Healthcare's Digital Revolution: Why Cutting Remote Monitoring is a Step Backwards

UnitedHealthcare's plan to limit remote patient monitoring (RPM) reimbursement starting in 2026 is a big mistake.

The Decision and Its Implications

• Limited Coverage: Only heart failure and hypertensive disorders during pregnancy will be covered.
• Ignored Evidence: Growing evidence shows RPM helps manage common conditions like hypertension and diabetes.
• Contradicts Modern Trends: Goes against the trend of modernizing chronic care.
• Potential Consequences:
• Widening health gaps
• Making value-based care harder
• Increasing unnecessary costs

The Facts

• UnitedHealthcare's Stance: Claims RPM is not necessary for many conditions due to lack of proof.
• CMS's Stance: Recently added new codes to make RPM more flexible and aligned with real-world use.

Evidence Supporting RPM

Heart Failure

• Benefits: Reduces hospitalizations and can lower mortality rates.
• Key Factors: Daily data capture, blood pressure monitoring, and responsive workflows.

Hypertension

• Benefits: Connected blood pressure monitoring improves control and reduces emergency visits.
• CMS Recognition: Acknowledged these benefits by making RPM more adaptable.

Diabetes

• Benefits: Improved blood sugar control and fewer emergency visits.
• Study Findings: Cellular-connected glucose monitoring devices reduced average A1c by 2.8 points over 12 weeks.

Criticisms and Improvements

• Older Studies: Pointed to lack of significant benefits but taught us how to improve RPM.
• BEAT-HF Study: Highlighted the need for clearer action protocols, leading to better outcomes.

Recent Studies

• 2025 Study (American Journal of Managed Care):
• RPM program for Medicare patients with care coaching reduced high blood pressure readings.
• Percentage of patients with stage 2 hypertension dropped from 100% to 25% after a year.

Economic Perspective

• Cost-Effectiveness: RPM is increasingly cost-effective, especially for cardiovascular diseases.
• Key to Success: Paying for the right RPM programs tied to outcomes, not cutting coverage.

Conclusion

• UnitedHealthcare's Decision: A step backward that could disrupt care continuity for millions.
• Recommended Approach: Focus on building outcome-linked RPM coverage.
• Potential Solutions:
• Tying reimbursement to program design features linked to outcomes.
• Using episode-based payments.
• Requiring transparent reporting.
• Final Thought: RPM saves lives and money when done well. Rolling back coverage is the wrong answer.