Remote Patient Monitoring Improves Type 2 Diabetes Outcomes

A remote patient monitoring platform managed by a pharmacist helped to improve outcomes for patients living with type 2 diabetes, according to a study out of the St. Joseph’s/Candler (SJ/C) health system in Savannah, Georgia. 

The Savannah, GA-based health system integrated pharmacists into its primary care services in 2017 to help with chronic disease management. More recently the health system launched an RPM platform to help manage care for patients at home, in between in-person visits.

Prior to the pandemic, pharmacists usually conducted in-person visits with patents, with  a primary care physician supervising the encounter. But when the pandemic hit and in-person visits became a challenge, the pharmacists leveraged telehealth services and remote patient monitoring to continue care delivery.

With Medicare expanding coverage to audio-only telehealth during the pandemic, the SJ/C pharmacists focused on phone calls with patients and patient-reported RPM data.

For their study, researchers looked at 30 patients who received type 2 diabetes care between August 2019 and February 2020 - prior to the pandemic - and 61 patients who received care between March and October 2020, to determine the change in A1C levels before and after the pandemic and the introduction of telehealth services. All patients had an initial A1C value of 8 percent or higher.

At the three- and six-month marks, the patients in the pre-COVID-19 group saw an average A1C reduction of 1.3 percent and 1.2 percent, respectively. The patients who received telehealth care during the pandemic saw a greater decrease of A1C levels, with 2 percent and 2.2 percent reductions at three and six months, respectively.

The researchers also sought to determine if telehealth had any influence on the percentage of patients on statin therapy and how telehealth affected quality measures relating to Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) goals.

More patients were on statin therapy before the pandemic (96.2 percent) compared to during the pandemic (82.6 percent), but the study authors noted this may be due to the number of patients in the telehealth group with allergies or intolerance to statin.

Telehealth and RPM use for type 2 diabetes treatment also improved factors that HEDIS and MIPS measure for performance quality. In the pre-telehealth group, 41.7 percent of patients had their A1C levels under control, according to HEDIS standards; in the telehealth group, 54 percent of patients met that goal.

In the telehealth group, 73.8 percent of patients met the MIPS standard of having an A1C of less than 9 percent, compared to the 60 percent of patients in the pre-telehealth group, the researchers noted.

Researchers also found that RPM reduced the number of in-person visits while also improving patient health outcomes, and patients found the virtual care platform to be both timely and convenient.

CMS has updated its policies and requirements for remote patient monitoring each year since introducing coverage in 2019. The agency now requires that RPM devices meet the FDA’s definition of a medical device and must upload patient data automatically to qualify for Medicare reimbursement.

The study acknowledged that further use of successful RPM programs to treat type 2 diabetes may require additional resources to ensure compliance with CMS.

Despite studies that have shown how telehealth, remote patient monitoring, and mHealth tools improve diabetes outcomes, CMS has not approved Medicare coverage for virtual care in Diabetes Prevention Programs, a move that could benefit millions of patients at risk of developing  diabetes.