The Importance of Patient Engagement and Virtual Care for Hypertension Patients

Impact of COVID-19 in Hypertension Patients

Today as we continue to hear about ramping new cases of COVID-19 it is difficult to think of any other healthcare issues, and yet, the management of chronic conditions continue to be of critical importance. In this article, we'll cover how virtual care programs can help hypertension patients better manage their condition.

Hypertension - Virtual Care and Patient Engagement

Almost one in two adults in the US has high blood pressure (BP) or hypertension,¹ defined as adults with blood pressure consistently 140/90 mm Hg or higher. Patients with hypertension are at higher risk for heart attacks, strokes, heart failure, kidney disease and peripheral vascular disease. Unfortunately, about 76% of people with high blood pressure don't have good control of the condition.¹

There is not a cure for hypertension, and the goal of all interventions (both pharmacological as well as lifestyle changes) are to control the condition so it does not lead to worse outcomes.

While engaging the patient in their own care has always been crucial in treating chronic conditions, the current epidemic and its impact on reducing patients’ visits to doctors offices, makes patient engagement and virtual care an imperative. In hypertension, there are three main pillars in controlling patients' blood pressure: adherence to medication, lifestyle changes and BP monitoring.

While the use of the correct technology for virtual care can facilitate long-term success, it is important to understand that a virtual hypertension program hinges on multiple elements, most of them human-based, among them:

• Shared goal setting - the clinical team needs to understand and engage each patient when setting goals, so they can be meaningful and achievable for the patient

• Patient education on their condition, their goals and how to attain them, so they feel empower to take control of their care

• Regular feedback sessions (can be virtual)

• Patient education on the right way of measuring their BP at home. The American Medical Association (AMA) has great infographic² that can be shared with patients at home

• Patient support through their journey by guiding them day to day in their care plan, based on their individual goals

Our platform, Prevvy, was designed to provide comprehensive virtual care to patients. The patient relationship manager (PRM), the provider platform, includes a care plan editor, so starting from existing care plan templates, each care plan can be modified to accommodate a patient's agreed goals.

Prevvy’s patient health assistant, the patient end of the platform, guides the patient day by day, on the activities that are part of the care plan. The patient can monitor her adherence to the care plan and see how their BP tracks according to set goals. All the data collected from BP monitors at home is immediately shared with the care team, which can include family members or caregivers that encourage the patient to remain adherent to their care plan.

Embracing Virtual Care

Even prior to the pandemic CMS and many other payers were starting to embrace and even incentivize the use of virtual care. CMS already had expanded reimbursement and billing codes to include more services that could be offered to patients remotely, such as chronic care management, remote patient monitoring and virtual check-ins. The constraints that existed around telehealth limited its use to a minimal number of physicians and patients, but with the current COVID-19 pandemic and telehealth restrictions lifted, patients, providers and payers have happily moved to remote communications that many times are more efficient for everyone involved.

For hypertension specifically, SMBP at home is an important part of many patients’ care plans. The AMA has a nice guide³ on current codes available to bill for patients’ SMBP related activities. In addition to general remote patient monitoring codes (Table 2), there are new CPT codes specific to SMBP, 99473 and 99474 (Table 1). General remote patient monitoring codes are included in the digitally stored data/remote physiologic monitoring section of the CPT code set, and require that data is digitally stored and/or transmitted back to the physician or other qualified health professional, and that there is an interactive communication between the physician/other qualified health professional and patient and/or caregiver, although an interactive video connection is not needed.

The importance of SMBP has also been made salient by recent revisions in HEDIS quality metrics. As of July 1, 2020, BP readings taken digitally by patients using validated BP remote monitors⁴ and shared digitally with clinical team members can be considered for inclusion in the numerator. In addition, telephone visits, e-visits and virtual check-ins have been added as appropriate settings for BP readings.

Post-COVID-19 Virtual Care

As we continue to hear good news of effective vaccines (Pfizer last week, Moderna this week), it is clear that even in a post-COVID-19 era, virtual care is here to stay.

For chronic conditions, such as hypertension, where the actions of the patient in their daily life determine the evolution of the disease, frequent touch points (even if automated) with the patient, remote monitoring and a daily lifestyle guidance can represent the difference between a fulfilling life or a visit to the emergency department because of complications.

Sources:

1. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019. Available at: https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html#:~:text=Nearly%201%20out%20of%202,modifications%20only%20(21%20million).

2. Available here: https://targetbp.org/tools_downloads/how-to-accurately-measure-blood-pressure-2

3. SMBP CPT® coding, © 2020 American Medical Association. Available at: https://www.ama-assn.org/system/files/2020-06/smbp-cpt-coding.pdf and https://www.ama-assn.org/delivering-care/hypertension/7-step-self-measured-blood-pressure-smbp-quick-guide

4. https://www.validatebp.org/