How an FQHC is Using RPM to Care for its High-Risk Patient Population

February 27, 2024 - A trenchant problem in efforts to advance virtual care utilization is that patients who would benefit the most from these technologies are often unable to access them. To address this issue, rural healthcare providers, including community health facilities and federally qualified health centers (FQHCs) that typically cater to more vulnerable populations, are entering partnerships to extend access to emerging digital healthcare models.

Last month, Desert Senita Community Health Center became one such rural health facility, partnering with Clear Arch Health to launch remote patient monitoring (RPM) services.

RPM has the potential to transform clinical outcomes for some of the most common and deadly chronic diseases plaguing Americans. From diabetes and hypertension to cancer, a growing body of evidence shows that RPM-based care models can change chronic disease management for the better. As a result, RPM use skyrocketed during the COVID-19 pandemic, with claim volumes increasing by 1,294 percent from January 2019 to November 2022.

By partnering with a technology vendor, Desert Senita aims to bring the benefits of RPM tools and approaches to its patients. However, to ensure equitable access to the services, the FQHC had to be mindful of the implementation process, ensuring it identified and removed barriers to access.

CARING FOR A DIVERSE POPULATION

Daniel Barbara, DHSc, CEO of Arizona City, Arizona-based Desert Senita Community Health Center, describes the FQHC’s patient population as incredibly diverse. The FQHC’s locations in Arizona City and Ajo, Arizona, primarily care for retired Americans with substantial health challenges and new immigrant families, mainly from Mexico.

“From full-time residents who make up the majority of the population to seasonal residents — it’s a very, very broad demographic,” Barbara said in an interview with mHealthIntelligence. “A lot of winter visitors who are Caucasian retired folks from up north and a very large number of Hispanic and Native American community members, of course. The demographic leans toward the older population; it leans higher risk and higher acuity. And there are really, aside from us, there are really no other healthcare resources in the community at all.”

In addition to its two locations in rural Arizona, the FQHC has plans to open two more in the coming months.

The two new locations have a similarly vulnerable demographic. One of the locations will be in Stanfield, Arizona, which is more than 90 percent Hispanic, with a vast majority being migrant workers. The second location is in Coolidge, which is 60 percent Hispanic and 40 percent working-class families from the manufacturing sector and the local Arizona state and federal prisons in the area, Barbara described.

“It is a very challenging demographic to be able to provide care to because of the limited availability of resources and the acuity of their conditions,” he said. “A high rate of diabetes, high rate of a co-occurring disease, cardiovascular disease, mental illness, substance abuse…So the more direct care, the more coordinated care case, managed care that we can provide, the better the outcomes.”

This led to the decision to partner with Clear Arch Health to launch RPM services.

LAUNCHING RPM SERVICES FOR CHRONIC CARE

Desert Senita’s RPM services are designed to target patients with complex and chronic diseases, including cardiovascular disease, diabetes, and pulmonary disease, especially those with more than one condition, Barbara said.

The physicians monitor patients through a tablet-based health monitoring platform from Clear Arch Health, which includes a personal emergency response system and RPM telehealth technology. The platform has numerous capabilities, such as video visits, medication reminders, and text/email messaging.

They use the platform to monitor several health metrics, such as patients' blood sugar levels, pulse and heart rates, and blood pressure. The center plans to launch pulse oximetry monitoring to track blood oxygen levels.

The services are available to anyone who stands to benefit from continuous monitoring.

“We try not to be prescriptive with our providers,” Barbara said. “If our providers feel like a patient would respond well to remote patient monitoring because it will improve their care outcomes and their coordination of care, keep them more connected, then we'll gladly offer it to them.”

The tablets are provided at no cost to the patient, Barbara stated. The FQHC bills insurance plans, Medicaid, and Medicare for the case management associated with RPM, enabling it to provide the units to patients for free.

The RPM services are tailored to each patient and their lifestyle, including their dietary intake and activity levels, Barbara noted. In the case of mental health patients, the FQHC’s clinicians conduct check-ins to assess how patients are coping daily.

It took about three months to soft-launch the program, meaning that while it has started accepting patients, the FQHC hasn’t yet marketed it to internal stakeholders and the community, Barbara said.

The FQHC has thus far deployed 25 tablets, and Barbara envisions having more than 500 deployed by the end of the calendar year.

STRATEGIES FOR SUCCESSFUL RPM IMPLEMENTATION

Implementing RPM services while also ensuring health equity requires a thoughtful approach. For Desert Senita Community Health Center, this approach centered on identifying opportunities to coordinate care.

For instance, the FQHC developed a community health worker program and deployed it alongside the RPM services to ensure patients had the support they needed.

The community health workers, who have a basic certified nursing assistant (CNA) level of training, are tasked with being health advocates for their communities, providing health education and information, transporting patients to receive care, setting up appointments, and addressing social determinants of health (SDOH).

“It helped us overcome a lot of barriers…These [community health workers] are utilizing this opportunity to develop relationships with patients in the community to garner trust and to be seen as the individuals who can help them with the problems of utilizing the equipment, deploying the equipment, etcetera,” Barbara said. “And they're also seen by the providers the same way as troubleshooters.”

Finding the right technology was also vital to implementing the RPM services. The FQHC spoke with five vendors and interviewed three more before partnering with Clear Arch Health.

“They had the most attractive package,” said Barbara. “Other RPM programs focused more on bells and whistles of individual devices…But this was the most comprehensive package that we were able to find. It was very clear, clearly designed to do exactly what we wanted it to do.”

As the FQHC looks to open the two new locations, it has preemptively ordered more units of the RPM platform to ensure they can deploy them in the centers as soon as possible.

Not only did Desert Senita carefully consider the appropriate technology for its needs, but it has also implemented comprehensive data collection and analysis protocols.

The organization developed data collection pathways in partnership with its quality control teams, Barbara said. The FQHC is capturing data about how RPM is being used, what conditions are being addressed, how patient outcomes are impacted, and what medication changes result from real-time data input. It plans to use the data to determine patterns in healthcare utilization among its patient population.

Desert Senita Community Health Center’s diverse patient population has wide-ranging and complex needs, and given the lack of healthcare resources in the area, Barbara highlighted the critical role RPM will play in extending care to those who need it most.

“It’s impossible for us to be everywhere all the time,” he said. “So, the idea of being able to expand our ability to provide patients with a safety net of services in their homes through RPM, to ensure that they have access to real-time data delivery, to their providers, and coordination of care -- all of that is very attractive to us.”