For Health Plans & Payers
Remote Monitoring and Care Management for Health Plans and Payers
The members who drive your medical spend are usually the ones with the most open quality gaps. We monitor them at home with cellular devices, a care team acts on the readings, and you get member-level reporting on what changed.
HIPAA · SOC 2 Type II
No long-term contract
Live in about 30 days
2,000+Providers on HealthArc
100,000+Patients monitored
45+States covered
9CMS programs, one platform
What’s at Stake
Your Quality Scores Are Decided Between Office Visits
Controlling High Blood Pressure scores the last reading of the year. If that reading comes from a rushed office visit after a missed dose, the member fails the measure even when their pressure is usually fine.
Home readings change the math. Health-plan guidance on the NCQA specification accepts member-reported readings from a digital device once they’re documented in the medical record, and the newer diabetes measure accepts a glucose management indicator from a continuous glucose monitor.
Most plans capture neither.
The cost side is just as concentrated. The CDC estimates that 90% of the nation’s $4.5 trillion in annual health care spending goes to people with chronic and mental health conditions, and a plan’s highest-cost members are almost always the ones whose blood pressure, glucose or weight went unwatched between visits.
Chronic share of US health spending
90% (CDC)
HEDIS CBP
Last reading of the year, <140/90
Home readings
Count when from a digital device and in the chart
Diabetes measure (GSD)
Accepts CGM-derived GMI
Gaps close too late
Fourth-quarter outreach chases members who haven’t had a reading since spring. A monthly program closes gaps as the year goes.
Network practices vary
Some providers in your network run care management well. Many have no staff for it, and you don’t control their hiring.
High-cost members surprise you
An admission shows up in claims weeks after the warning signs. By then the cost is already incurred.
Vendor reports stop at enrollment
A count of enrolled members doesn’t tell you whether readings came in or whether anyone acted on them.
How It Works
Built Around the Members Who Move Your Numbers
Three pieces, run as one program: the measures, the member contact and the reporting.
Quality measures
Close HEDIS and Star Ratings Gaps With Home Readings
Cellular blood pressure cuffs and glucometers send readings straight to the care team. The readings that matter are documented in the member’s chart, where they count toward the measure.
You stop depending on a single office reading taken on a bad day.
- Blood pressure readings for Controlling High Blood Pressure
- Glucose data for the diabetes glycemic status measure
- Post-discharge contact that targets 30-day readmissions
- Medication follow-up that supports Part D adherence measures
Member engagement
Reach Members Who Ignore Mail and Portals
Members get a device that works out of the box, with no app and no Wi-Fi. A care team follows up by phone, SMS, email or portal, whichever the member actually answers.
Engagement holds past the first month because a person is on the other end.
- Cellular devices shipped activated to the member’s home
- Outreach by phone, SMS, email and portal
- Escalation to the member’s primary care provider by agreed protocol
Reporting
Track Every Monitored Member From One Dashboard
Readings arrive as they’re taken, early enough to act on. Your team sees which members are on track, which have gone quiet and which were escalated.
Reports roll up by measure, by provider group and by line of business.
- Enrollment and reading adherence by member
- Alerts, escalations and outcomes
- Measure status across the monitored cohort
What It Moves
Which HEDIS and Star Ratings Measures Remote Monitoring Reaches
Measure definitions change every measurement year, so this maps the program to what each measure needs rather than promising a score.
| Measure | What it needs | What HealthArc adds |
|---|---|---|
| Controlling High Blood Pressure (CBP) | Last blood pressure of the year below 140/90 | Home readings from cellular cuffs documented in the chart, plus medication follow-up when readings run high |
| Glycemic Status Assessment for Patients with Diabetes (GSD) | Last HbA1c or GMI of the year below 8% (and not above 9%) | Glucose monitoring and monthly care-plan follow-up, using CGM data where the member has one |
| Plan All-Cause Readmissions (PCR) | Fewer unplanned readmissions within 30 days of discharge | Contact within 2 business days of discharge and 30 days of home monitoring |
| Part D medication adherence | At least 80% of days covered for diabetes, RAS antagonist and statin medications | Medication reviews and refill follow-up through medication therapy management and monthly calls |
Measure requirements are summarized from health-plan provider tip sheets on the NCQA HEDIS specification (Blue Cross Blue Shield of Illinois, Point32Health) and the CMS Star Ratings measure set. Check the current measurement-year technical specifications before you change a workflow.
How It Runs
Run It Through Our Care Team or Your Network
Plans use HealthArc two ways, and many use both: a direct member program, and a program run inside network practices.
Direct member program
- Our clinical team contacts members under your program name
- Readings reviewed and acted on every month
- Escalations go to the member’s primary care provider
- Built for high-cost, high-utilization cohorts
Inside network practices
- Practices bill RPM and CCM under their own NPI
- We run the program for practices with no staff
- One protocol set across the network
- No practice-by-practice rollout project
Reporting for the plan
- Member-level enrollment and adherence
- Measure status for the monitored cohort
- Escalations and outcomes
- Monthly, not at year-end reconciliation
HIPAA compliant and SOC 2 Type II. We sign a BAA, and data sharing follows the agreements your plan already has in place with its network.
Evaluating Vendors
What Health Plans Ask Before Choosing a Remote Monitoring Vendor
Questions from quality, care management and network teams at health plans.
| The question | Our answer |
|---|---|
| Can home blood pressure readings count for HEDIS CBP? | Yes, when they’re taken with a digital device and documented in the member’s medical record. The last reading of the measurement year is the one scored. |
| Which lines of business does this fit? | Any line with chronic-condition members, including Medicare Advantage and Medicaid. Measure sets differ by line, so we map the program to the measures you report. |
| Who contacts the member? | A HealthArc care team, working with the member’s primary care provider. You can also run it inside network practices instead. |
| Do members need a smartphone? | No. The devices have their own cellular connection, so readings arrive without an app or Wi-Fi. |
| How do you report results? | Monthly member-level and cohort reporting: enrollment, reading adherence, alerts, escalations and measure status. |
| Can we test it before committing? | Yes. We’ll ship a device and set your team up on the portal so you can see the member experience first. |
Implementation
From Signed Agreement to Monitored Members in About 30 Days
Start with one cohort and one or two measures, then widen it.
1
Week 1
Pick the cohort and the measures
Usually members with uncontrolled hypertension or diabetes. We agree the baseline and the measures you’ll judge the program on.
2
Week 1–3
BAA, data sharing and protocols
Eligibility files, escalation rules and the provider-communication plan are set with your medical director.
3
Week 3–4
Outreach and devices
Our team contacts members, records consent and ships activated cellular devices.
4
Month 2 onward
Report and expand
Monthly reporting to your quality and care management teams, then the next cohort or measure.
FAQ
Remote Patient Monitoring for Health Plans: FAQ
Common questions about running remote monitoring and care management for a member population.
How does remote patient monitoring help health plans?
It gives the plan continuous blood pressure, glucose and weight data for the members who drive cost and quality gaps, plus a care team that acts on it. That closes gaps such as Controlling High Blood Pressure during the year and catches deterioration before it turns into an admission.
Do member-reported blood pressure readings count for HEDIS?
Yes. Health-plan guidance on the NCQA Controlling High Blood Pressure measure accepts member-reported readings taken with a digital device and documented in the medical record. The last reading of the year is the one scored, and it has to be below 140/90.
Can CGM data count toward the HEDIS diabetes measure?
Yes. The Glycemic Status Assessment for Patients with Diabetes measure, which replaced the HbA1c control measure, accepts a glucose management indicator calculated from continuous glucose monitor data as well as a lab HbA1c.
Which Star Ratings measures can remote monitoring support?
Mainly Controlling Blood Pressure, the diabetes glycemic status measure, Plan All-Cause Readmissions and the Part D medication adherence measures. Monitoring supports the care that moves them; it doesn’t change the scoring rules.
Is HealthArc a health plan or a care management vendor?
A care management vendor. HealthArc provides the remote monitoring platform, the devices and the clinical team. We don’t adjudicate claims or take on insurance risk.
Who We Serve
Built for Other Kinds of Organizations Too
Get Started
Try It With a Small Member Cohort First
We’ll ship a device and set your team up on the portal, so you see the member experience before you commit to anything.
- A cohort and measure plan for your population
- A free device trial for your team
- Sample member-level reporting
- BAA and security documentation up front
Schedule a Demo
Request a Free Device Trial
HIPAA Compliant • SOC 2 Certified • No long-term contracts
sales@healtharc.io • +1-201-885-5571
sales@healtharc.io • +1-201-885-5571
Talk to a Remote Care Specialist
How Can HealthArc Help You?
Want a demo, or just have a question about remote care in your practice? Send us a few details and a remote care specialist will get back to you shortly.
- RPM, CCM & 7 more CMS programs
- Automated time tracking & CPT billing
- Two-way EHR integration
- Managed care team, or your own
- Pre-configured cellular devices shipped
- Live in about 30 days
HIPAA compliant SOC 2 Type II No long-term contracts
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