In my previous post, I discussed some generalities of remote patient monitoring (RPM). The current value of the RPM market is estimated at $10.6B. There are diverse clinical and non-clinical environments in which RPM might be utilized. The healthcare ecosystem is becoming a continuum of care more than discrete silos of acute care and various post-acute care settings which must interact with each other in order to result in better outcomes and prevent hospital readmissions. These are the motives for the institution of RPM along this continuum. There are different models of deployment of RPM which affect investment by providers, ROI of the process, and logistics and workflows which I will discuss.

1. Monitoring performed primarily by the individual. This would include glucometers, blood pressure recordings, weight scales, and other accessories to smartphones or computers which via wireless communication transmit and store measured data points. The patient can then present the data to a healthcare provider or have it sent electronically. This allows for the direct flow of data from the patient to the provider. There is little investment from a financial perspective in this model.

2. Monitoring by the vendor. In this model, the technology vendor itself provides technical data support and acts as an intermediary between the patient and provider. This was the original model adopted for RPM of implantable cardiac rhythm devices. This type of model might involve partnering of the monitoring company and a wireless provider such as seen between Intuitive Health Inc. and ATT&T. The cost of monitoring in this model is built into the cost of the technology if used with Medicare reimbursement because of safe harbor law restrictions.

3. Monitoring by a local healthcare system. A local healthcare system might perform its own monitoring. In this model, non-healthcare providers might take directives from physicians who set alerts and algorithms to treat patients based on data received if necessary. This logistical model also facilitates integration with the patient’s EHR. Patients can also call in and discuss related symptoms with the providers and appropriate follow-up appointments made if necessary.

4. Centralized healthcare system monitoring. Countries in Europe have large academic institutions performing RPM regionally for smaller hospitals and unaffiliated healthcare providers. They are equipped to handle the 24/7 coverage as well as possibly the clinical expertise (as seen with implantable cardiac devices for example) not otherwise available.

5. Other third party commercial monitoring centers. There are a growing number of companies performing RPM. Some offer physician expertise (professional component) as well as the technical component of monitoring. These companies might have an advantage of 24/7 coverage over small hospital-based monitoring centers.

There are advantages and drawbacks of all the above-mentioned models, and there might be others not discussed. The lack of reimbursement for RPM might slow adoption, however the most significant impetus for the recent uptake in use has been the hospital readmission penalty policy. It remains to be seen which operational and business models fair economically better than others and more importantly, which ones produce better short and long-term patient outcomes.