UnitedHealthcare to End Coverage for some Remote Patient Monitoring Programs
WASHINGTON – UnitedHealthcare is considerably scaling back its coverage of remote patient monitoring (RPM) programs, a move impacting thousands of patients with chronic conditions and raising concerns about access to preventative care.The insurer informed providers this week it will no longer reimburse many RPM services starting January 1, 2025, citing a lack of evidence demonstrating improved health outcomes and concerns over program integrity.
The decision affects a wide range of conditions currently managed through RPM, including hypertension, diabetes, and chronic obstructive pulmonary disease (COPD). While UnitedHealthcare maintains it remains committed to value-based care, the abrupt shift leaves patients and healthcare providers scrambling to understand the implications.This comes as UnitedHealth Group, UnitedHealthcare’s parent company, navigates a period of financial scrutiny and attempts to address allegations of improper claim denials, further intensifying focus on the insurer’s cost-cutting measures.
Remote patient monitoring utilizes devices like blood pressure cuffs, glucose monitors, and wearable sensors to collect patient health data outside of customary clinical settings. This data is then transmitted to healthcare providers, allowing for proactive intervention and personalized care management. The practice gained prominence during the COVID-19 pandemic as a way to maintain continuity of care and reduce hospital readmissions.
UnitedHealthcare’s decision specifically targets RPM codes that do not meet certain criteria, including those lacking a minimum duration of monitoring or failing to demonstrate a clear link to improved patient outcomes. In a notice to providers,the insurer stated it will continue to cover RPM for specific conditions where clinical evidence supports its effectiveness,such as cardiac rehabilitation and post-stroke care.
“We regularly evaluate our coverage policies to ensure they align with the latest clinical evidence and deliver value for our members,” a UnitedHealthcare spokesperson said in a statement. “This change reflects our commitment to evidence-based care and responsible use of healthcare resources.”
However, healthcare providers and patient advocacy groups are pushing back, arguing that the insurer’s decision is short-sighted and will disproportionately impact vulnerable populations. They contend that RPM can be particularly beneficial for patients in rural areas or those with limited access to healthcare.
“This is a step backward for preventative care,” said Dr. Emily Carter, a cardiologist who utilizes RPM in her practice. “RPM allows us to identify and address health issues before they escalate, reducing the need for costly hospitalizations. To eliminate coverage for so many programs based on a narrow interpretation of ‘evidence’ is simply unacceptable.”
The American Telemedicine Association has also expressed concerns, stating that UnitedHealthcare’s policy change could stifle innovation in digital health and limit patient access to valuable care options. The association plans to engage with the insurer to advocate for a more nuanced approach to RPM coverage.
The move by UnitedHealthcare follows a broader trend of insurers scrutinizing RPM reimbursement rates and coverage policies. As the RPM market continues to grow, payers are increasingly focused on ensuring that these programs deliver demonstrable value and are not subject to fraud or abuse. The Department of Justice is currently investigating UnitedHealth Group over allegations of systematically denying coverage for medically necesary care, and the company is also undergoing a financial turnaround, adding to the pressure on its spending.
