In this episode, we dive into another health center’s digital health solution journey with remote patient monitoring (RPM) during the Covid-19 pandemic. Northeast Valley Health Corporation realized early in the pandemic that although its video visits were going well, few patients were coming into the office to get their blood pressure readings, creating a vacuum in quality metrics and increasing the risk of uncontrolled blood pressure and stroke. To counter this problem, the health center piloted a platform that allowed patients to take their blood pressure readings at home and share them with the care team. We chat with Northeast Valley Health Corporation as they share some of the early successes and challenges faced in using this platform, as well as what implementing RPM looks like in the near future. Learn more about the key role of care coordinators and care teams in advancing this important work, which helps patients take charge of their health.
Listen and subscribe to our podcast on Apple Podcasts, Spotify, and elsewhere. Below is a transcript of the episode, edited for readability.
EPISODE TEASER / Debra Rosen (guest):
“We saw the success in our pilot […] We know that patients will continue using telehealth, will not necessarily come in for each and every visit, and they don’t need to, as long as we can continue reaching out to our patients outside of the health center. That’s where remote patient monitoring is so important and so valuable.”
Jessica Ortiz (host):
Hi, everyone. I’m Jessica with the Center for Care Innovations, and today we’re talking about one of the exciting projects that Northeast Valley Health Corporation has been working on for the past year and a half. Our hope is that by sharing the highs and lows of this particular digital health solution, safety net organizations can apply our lessons learned to their own challenges. I’m here with Debra Rosen, one of our Tech Hub learning community members in our Tech Hub learning network, which is 14 tech forward California based community health centers, clinic coalitions, and primary care departments in county health systems that are working to accelerate the adoption of innovative technology. We partner with our Tech Hub members to vet, pilot, evaluate, and spread innovative digital health solutions, targeting Medicaid markets and historically under invested communities. We are excited to bring you this story today.
Jessica Ortiz:
Debra, can you tell our listeners a bit about who you are and your organization?
Debra Rosen:
My name is Debra Rosen. I direct quality and health education at Northeast Valley Health Corporation. My division is very large. It includes managing patients with chronic disease, our dietitians, a lot of work around quality as I said, and also immunizations. So been more recently, very busy with COVID vaccinations at my organization. So I wear a lot of hats at Northeast Valley.
Debra Rosen:
Northeast Valley Health Corporation is a Federally Qualified Health Center in Los Angeles County. We are quite large, with 17 licensed health centers. We have approximately 82,000 users through each year and about 350,000 visits. Our population is about 84% Latinx, and we still have 21% of our population uninsured.
Jessica Ortiz:
Welcome, Debra. So happy to have you here and sharing your expertise and experience with the rest of the community.
Jessica Ortiz:
Tell us more about your project that you’re working on. Where did you start?
Debra Rosen:
When the pandemic hit in March of 2020, we, as many other organizations, quickly pivoted to telephone and telehealth visits, or video visits, and so most of our patients were not coming into the health center physically. That certainly had wonderful advantages to continue serving our population, but as a result, many of the quality metrics weren’t happening because some of those have to be done in person. What we were finding out was that many of our patients did not have their blood pressure measurements in our system. We were quite concerned about that. What we began to do is increase the number of blood pressure monitors that we were sending out to patients.
Debra Rosen:
We actually have two processes to do that. One, is if they have Medi-Cal managed care, the provider can order through Durable Medical Equipment, a blood pressure monitor. We also received some free blood pressure monitors through the Community Clinic Association of LA County. We have an internal funding mechanism at Northeast Valley. It’s called, “I Support You,” where we, actually, as an employee can give back to Northeast Valley. That was chosen as one of the “I Support You” funds. And so we were able to purchase unconnected blood pressure monitors.
Debra Rosen:
I’ll give you an amazing number. We have provided since March of 2020, about 560-plus blood pressure monitors through health education for patients who are uninsured, and through Durable Medical Equipment, over 850. So, a lot of blood pressure monitors went out into patients’ hands.
Debra Rosen:
However, although we taught them how to use the monitor, we distributed those monitors, we didn’t get their blood pressure measurements back so easily. We did discover that the unconnected process didn’t solve all of our problems. So, as we began to work on ways to get those blood pressure values in our system for those who had an unconnected monitor, we knew that we needed to try a different approach, which was a higher-tech approach, and we looked into various remote patient monitoring vendors so that we could get the data across seamlessly. And so, with that, we were able to evaluate a number of vendors.
Jessica Ortiz:
Thanks for sharing that, Debra — that is really impressive. I’d like to hear more about the solution that you chose. Could you share more about the digital health solution that ultimately you went for with your project?
Debra Rosen:
I think it was just over a year ago where I participated in an advisory committee through the California Health Care Foundation. We were given the responsibility and opportunity to assess various remote patient monitoring vendors, mostly around cardiovascular diseases. We focused a lot on blood pressure and glucose monitoring; those were the two main ones. So, I had an opportunity to look at a number of vendors and really was impressed with the vendor we ultimately chose, which is called Rimidi. The reason why we were impressed with them is for a number of reasons.
Debra Rosen:
The first one, I think primarily the most important one, was that it was a cellular connection. What that means is that our patients didn’t have to download an app. They didn’t have to register or create an account. So because it’s over cellular connection, that means that it isn’t through Bluetooth, so it’s actually much easier for patients to utilize the Rimidi blood pressure monitors. The connection is really seamless. The patient takes their blood pressure at home and it actually interfaces into a platform that can be accessed within our electronic health record. That was also very important to us because we didn’t want it to go into the health record immediately without somebody reviewing the data first. And so having it go into a platform, allows our Care Coordinators to look at the information and receive alerts, and so they are really the connector between the patient and the care team. They assess that information first, and then relay that important information to the provider.
Jessica Ortiz:
How did you select the patients for the project?
Debra Rosen:
We didn’t have a difficult time selecting the patients. I was actually surprised how easy it was. We have a clinical pharmacist and he chose some of patients, and our Care Coordinators that work with patients identified some as well. It turned out that the 50 patients that are on the pilot, represent 10 health centers, they come from 10 different health centers, with about 26 different primary care providers. So it was actually very easy. We easily identified the patients.
Debra Rosen:
What was interesting is that initially I thought it might be better to just choose a small cohort of providers, really two or three, but then our Medical Director thought this was an opportunity that many of our providers would want to participate in with their appropriate patients, and so we opened it up and again, 26 providers are participating with patients that are in their panel. That was very exciting.
Debra Rosen:
The reason why I wanted to keep it small is that we can control a small pilot. But with only 50 patients, what it turned out to be is that our Care Coordinators throughout each of our health centers only have a small cohort that they’re responsible for. So that’s worked out really well. We taught all the Care Coordinators how to manage patients on Rimidi, but they only have a small group that they have to manage.
Jessica Ortiz:
Who handles the onboarding process for patients?
Debra Rosen:
Onboarding is actually very easy. We have Care Coordinators at each of our health centers and they would handle distributing the blood pressure monitor, ensuring that the patient is taught and can use the monitor correctly. And then it goes home with the patient and we’re waiting for that blood pressure measurement to interface into that platform. So the Care Coordinators not only onboard it with the patients, but they’re monitoring the platform for alerts. So we’re getting alerts from the platform through Rimidi for patients who have an elevated blood pressure.
Debra Rosen:
And by the way, we’ve made the decision of when to receive these alerts, at what levels. We also get alerts if the patient didn’t take their blood pressure over a designated period of time – we’ve also made those decisions; what we’re looking for.
Debra Rosen:
So, they’re managing that process and then they relay the information that they’re seeing to the provider when necessary. They’re the first line. They will first call the patient if they’re not seeing a blood pressure measurement over the specified time period. They will call a patient if the blood pressure is elevated. So they’re the first contact that patient has, checking to make sure that they took their medication, checking for any other symptoms, and once again, relaying that information to the provider.
Jessica Ortiz:
Thanks for sharing that detail.
Jessica Ortiz:
Thinking about Rimidi as a platform, what was that vetting process like? For example, you probably know at CCI, we suggest this framework of making sure there is a mission fit, operational fit and sustainability. Did this framework play into your decision making at all?
Debra Rosen:
Being that I really had an advantage of being on the advisory committee through the California Health Care Foundation, I really looked at many organizations. I think there are many, many vendors, about 20. And we certainly were assessing each of the vendors for their mission, for diversity, and their board or leaders, and also sustainability as well as their organizational mission. That was part of my vetting process. I will tell you that Rimidi came out close to the top when I reviewed it and also when the larger committee reviewed it. Those were many of items that we did look at in terms of vendors that we wanted to work with.
Debra Rosen:
Rimidi stood out. It stood out then. They continue to stand out. We’re really working at improving the platform for us. What we found out is that patients who were well controlled with their blood pressure, they didn’t need to continue taking it every single day. And so we’ve been working with Rimidi for identifying different tiers; those that are in control, how often do they need to take their blood pressure, those that are not in control, and coming up with a different approach for alerts, so that we don’t have “alert fatigue” for our Care Coordinators and not for our patients as well.
Debra Rosen:
I think that again, the very important aspect of Rimidi was how easy it was really for our patients to use. And the fact that they don’t have to download an app. It is not Bluetooth. It is cellular. And that connection is really easy for our patients. Our patients, as I described earlier, do experience that digital divide, so an easy system for them to use is really a top priority.
Jessica Ortiz:
That’s incredibly important with using technology. This kind of leads into my next question about sharing some top highlights with your project.
Debra Rosen:
I think the project has been very successful. First of all, we are comparing our pilot population – just the 50 who are on Rimidi with the connected blood pressure monitors – to patients who have unconnected blood pressure monitors, and then to the entire population at Northeast Valley who have a diagnosis of hypertension. We are seeing with our pilot much higher control rates with their blood pressures.
Jessica Ortiz:
You have this incredibly successful program. I think the community would really benefit from learning what are these challenges that you faced and maybe some tips for overcoming them.
Debra Rosen:
I think the first one is really cost. We know that there is a cost to this, although the non-connected blood pressure monitors are also costly. So we have to look at a way to continue offering the unconnected monitors as well. The connected approach is a little bit higher cost. We are hoping in the future, a couple of things, we’re hoping through for our Medi-Cal managed care patient, through their Durable Medical Equipment, that instead of an unconnected blood pressure monitor, we’re hoping that they will support connected blood pressure monitors.
Debra Rosen:
We’re really excited to be able to share the data on that. I wanted to do the pilot first to prove the concept. And then now it’s really my responsibility to take this to the health plans, both to see if they will cover it for their patients, but also if there’s additional payment for this work that we’re doing for remote patient monitoring.
Debra Rosen:
So now that I have the data showing that we have improved control rates for patients with the connected blood pressure monitor pilot, we would like to see that the cost for the program will be sustained and supported through health plans. As I mentioned earlier, 21% of our patients are still uninsured, so we will need a method to help support remote patient monitoring for those patients who are uninsured.
Debra Rosen:
This is not going away. We will continue to see patients remotely and we know that. And we know that it will still be a challenge to get patients to have their blood pressure values in our system, and to be able to manage their blood pressure even when they’re not coming in physically to the health center.
Jessica Ortiz:
Who do you plan to approach thinking about plans and cost?
Debra Rosen:
I’m going to be approaching the individuals that I work with on quality metrics. That would be the first line. And then really writing up a summary of the work that we’ve done and also our improved patient outcomes, which the health plans are quite interested in that. I will be writing up a short report to show them how this has improved clinical outcome metrics with their blood pressure control. And also the number of patients who have hypertension and don’t have blood pressure values within our electronic health record, which is really, really concerning, that’s something that we need to continue to work on. So, we are continuing to reach out to each of our patients to get their blood pressure values so that we can help manage their chronic disease.
Jessica Ortiz:
What was your experience like in remote patient monitoring before the pandemic?
Debra Rosen:
In 2019, we were actually distributing some blood pressure monitors as an incentive. We were trying to get our patients to come to our hypertension classes. So we came up with a plan that if they came to three classes, they would get a free blood pressure monitor. So we made them work for it a little bit, but that was a really nice incentive, and many of our patients did come to three classes and got their blood pressure monitor.
Debra Rosen:
But when the pandemic started, we wanted to make it a little bit easier for our patients to get a blood pressure monitor. That’s when we really switched to giving it out to patients who had a diagnosis of hypertension and their blood pressure wasn’t under control. That was our goal was really to increase the number, not to necessarily use it as an incentive, but to really increase the number of blood pressure monitors that we were distributing.
Debra Rosen:
We were also in the past – the providers were ordering DME, Durable Medical Equipment, for patients who had uncontrolled hypertension, but the numbers increased significantly during the pandemic. And we’ve now also taught health educators, our Care Coordinators to order the DME, so it didn’t have to rely just on the provider to order it. Of course, it has to be approved for that patient, but they are approving in many cases that blood pressure monitor to be sent to the home.
Jessica Ortiz:
It’s interesting to think about how we’re approaching remote patient monitoring before even thinking about it and then the acceleration of the pandemic and staying connected to patients.
Debra Rosen:
Well, we did have some experience with a vendor called Propeller Health. That is a product that provides sensors to patients with asthma. This is connected to a platform that we have access to. It’s a web-based platform. We implemented Propeller Health on patients who had uncontrolled asthma and we were able to help them manage their chronic disease by assessing: how often did they take their controller medication every day? Were they taking their rescue medication too frequently? And then we would reach out to our patients based on that information. We helped manage those patients with asthma. The goal is to keep them out of the emergency room and help manage their asthma outside of their medical visit.
Jessica Ortiz:
What was it like to innovate during a pandemic, as compared to what you were already trying to do pre-COVID-19?
Debra Rosen:
Innovation during the pandemic was rapid. I will say rapid, because we had a problem and we needed to quickly solve that problem. Usually we spend a lot more time planning, thinking, testing, but when the pandemic hit, we identified, as I mentioned, patients weren’t coming in, that meant we weren’t getting blood pressure measurements. So our goal was to get them blood pressure monitors as quickly as possible into their hands, teach them how to use it and then work on getting those measurements back into our system. It was much more rapid than it usually is.
Debra Rosen:
We are continuing to evaluate as we go forward. And as I mentioned that, although we had so many blood pressure monitors in our patients’ hands, we weren’t necessarily getting that information back into our system. And so then our work began, how are we going to get the information back?
Debra Rosen:
So, in addition to the pilot for the connected blood pressure monitors, we’re continuing to test the unconnected approach. We’re sending text messages to patients who have a monitor with an upcoming telehealth appointment, asking them to be prepared, to take their blood pressure at the visit. We are alerting our care teams, our MA’s on intake; this patient has a blood pressure monitor at home, please make sure to remind them to take their blood pressure. Those are interventions and improvements that we’re working on, but the innovation is really that connected blood pressure program through Rimidi, because that information is coming over seamlessly.
Jessica Ortiz:
I’ve been really excited to know that you are doing these two different approaches to RPM all within your same organization and watching that happen. It’s really exciting to continue to learn more. In spirit of learning, you are a part of our learning network. And here we are big believers in collaboration and not reinventing the wheel. How did your peers in the Tech Hubs program support and help you push this project forward?
Debra Rosen:
Lots of support through Tech Hubs, as well as the CCI grant, Connected Care Accelerator. That work really overlapped with each other because a number of organizations were doing work around remote patient monitoring, and so there was really, I would say synergy among those two programs.
Debra Rosen:
We did decide at Northeast Valley that we would create two cohorts. We would do one cohort on video visits, our telehealth component of Connected Care Accelerator, as well as our Remote Patient Monitoring Program. Dr. Park led our telehealth work. She’s our chief medical officer, and I led the work around remote patient monitoring.
Debra Rosen:
With that, we had an opportunity both through our Tech Hubs and through Connected Care Accelerator to share our work and listen to other organizations sharing theirs. Definitely have learned a lot about different vendors – advantages and disadvantages. We continue to be happy with the one that we chose. Again, ease of use is really a primary consideration for our patients. We continue to be very happy working with Rimidi, and we’re looking forward to expansion.
Jessica Ortiz:
It’s really nice to hear how this learning community is sharing and learning and impacting each other’s growth. As a community of safety net providers, how can this community support your efforts with the health plans, with pushing this work forward?
Debra Rosen:
I think that one of the things that we’d like to do with Tech Hubs, we have talked about this, to invite health plans to our meetings. I think that would be a very good support for the Tech Hubs, because I think that we’re doing so much, we are innovating and the health plans really need to hear the work that we’re doing. They need to hear about our successes, our challenges. We need to really have that conversation, ongoing conversation about what they’re interested in supporting and what we need support for. So I’m really looking forward to including the health plans in our Tech Hubs conversations.
Jessica Ortiz:
Any advice for listeners in thinking about implementing similar technology like Rimidi for RPM?
Debra Rosen:
My advice is always to talk the organizations. We did talk to various organizations before we made our choice. We, as I said, vetted many organizations, but I think what stands out is when you really talk to individuals in the organizations that are implementing this. I know that sometimes is challenging, because we often get calls and it is time that it takes from us, but I think it’s important to collaborate, to share our successes, our challenges, and really learn from each other – so whenever possible, we do. We do.
Debra Rosen:
I almost always say “yes” to a call from an organization and I hope that they will say “yes” as well because that learning is so important. We really want to hear from others what’s been successful, what the challenges are. That’s where participating in the Tech Hubs and these grants are so valuable as well. We can really learn from each other what works and what the challenges are for the different products, the different vendors.
Jessica Ortiz:
Thanks, Debra. I’d love to hear what’s next for you.
Debra Rosen:
We’re really excited to expand Rimidi. We saw the success in our pilot. We do have funds through the American Rescue Plan Act, ARPA, and we are using some of that money. I think that Northeast Valley Health Corporation really sees remote patient monitoring as very important for future work. We know that patients will continue using telehealth, will not necessarily come in for each and every visit, and they don’t need to, as long as we can continue reaching out to our patients outside of the health center. That’s where remote patient monitoring is so important and so valuable.
Debra Rosen:
We were willing to use some of the ARPA funds to invest in remote patient monitoring. We right now are in conversations with Rimidi to expand blood pressure monitors as well as our glucose monitors. So we’re really excited to move into that different area. We know some of our patients have diabetes and hypertension and may use both of those monitors. We’re looking forward to seeing what we can afford right now, and then adding and getting experience with glucose control through remote patient monitoring. We feel like we have a lot of experience and this will be relatively easy as we know how Rimidi works, and we know that there is an interest by our providers.
Debra Rosen:
What we do have to be concerned about is as we increase the numbers, we will also increase the work that we put on our Care Coordinators because they are really that frontline. They’re the connection between that patient who is taking blood pressures at home, testing their glucose at home, and relaying the most critical information to the provider and to the care teams. They’re the first line of reaching out to that patient to really manage their chronic disease. And so we need to be mindful of how much bandwidth our Care Coordinators have as we expand remote patient monitoring.
Jessica Ortiz:
Thanks, Debra. I really appreciate your thoughtfulness around that. Thanks for sharing your expertise with us today. It was really nice talking with you.
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