Hypertension, Digital Health and Remote Monitoring in 2024
Hypertension or High Blood Pressure is an issue across America that will impact nearly 50% of the population. There are several areas of focus that hold the ability to improve overall care around patient awareness, engagement and the reliability of in-office readings. This can be accomplished through digital health platforms like Mozzaz and remote monitoring to better connect patients and care team workers outside of the standard office environment. By providing vital readings connected through digital platforms you increase the number and reliability of readings while helping to confirm diagnosis of the condition in its various stages.
Hypertension, also commonly referred to as High Blood Pressure, is defined as the consistent and sustained elevated pressure within blood vessels measured at 130/80 mmHg or higher. At that rate, the force of blood flow can cause damage to blood vessels, making them stiffen, weaken, or narrow over time. Unmanaged hypertension has been observed to cause extensive damage to several key organs such as your heart, kidneys and eyes – and is one of the leading risk factors associated with heart disease and stroke.
“Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion across the United States. This warrants intense effort toward hypertension prevention and management.”
PubMed: Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014
As you can imagine there is significant opportunity for improvement in terms of patient education and engagement in care for hypertension. One of these enhancements has through technology in the form of connected-personal health devices and digital health platforms to enable remote condition monitoring. The result of this embrace has been connecting patients and care team workers outside of the standard office environment, improving patient engagement, increasing touch points in between visits and improving overall blood pressure control.
Blog Overview:
Digital Health, Patient Monitoring and Hypertension
Background on Hypertension
Across the United States, approximately half of adults (47%, 122.4 million individuals) are estimated to have hypertension with many of them unaware of their underlying condition - of the individuals with hypertension, about 48% have their blood pressure under effective control.
Hypertension is entirely treatable with a variety of effective medications and care adjustments that can remediate its impacts on patients. These include lifestyle changes like low sodium diets, cessation of smoking, improved physical activity and weight loss; however, some individuals will require medication regardless of adjusted factors.
One of the largest areas for improvement in care for hypertension is improving patient awareness of the condition as it progresses, educating patients, and improving the reliability of readings – all of which can be accomplished with digital health platforms like Mozzaz.
When examining the different degrees of hypertension, the condition can be broken down into four categories depending on the measurement of blood pressure:
Digital Health, Patient Monitoring and Hypertension
One of the major problems today is that of patients unaware of their hypertension and the difficulties in getting reliable readings to provide a meaningful diagnosis. Traditionally, hypertension is diagnosed depending on two or more readings taken at two or more different times. Often readings taken within the clinical environment have demonstrated significant variance from readings taken within the home and ambulatory environment. As a result, many care workers are unable to put full weight behind standard readings, making diagnosis more challenging.
This is where digital health technology comes in to fill the gap by providing connected medical devices like blood pressure monitors and platforms such as Mozzaz. This combination enables patients to take more frequent readings from the comfort of their own homes, providing additional data points in between clinical visits to allow better insight for the care team. Through this regular contact, your care team is empowered with a wealth of information to make more informed clinical decisions based on data taken from patient’s naturalized environment. This can help mitigate the many factors that can impact blood pressure in the short-term, making infrequent readings hard to trust.
Devices to Monitor Hypertension Remotely
Many digital health programs for remote hypertension monitoring consist of both an active data collector such as a blood pressure cuff, and a passive data collector, such as a smart watch or activity tracker. The type of health data available from these devices can be found described below:
Blood Pressure Cuff:
A digital blood pressure cuff for remote home use is an electronic, portable device that measures systolic and diastolic blood pressure along with heart rate. It typically consists of an inflatable arm or wrist cuff, a digital display unit, and electronic sensors that detect arterial pressure. These devices are designed for easy operation by individuals without medical training and often feature connectivity options for remote monitoring and data sharing with healthcare providers.
Smart Watch:
A smartwatch is an optional accessory to bolster any digital health program, providing a variety of health information through the wrist-worn electronic device. These smartwatches are designed to seamlessly integrate with smartphones and other digital platforms, allowing users to track their health metrics, receive real-time feedback, and share activity data with healthcare providers through platforms like Mozzaz.
Some common health metrics gleanable can be found below:
Heart Rate Monitoring: Continuous and on-demand measurement of heart rate, often using optical sensors that detect blood flow through the skin.
Blood Oxygen Saturation (SpO2) Monitoring: Measurement of blood oxygen levels to monitor respiratory health and detect potential issues like sleep apnea.
Electrocardiogram (ECG): Ability to record the heart’s electrical activity, providing insights into heart rhythm and detecting anomalies such as atrial fibrillation.
Sleep Tracking: Monitoring of sleep patterns, including duration, quality, and different sleep stages (light, deep, REM sleep).
Activity and Fitness Tracking: Tracking of physical activities such as steps taken, distance traveled, calories burned, and specific workouts (running, cycling, swimming, etc.).
Stress Monitoring: Assessment of stress levels using heart rate variability (HRV) and other indicators to provide insights into overall well-being.
Body Temperature Monitoring: Measurement of skin temperature to provide insights into body temperature trends and potential health issues.
Additional information can also be attained through in-app and SMS-based tools such as:
Medication adherence tracking through SMS reminders or in-app success messaging
Built in nutrition tracking through patient-facing mobile applications
Push surveys for subjective data like mood, pain and more
Case Studies and Evidence
Being part of CMS’ core reimbursable digital health offerings, remote physiologic monitoring for hypertension has proven to be a vital tool in improving patient outcomes, especially for rural patients.
In a recent prospective cohort study in the Journal of Human Hypertension, home blood pressure monitoring successfully improved blood pressure compared to the control group, and RPM participants were more likely to have controlled high blood pressure at 3 months with the difference persisting at 12 months.
Additional evidence of remote monitoring’s efficacy in improving hypertension outcomes include:
Association of Remote Patient Monitoring with Mortality and Healthcare Utilization in Hypertensive Patients: a Medicare Claims–Based Study: One randomized trial compared three treatment groups—RPM with office visits, RPM with remote care, and ambulatory self-measurement with office visits—and found that the two groups with RPM had better BP control (69% and 67%) compared to the routine care group (50%) at 24 weeks of follow-up among patients >55 years of age. Likewise, a meta-analysis that compared telemonitoring and routine care reported an average decrease of 7 mmHg for systolic BP in the telemonitoring group compared to 3 mmHg in the control group. The study assessed clinical outcomes such as mortality and hospitalizations, and found consistent results regarding the superiority of RPM for BP management.
Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial: At home blood pressure monitoring combined with pharmacist case management achieved better BP control compared with control group during 12 months of intervention that persisted during 6 months of postintervention follow-up.
In our own experience here at Mozzaz, we have observed that within one year in-program for hypertension an average reduction in systolic blood pressure by 4.6 mmHg with a reduction in out-of-range readings by 37.5%
CMS Reimbursement for RPM in Hypertension
Reimbursement for remote monitoring of hypertension is most often covered by the following CPT codes:
99453: Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment. Average national reimbursement rate of $19.32
99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s)or programmed alert(s) transmission, each 30 days. Average national reimbursement rate of $50.15
99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. Average national reimbursement rate of $48.80
99458: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes. Average national reimbursement rate of $39.65
This reimbursement aligns to incentive care providers to establish digital offerings to improve the health of the patients they serve.
Mozzaz offers both platform-only and managed care options for our clients, making starting new programs and expanding existing ones simple. If your organization is looking to implement or expand on your digital health efforts for hypertension or other conditions do not hesitate to reach out to one of our health technology experts today.