Brown University Health’s primary care group has eliminated its home care monitoring programs for about 700 patients diagnosed with heart failure, high blood pressure and Chronic Obstructive Pulmonary Disease, or COPD.
The programs, terminated as of May 5, allowed nurses and health coaches to remotely monitor patients by providing them with blood pressure cuffs, oxygen monitoring devices, scales and other medical equipment linked to software programs. The health data from the devices allowed the staff to intervene if the patients’ conditions worsened between doctor’s visits.
Brown Health said the programs actually saved more money in avoided health care expenses than they cost to run. But those savings were not enough to offset the losses Brown Health faced due to insurance premiums failing to keep up with the overall rise in health care costs, according to a Brown Health spokesperson.
Remote monitoring of patients with cardiac conditions is associated with lower mortality rates, improved patient outcomes and reduced hospital readmission rates, studies show. Remote monitoring has also been linked to lower hospitalization rates for COPD patients.
The termination of these disease management programs raises questions about the future of services adopted under value-based contracts, where insurers and health care providers generally agree to a flat fee that covers the total cost of care per patient. The fixed amount is designed to maintain services that help keep patients healthy and reduce hospital admissions and visits to expensive specialists.
Brown University Health inherited the home care monitoring programs in 2021, when the state’s largest hospital system, formerly known as Lifespan, acquired Coastal Medical, then one of the state’s largest primary care providers. (Lifespan last year changed its name to Brown University Health.)
Coastal Medical had gained recognition for lowering costs and improving patient outcomes. U.S. Sen. Sheldon Whitehouse praised Coastal Medical in a 2024 Senate Budget Committee hearing as a model for how to improve primary care.
For years, the remote home care monitoring programs saved the health system “more than twice what they cost” to operate, Brown Health spokeswoman Jessica A. Wharton said in an email. “When we were in value-based care contracts, we shared these savings with insurers,’’ she said in the email, “which allowed us to fund and grow the programs.’’
But more recently, total health care expenses have soared, Wharton said, driven in part by prescription drugs such as the popular and pricey new weight loss medications.
When Brown Health’s overall health costs exceeded the targets set in the value-based insurance contracts, Wharton said, the company “faced steep financial penalties.”
“Unfortunately, insurance payments do not cover the costs of well-coordinated, team-based care that serves patients’ needs,” Wharton said in the email, “and will set back the improvements we’ve made in care delivery” in Rhode Island.
Brown Health previously had value-based contracts with six commercial insurers, the two government health insurance programs – Medicare and Medicaid, as well as Medicare Advantage plans run by commercial insurers.
Blue Cross & Blue Shield of Rhode Island, the state’s largest commercial insurer, has been a leader in the state’s value-based care. BCBSRI declined to discuss its contract with Brown Health, saying its contracts with providers are “confidential,” Rich Salit, a BCBSRI spokesman, said in an email.
Rhode Island health officials and more than a dozen health care providers, insurers and professional medical groups signed a compact in 2022 designed to reduce health care costs by “accelerating the adoption of advanced value-based payments (VBP) models.” The compact is set to expire Jan. 1, 2026.
However, due to the timing of the compact and the subsequent leadership changes at the state’s two largest health systems, “there was very little collaborative progress on meeting the milestones’’ in the compact, state Health Insurance Commissioner Cory King said in an email.
And King expressed concerns about the future of these agreements.
“If providers and payers walk away from these value-based care arrangements,’’ King said in an interview, “there won’t be money or incentive to invest in programs that better manage patients’ care and that lower cost and improve quality.”
Brown Health patients in its remote monitoring programs have been allowed to keep the scales, blood pressure cuffs, oxygen monitoring devices and other medical equipment for “self-monitoring,” Wharton said. However, the platform that transmitted the readings from their devices to nurses and health coaches, she said, was shut down on May 5.
The patients “will continue to have full access to their primary care teams,” she said, “and medical oversight of their conditions.”
The termination of the programs also resulted in the layoff of about 20 staff.
