Healthcare is experiencing a seismic shift, and we're pulling back the curtain on one of its most significant transformations: how providers get paid. The traditional fee-for-service model—where compensation happens only during office visits—is giving way to something far more revolutionary.
Medicare's Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs are leading this charge, creating legitimate reimbursement pathways for the vital care that happens between appointments. This isn't just bureaucratic reshuffling; it's a fundamental realignment that values prevention, continuous monitoring, and proactive intervention.
We explore how technologies like AddisonCare are helping providers navigate this new landscape by automating documentation and streamlining the billing process for these continuous care models. The financial implications are striking—practices implementing these approaches often see positive returns within months, creating more predictable revenue streams while delivering better patient care.
The ripple effects extend beyond balance sheets. This evolution transforms the provider-patient relationship itself, emphasizing ongoing connection rather than episodic transactions. As we look toward healthcare's future, we must consider how these changes will reshape our expectations about care delivery and the growing role of technology in maintaining our health.
What might your relationship with your healthcare provider look like when the system values not just treating illness but preventing it? How will technology bridge the gap between clinic visits? These questions aren't just academic—they're the leading edge of a healthcare revolution happening right now.
Episode Transcript
Welcome In this deep dive.
We're really trying to get ourheads around a pretty
fundamental shift happening inhealth care payments.
Speaker 2 (00:09):
Right, we're moving away from that old model, aren't
we Paying for every singlevisitor procedure?
Speaker 1 (00:19):
Exactly the fee-for-service system and we're
moving towards.
Well, drawing on insights froma source called Episode 5,
activating ReimbursementPathways is how new ways of
delivering care are adapting.
Speaker 2 (00:30):
Especially care that happens outside the doctor's
office, that continuous careelement.
Speaker 1 (00:34):
Yes, and the source brings up Medicare's RPM and CCM
programs.
Speaker 2 (00:40):
Yeah, remote patient monitoring, that's RPM, and
chronic care management, ccm.
They're really key examples.
Speaker 1 (00:46):
So what are these exactly?
How do they fit into this shift?
Speaker 2 (00:49):
Well, think of them as Medicare, basically saying OK
, we'll now pay you for keepingtabs on your patients and
managing their chronicconditions, even when they're
not physically in front of you.
Speaker 1 (00:58):
That sounds well quite different For ages.
It was just.
You know, you go in, you getseen, there's a bill
transactional.
Speaker 2 (01:05):
Precisely, but the focus now is shifting towards
prevention, towards managingongoing conditions better.
A lot of that happens betweenvisits.
Speaker 1 (01:14):
So Medicare is acknowledging that work, now
creating ways to bill for it.
Speaker 2 (01:18):
That's the idea.
It recognizes the value in thatcontinuous support.
Speaker 1 (01:22):
Is this mostly about saving money in the long run, or
is there more to it?
Speaker 2 (01:27):
Cost is definitely a big factor, no doubt, but it's
also driven by the potential forgenuinely better health
outcomes.
Speaker 1 (01:34):
How so.
Speaker 2 (01:35):
Well, if you're constantly monitoring, say,
blood pressure, remotely usingRPM tech like wearables and
things- Right, like smartwatches.
Sort yeah, or specific medicaldevices.
You can spot problems earlier.
You can intervene beforesomething becomes a major crisis
like a hospital admission.
Speaker 1 (01:52):
Okay, so intervening sooner, potentially avoiding
bigger problems down the line,that makes sense.
Better care, maybe lower costseventually.
Speaker 2 (01:59):
Exactly, and it's not just good for patients.
The source suggests thiscreates more sustainable
business models for theproviders too.
Speaker 1 (02:07):
Which is crucial.
How does that work?
Speaker 2 (02:08):
Well, the source we looked at mentions a specific
technology example AddisonCare.
Speaker 1 (02:13):
AddisonCare OK.
Speaker 2 (02:14):
And it seems designed to fit right into these new
reimbursement pathways, RPM andCCM.
Speaker 1 (02:19):
So how does a technology like that actually,
you know, help a clinic get paidfor this continuous care stuff?
Speaker 2 (02:26):
What AddisonCare does , according to the source, is
help automate a lot of the adminhassle.
Speaker 1 (02:31):
Ah, the paperwork, Always the paperwork.
Speaker 2 (02:33):
You got it.
It helps automatically documentthe monitoring, the patient
check-ins, the interventions,Basically all the things that
qualify for those monthlyMedicare payments.
Speaker 1 (02:44):
So it's not just the monitoring tech itself but the
system behind it that tracks anddocuments for billing purposes.
Speaker 2 (02:49):
Exactly Because imagine trying to manually log
every single remote data pointor brief check-in call for
hundreds of patients.
It'd be overwhelming.
Speaker 1 (02:58):
Yeah, no kidding.
So this automation sounds key.
It helps deliver the care anddeal with the billing complexity
.
What does this mean financiallyfor a practice?
Speaker 2 (03:07):
It potentially creates a much more predictable
recurring revenue stream.
Speaker 1 (03:10):
Instead of just relying on people coming through
the door.
Speaker 2 (03:13):
Right.
You get this monthly incomefrom managing these patients
remotely under the RPM and CCMrules.
The source even implies thatpractices using tech like this
can actually see a positive ROI.
You know, return on investmentpretty quickly.
Speaker 1 (03:27):
Wow, even factoring in the cost of the technology.
Speaker 2 (03:30):
Apparently so, within months in some cases, based on
the source material.
Speaker 1 (03:34):
That really drives home the point, doesn't it, that
healthcare economics isshifting towards valuing the
relationship, the ongoing care,not just the one-off transaction
.
Speaker 2 (03:44):
Absolutely.
It's about managing health overtime, and technologies that
enable and, crucially, documentthat continuous care are
becoming vital for financialhealth.
Speaker 1 (03:53):
And you'd imagine, this trend will likely continue
as Medicare expands remoteoptions and maybe private
insurance follows.
Speaker 2 (04:00):
That seems to be the direction.
Yes, All aimed at improvingoutcomes while managing costs.
Which leads to a final thought,really, for everyone listening
how might this shift, this movetowards valuing continuous care,
change your expectations whenyou interact with your doctors
or healthcare providers in thefuture?
Speaker 1 (04:19):
And what role do you see technology playing in that
relationship as it evolves?
Speaker 2 (04:23):
Yeah, it's a fundamental change to think
about.
It's not just about new gadgets.
It's about a whole new way ofapproaching healthcare delivery
and how we pay for it.
Speaker 1 (04:31):
Definitely something to mull over.
A different future for patientcare, potentially.
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