 40.6 percent.

By August, the RPM program patients had a 70 percent control rate, whereas the overall population had a 48.5 percent control rate.

Green River Medical Center boasts a similarly high hypertension control rate: 67 percent, Rundell said.

In addition, Green River Medical Center has received good patient feedback on the program and high engagement.

"Our patients aren't exactly the most tech savvy," he said. "They don't all have smartphones. They're not really all interested in that technology portion, but we have seen actually quite a bit of involvement from our patients and actually behavior changes and them reaching out and saying, 'Hey, my blood pressure's been this, what do you want me to do?' We've been able to adjust medications, and again, just keep a closer relationship with our patients."

As RPM technology becomes more sophisticated and regulatory support grows, FQHCs with budding RPM programs can look ahead to the next step.

Currently, NEVHC has only offered the program to the initial 50 pilot patients, but the health center is exploring expansion strategies.

"We're taking into consideration bandwidth, how can we expand and what's within our capacity to expand since it requires close monitoring and very engaged communication with the patient and the clinical care teams," Mata said. "We're still brainstorming how we would like to expand, but we see such great benefit coming from RPM, and we would like to see it offered to more patients."