Frederick Health Hospital is a not-for-profit, 501^©(3) hospital in Frederick County, Maryland that offers comprehensive medical services. The system consists of Frederick Health Hospital, James M. Stockman Cancer Institute, home care and hospice providers, an ACO group, and a network of primary and specialty care providers. They have a significant footprint within the county, with 25 locations and 4,000 employees, serving a growing population that increased ~40% over the last 25 years by approximately 95,000 people.

The home health program provides disease management and virtual care services aided by telemonitoring devices. However, there were high readmission rates among chronic care patients who had been discharged from the program. Therefore, the program implemented RPM services in a focused manner beginning by fostering a collaborative vendor relationship. The program started small and gradually enrolled more patients while program leadership gathered data over a significant period of time to demonstrate sustained improvements to gain clinician support. Finally, they established a patient-centered model which resulted in reduced readmissions and ED visits for these patients, prompting the program to become its own department to support a growing number of chronic and transitional patients.

Frederick Health first launched RPM services as an offering within their home healthcare department. After around 18 months, they started to see a reduction in ED visits and readmissions, and decided to create a new department for RPM services, separate from the home care service line. The program has grown from 30 patients and one RN to a clinical team of eight that currently serves an average of 450 patients per month. Results collected from January 2023 to December 2023 include:

• Patient satisfaction rate of 96%
• Cost savings of $2.3 million over a 12-month period
• Reduced readmissions and ED visits:
  • 30-Day Readmission and ED Rate: 2% readmission rate and less than 1% ED visit rate.
  • 60-Day Readmission and ED Rate: 3% readmission rate and 1% ED visit rate.
  • 90-Day Readmission and ED Rate: 4% readmission rate and 2% ED visit rate.

Frederick Health built out their RPM program to provide additional support for chronic care patients and reduce their likelihood of readmission. Patients enrolled in the home care program were equipped with monitoring devices in home. However, after being discharged from the program, patients presented at the emergency department and were readmitted. To address this issue, one of the nurses proposed a solution to reduce the intensity of health services but continue monitoring patients. The organization designated a nurse leader to develop the program and support the transition as the program became its own department. Working with a vendor that best fit the needs of the RPM team, program staff generated positive outcomes for providers and patients.

Demonstrating ROI for RPM is a challenge because the benefits and outcomes accrue over longer periods of time. In contrast, leaders often want to see an ROI within a short window. Frederick Health started their RPM program in a focused way to keep it reasonably sized while collecting the data they would need across time to make the case for expansion. After 1.5 years, they had sufficient data showing reductions in both readmissions and ED visits, and that most patients were compliant with their equipment.

The RPM team then advertised these outcomes to key groups including provider groups, and social service agencies, to raise awareness about the program’s benefits. Because the program receives most referrals from the hospital and physician offices within their health system, they chose to focus their attention there. Each quarter, RPM program leaders sent email updates to senior leadership at the hospital and attended meetings with primary care physician practices to share program details and outcomes. When providers learned that patients in the program had significantly reduced risk of readmitting or visiting the ED, they saw the value of the program and became more receptive and participatory. Additionally, Frederick Health became a care transformation organization within the Maryland Primary Care Program, which provides resources to primary care teams to better manage and coordinate care.² As a result of this initiative, community-based practices can identify and refer chronic care patients to the program.

Clinicians and healthcare providers are more likely to support and refer patients to the RPM program when they see that it is sustainable and capable of delivering measurable benefits. By proving its value and integrating it into broader healthcare networks, Frederick Health boosted clinician buy-in, which is essential for the program’s success and expansion.

Frederick Health recommends two important considerations when choosing RPM vendors: pick a vendor that can grow with your program and collaborate as an equal partner.

1. Pick a growth-oriented vendor

Frederick Health began their program with a scoped ambition of 30 monitors and a well-defined patient population. The modest size of their vendor, Health Recovery Solutions (HRS), enabled a focused partnership. HRS offered expert advice on best practices for optimal nurse-to-patient ratios, determining the frequency and formats of reporting, and developing effective strategies for demonstrating ROI. They were able to focus on Frederick Health as a partner and set the stage for downstream growth.

2. Work in partnership

Frederick Health has worked with the same vendor for 10 years and cites several advantages to their collaboration. Frederick Health purchases its devices from HRS and, through their partnership, was able to quickly and efficiently be onboarded and set up all equipment. Through this process, HRS provides infrastructure and EHR integration support as they aggregate Frederick Health’s data and can share it in different formats to meet specific program needs. For example, the program leader can access raw data to do pre- and post- reports of readmissions and ED claims to assess how the program’s performance. HRS also provides technical support by communicating directly with patients to resolve any issues with the equipment. The RPM team at Frederick Health is small, so it was important that they could offload technical support duties. Responsive technical support enhances patient compliance and allows the clinical team to dedicate their time to providing care.

Frederick Health places the patient at the center of the program to ensure their engagement, which is crucial for reducing readmissions. The RPM team, consisting of eight FTEs five RNs, two LPNs, and one social worker, centers the patient at every step of their journey:

• The team coordinates initial setup, which includes a home visit to determine the best fit for the patient’s needs, who are then enrolled in the program or referred to different services.
• Nurses on the RPM team monitor and report the data. They also have bi-weekly calls with patients to help coordinate their care.
• The program focuses on tailoring the RPM experience to meet individual patient needs, ensuring that they’re not overwhelmed and receive the necessary support. For instance, a patient may start with blood pressure monitoring for a week, then gradually introduce additional components based on the requirements of their care plan.
• The team also engages the patient's immediate care circle. Involving family members and caregivers in communication adds a personal touch and helps engage patients who may have lower tech literacy or rely on others for assistance.

This approach helps patients achieve personalized outcomes. Anecdotal evidence from Frederick Health highlights instances where the program has successfully helped patients meet their individual care goals, such as attending important events without the need for supplemental oxygen. By facilitating regular touchpoints providing better insight into patients' conditions and care goals, RPM keeps patients engaged, while also allowing the clinical team to provide proactive and personalized care.

From January 2023 to December 2023, Frederick Health’s RPM program garnered successful results.³