Remote Patient Monitoring (RPM) Monitoring Team: Insource vs. Outsource

Remote Patient Monitoring (RPM) is a new and powerful reimbursable telehealth program changing the future of healthcare. Benefits of RPM include improved care outcomes, new revenue for your organization, and an improved patient experience.  

A successful RPM program requires software, devices, and people. 

When it comes to the people component -- we are talking about the actual frontline care team here (not the software engineers, device fulfillment folks, and others way behind the scenes). This care team includes a Qualified Healthcare Professional (QHP) under whose supervision the RPM program is being delivered and billed (assuming a reimbursement based model). However,  the QHP -- for example a Cardiologist or Primary Care Physician -- is not typically doing the “daily/always on monitoring” component of RPM service delivery. They are spending their time on their scheduled and/or most acute patient situations.  The “daily/always on monitoring” is provided by a monitoring/care coordination staff.  We are referring to this as the “Monitoring Team” and how to staff it is the subject of this post. 

The good news is you have choices around whether you want to staff your Monitoring Team with your existing team or folks you hire (i.e. “insource”), or contract with another organization for this component (i.e. “outsource”). However, these choices create a need to understand your options, so that you can make the most informed, beneficial decision for your organization.

This article will provide a simple framework to help you determine whether you should insource or outsource your Monitoring Team. 

[NOTE: If you need more context or background about RPM -- including how reimbursement works as part of your revenue plan -- you might want to first check out our 5 steps to getting started, and seven key updates to billing rules]

Your RPM solution requires a Monitoring Team that will review the patient measurements, reach out to patients to communicate and support their progress and other care needs, provide general care coordination services, and escalate to the Qualified Healthcare Provider (QHP), as needed. They will be using an RPM software solution to accomplish these tasks. You can insource your Monitoring Team, or outsource. If you outsource, it is typically to the organization that also provides your RPM software and supports the delivery/procurement of your RPM Devices. Below are three key aspects to consider when choosing your Monitoring Team approach:

1. Long Term Flexibility

   
   Regardless of whether you decide to start with an outsource or insource Monitoring Team, you should have the flexibility to change over time — WITHOUT HAVING TO CHANGE RPM SOFTWARE AND RPM DEVICE VENDORS. The best RPM solutions don’t require you to use their Monitoring Team -- or force you to hire and build your own.  They also don’t require you to pick one approach forever. You should be able to start with an outsource team to ramp quickly, then, if you choose, bring it in-house once you have the time, scale, and experience to do so. Or, they should let you start in-house, but then outsource to support your growth or general desire to simplify your operations.
   

2. Cost and Scale
   
   

   As with any outsourcing function, you may pay more for outsourcing over the long-run versus doing it yourself, especially at high volume or scale. However, the simplicity of outsourcing may actually cost less unless you are willing to invest the time and effort to properly train and support the Monitoring Team to perform the in-house function. 
   
   Additionally, if you don’t have enough patients to justify at least one full-time individual, you should know that it can be very difficult to be successful -- including financially successful -- with a part-time Monitoring Team employee. They may not provide the consistent, full-time support an RPM program and patients require while balancing the task with their other duties. Finally, the Monitoring Team will need to be fully trained to understand how to use the RPM software and have some general knowledge of how the devices work. If you are not sure that you can find an employee that can be proficient with technology, an insourced  team may not be a good fit. 
   
   We find that a well-trained, full-time care team member should be able to handle a patient panel of 200-350 patients each month. The range depends on the average amount of time being spent on providing virtual care for each patient (which is typically a function of their general state of health, and the supervising QHP’s preference for level and frequency of care). If you envision having hundreds or thousands of RPM patients, you can support one or more full-time care team members in-house. Assuming they are technologically competent and trained, they become as efficient and effective as an outsourced alternative, and your organization has time to support them, you will likely pay less on an RPM billable patient-per-month basis for an in-house team than an outsourced team. 

3. Strategic Focus and Control
   
   

   If providing RPM telehealth at scale is a long-term strategic focus for your practice or organization and you want to differentiate based on your capabilities, you will most likely bring it inhouse at some point in time. Unlike an administrative function, the Monitoring Team is actively involved in delivering care to your patients. This will give you the most control over the Monitoring Team members and their integration into other aspects of your service delivery model. However, if you aren’t sure or don’t have the time right now or don’t have the initial scale — starting with an outsourced team is a great option. Remember, you should not have to be locked into one model or the other over the long term.
   

SUMMARY:

You can insource or outsource your Monitoring Team. The RPM software and devices you choose should not lock you into one approach -- you should be able to change over time. Outsourcing is better if you don’t have the time or focus or scale to really hire and pay a full time Monitoring Team. Insourcing is more cost effective at scale assuming you can dedicate the time to hire and train a Monitoring Team whose full time job will be to live in the RPM software to perform the function. 

At 1bios we support every Monitoring Team model and don’t force you to choose a single approach. You can start with your own staff and transition to ours, or start with ours and transition to yours or another partner. 

We also have specialist Monitoring Team partners that can help for example in after hours situations, and combo delivery of RPM with Chronic Care Management (CCM) and other other telehealth programs. 

If you want to discuss the best Monitoring and Care Team approach for RPM, CCM, and other telehealth programs, book a virtual meeting with us, today!