A group of partners has launched a turn-key program to help pharmacies embrace remote patient monitoring (RPM) and get reimbursed.
The partnership is between telehealth infrastructure provider OpenLoop, RPM platform Tenovi and RxHealing, which provides operational support to pharmacies doing RPM. The program's goal is to empower pharmacies, particularly independent ones in rural areas, to oversee and support chronic care patients between scheduled office visits.
There is no cost to pharmacies to stand up the program, executives said. The program will initially bill Medicare Part B, with commercial expansion planned.
“It’s a pretty seamless, out-of-the-box thing,” Jon Lensing, co-founder and CEO of OpenLoop, told Fierce Healthcare. “The work that [pharmacies are] getting reimbursed for now, they have historically done anyway, so for them there’s really no extra workload or lift.”
OpenLoop, a white-label operator powering telehealth companies, will see patients and bill insurance for any necessary clinical care, while Tenovi will source and transmit data from medical devices to the relevant clinical teams, including pharmacists. Pharmacists participating in the program will need to work with OpenLoop providers.
In 2019, CMS introduced RPM codes, eventually expanding the opportunity to other clinical staff, such as pharmacists, under general supervision rules. These staff are permitted to set up equipment, provide patient education, collect data, monitor the devices and provide RPM treatment management services.
However, making RPM functional as a pharmacy is not simple. Pharmacies need to seek collaborative practice agreements in their state, source the medical devices and find ongoing tech and clinical triage support. “After two or three months, they say this is too much work and they give up,” Eric Lankford, CEO of RxHealing, said. The program solves for all those components.
The program, which launched in early April, has had an enthusiastic reception, per Lankford. So far, 138 pharmacies have joined. The partners will be tracking the program’s impact and plan to share data. “From mom-and-pop pharmacies all the way up to these enterprise pharmacies, they all want to move forward with offering this in some shape or form, because they see the clinical value to the patients,” Lankford said.
Pharmacies play a particularly important role in rural areas, per Lensing, counseling patients and supporting with follow-up. “That patient education is oftentimes the first foray that a lot of these rural patients get into the broader ecosystem,” Lensing said.
Additionally, pharmacists have established, trusted relationships with patients. “We really see that as a way to leverage their voice in the community and their ability to impact, and have the confidence and trust of these patients,” Brandon Haag, vice president of sales for PBM, payer and pharmacy at Tenovi, said.
While there is no official CMS list of qualifying diagnoses for RPM, both chronic and acute conditions are eligible, per Lankford. What qualifies a condition for RPM is medical necessity as determined by a treating provider, rather than a specific diagnosis code. The conditions that come up most often in practice, Lankford said, are those with a measurable physiologic signal, including hypertension, diabetes, congestive heart failure, COPD, asthma, obesity, sleep apnea and atrial fibrillation.