Impact of a Nationwide Remote Patient Care Hypertension Program on Clinical and Health Care Cost and Utilization Outcomes.

Abstract

To evaluate whether a remote patient care (RPC) hypertension program, which leverages remote patient monitoring and a technology-enabled, proactive care model, can not only improve clinical outcomes at scale for Medicare patients with hypertension but also reduce health care costs and utilization. From February 1 2022 to October 31 2023, Medicare patients with hypertension were enrolled into a technology-enabled RPC hypertension program, which leveraged automatically transmitted blood pressure (BP) from a cellular-enabled BP cuff and clinical visits, to optimize patient engagement and increase BP control. Mean reduction in BP and percentage of individuals at BP goal (BP <130/80 mm Hg) were evaluated using a paired t test and McNemar test, respectively. Using Medicare claims data, a retrospective difference-in-differences analysis was conducted to assess the impact of an RPC hypertension program on total health care costs and resource utilization over a 12-month period following program activation when compared with a propensity score-matched control group. The clinical analysis included 7256 enrolled patients (mean ± SD age, 73±9 years; BP, 142/81±16/9 mm Hg; rural/underserved, 3957 [54.5%]) followed up for a mean ± SD of 49±20 weeks. The mean ± SD reduction in BP was 8/4±16/9 mm Hg (P<.001 for both systolic and diastolic BP) with an 89% relative increase in the number of patients at goal BP at follow-up (36.1% [2619 of 7256] vs 19.1% [1386]; P<.001). The cost and utilization analysis included 3936 enrolled and 7671 control patients who were followed up for an average of 10±2 months and had similar baseline demographic clinical, cost, and utilization data. The RPC hypertension program decreased total cost of care (-$57.89 per patient per month; P=.07) over 12 months, primarily due to a reduction in inpatient costs (-$87.50 per patient per month; P<.001) and admissions (-6 per 1000 patients per year vs +44 per 1000 patients per year, 26.5% reduction; P<.01). Clinical, costs, and utilization results were similar among patients living in rural/underserved areas. An RPC hypertension program can positively impact the management of hypertension in the United States by improving BP control while also reducing inpatient spending and admissions.