BUSI 505 Week 5 Case Study Discussion Board Forum 3 Example

Case Study Discussion Board Forum 3: Telehealth and Remote Patient Monitoring

BUSI 505 Healthcare Informatics, Case Study Discussion Board Forum 3

Thread by [Student Name]

The primary care network, its program and the classmates are composites; the textbooks, Scripture and the peer-reviewed sources cited are real.

Our case is a primary care network of 14 clinics whose finance office proposed a remote blood pressure monitoring program after reviewing Medicare's monitoring billing codes. The plan was to give Bluetooth cuffs to as many patients with hypertension as possible, have readings flow into a vendor dashboard and bill monthly for device supply and data review. Clinic medical assistants would glance at the dashboard between visits when time allowed. The finance office projected a strong return; the medical director asked whether blood pressure control would actually improve and who would act on the readings. Nobody had planned what would happen when a patient's reading came in at 190 over 110 on a Friday evening, or how often a medical assistant with a full schedule of rooming patients could realistically review a dashboard.

Braunstein (2014) describes telehealth and remote monitoring as ways to extend care beyond the visit, but he emphasizes that their value depends on how information is reviewed and acted on. Nelson and Staggers (2014) similarly describe telehealth as a redesign of care processes, with clear roles, protocols and communication, rather than a technology installed on top of existing work. By that standard, our case plan was a device distribution program with a billing model attached, not yet a care model. It also lacked a plan for patients who struggle with technology, including older adults and patients with limited English, who are often among those with the poorest blood pressure control.

Evidence points to what the plan was missing. LaPointe and Merrill (2026) studied 1,464 patients with hypertension enrolled in a remote monitoring program across 68 primary care clinics in two states. Patients who sent readings consistently, at least three a week for most weeks, were 10% to 15% more likely to have controlled blood pressure at 4, 8 and 12 weeks, and patients monitored by the program's dedicated nurses did better than those monitored by clinic staff. The combination of consistent readings and dedicated nurse monitoring was associated with 26% to 27% higher prevalence of control at weeks 4 and 12. In other words, engagement and staffing, not the cuff itself, drove results, which is the opposite of the assumption behind our network's plan.

Winberg et al. (2026) examined Louisiana Medicare beneficiaries with diabetes or hypertension from 2016 to 2020 and found that starting remote monitoring was followed by a sharp increase in outpatient visits that gradually declined but did not fully return to earlier levels. The authors concluded that the value of monitoring depends on targeting the right patients, educating them and supporting clinicians' workflow. For our network, that means monitoring could add work and spending without improving outcomes if it enrolls patients whose blood pressure is already controlled.

I would recommend four changes. First, enroll patients with uncontrolled hypertension first, rather than everyone with the diagnosis. Second, assign dedicated nurses or pharmacists to review readings, with protocols that allow timely medication adjustment. Third, set expectations with patients about how often to measure and provide coaching for those who struggle with the device. Fourth, track blood pressure control at 12 weeks, the share of patients sending adequate readings and staff time per patient, alongside revenue, and report all four to clinic leaders monthly. A blood pressure cuff in a patient's home is not a program; the program is the nurse who notices the numbers and acts.

Jesus described Himself as the good shepherd who knows His own and is known by them (English Standard Version Bible, 2001/2016, John 10:14). Remote monitoring at its best extends that kind of knowing into the weeks between visits, so that a patient's numbers are seen by someone who will respond.

Reply to Alicia

Alicia, you raised an important point about continuity: many of our patients switch between traditional Medicare and Medicare Advantage plans, and their monitoring may not follow them. Plans differ in which monitoring services they cover, which clinicians are in network and what prior approvals they require, so a patient's program can quietly stop at the start of a new plan year. Recent evidence from national Medicare data suggests this is a real and lasting risk. Zhang et al. (2026) compared more than 140,000 older adults with hypertension who switched from traditional Medicare to Medicare Advantage in 2019 with matched beneficiaries who stayed in traditional Medicare. Switching was associated with lower adoption of remote monitoring, a greater chance of losing a clinician without replacement and higher rates of hypertension-related hospitalization through 2022, both for plans with value-based arrangements and for those without. Those findings suggest that coverage changes can interrupt exactly the kind of continuous management remote monitoring is meant to support. The authors observed the gap growing over several years, which means the harm is not a brief disruption but a lasting divergence in care for patients who switch. Winberg et al. (2026) also found that monitoring changes how patients use outpatient care, which means an interruption could leave patients without the follow-up their monitoring had created. Nelson and Staggers (2014) emphasize that telehealth programs depend on stable relationships between patients and care teams, and Braunstein (2014) notes that payment policy strongly shapes which telehealth services organizations can sustain. Together they suggest that a monitoring program should be designed to survive changes in payment rather than depending entirely on one billing code. For our network, a practical step would be to check each monitored patient's coverage at enrollment and annually, contact plans in advance about coverage for monitoring and keep clinical follow-up in place even when billing changes. That last point matters most: if the clinical relationship continues while billing questions are resolved, the patient's blood pressure management need not suffer. It would also help to track monitored patients' outcomes by plan type, so that leaders can raise problems with specific plans using their own data. Ezekiel describes the Lord seeking the lost and strengthening the weak (English Standard Version Bible, 2001/2016, Ezekiel 34:16), and patients who fall through gaps created by coverage changes are among those a faithful care system should seek out rather than wait for. Would your organization track monitored patients through plan changes and flag those who stop sending readings? An automatic flag after two weeks without readings could prompt a call before blood pressure control is lost, and the same flag would catch patients who stop for reasons unrelated to coverage, such as a broken cuff or a hospitalization.

Reply to Jerome

Jerome, you suggested that pharmacists might be better suited than physicians or medical assistants to manage remote blood pressure programs, since adjusting medications is often the main intervention. Physicians in busy practices rarely have time to review weeks of home readings, and medical assistants are not trained to change doses, so the question of who acts on the data is central. Evidence from a recent program evaluation supports your idea. Brown et al. (2026) evaluated a program at an academic medical center that combined Bluetooth cuffs, daily nurse monitoring and pharmacist-led medication management under a standardized protocol. Among matched patients who completed the program, systolic blood pressure fell by about 14.9 mmHg, compared with about 8.2 mmHg for similar patients receiving usual clinic care, a difference large enough to matter for stroke and heart attack risk. However, only 44.4% of active participants completed the program, a reminder that retention is a major challenge. Because the analysis focused on completers, the true effect across everyone who enrolled may be smaller, and any network adopting the model should track outcomes for all enrollees, not only those who finish. LaPointe and Merrill (2026) likewise found that dedicated monitoring staff and consistent patient readings together produced the largest gains in control, which suggests the care team's design matters more than the device. Nelson and Staggers (2014) describe telehealth as interprofessional by nature, with each discipline contributing its expertise, and Braunstein (2014) emphasizes that remote programs need clear protocols for who acts on data and when. For our network, a model with nurses reviewing readings daily and pharmacists adjusting medications under protocols signed by physicians would use each professional's skills well and free physicians for complex cases. State scope-of-practice rules and payer policies on collaborative practice agreements would need review before launch, and the network would have to decide whether pharmacist time can be billed or must be funded from savings and quality incentives. The program would also need a plan to keep patients engaged, such as reminders and coaching, since completion rates limit any benefit. Brief calls in the first two weeks, when patients are learning to use the cuff, may matter most. Paul wrote that believers have gifts that differ according to the grace given to them (English Standard Version Bible, 2001/2016, Romans 12:6), and a care team that assigns work according to each member's gifts and training is more likely to serve patients well. Would your clinic be willing to pilot pharmacist-led medication management for patients enrolled in monitoring, with blood pressure control as the main measure of success? A pilot of a few hundred patients would be large enough to show whether the model works in your population before the network invests in hiring more pharmacists.

References

Braunstein, M. L. (2014). Contemporary health informatics. AHIMA Press.

Brown, C., Chandra, S., & Clark, D. (2026). Pharmacist-led remote patient monitoring for hypertension: A retrospective evaluation of blood pressure outcomes. Journal of the American College of Clinical Pharmacy, 9(10), e70296. https://doi.org/10.1002/jac5.70296

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

LaPointe, S., & Merrill, M. (2026). Remote patient monitoring program components and short-term hypertension control: Retrospective cohort study. JMIR mHealth and uHealth, 14, e69546. https://doi.org/10.2196/69546

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. Elsevier Mosby.

Winberg, D., Stoecker, C., Li, J., & Shi, L. (2026). Remote patient monitoring in Louisiana Medicare beneficiaries with diabetes or hypertension: Retrospective cohort study of 2016-2020 claims data. Journal of Medical Internet Research, 28, e80782. https://doi.org/10.2196/80782

Zhang, D. S., Hong, K., Pollack, L. M., Luo, F., Zhang, H., Ying, M., Zhang, Z., Schoenthaler, A. M., Lawrence, K., & Mann, D. (2026). Remote patient monitoring adoption for hypertension management among Medicare beneficiaries. JAMA Network Open, 9(7), e2626522. https://doi.org/10.1001/jamanetworkopen.2026.26522