Healthcare Utilization and Costs Associated with Remote Blood Pressure Monitoring in a US Integrated Healthcare System

OBJECTIVES: Remote blood pressure monitoring (RBPM) may be a cost-effective strategy for improving blood pressure control by empowering patients with hypertension to participate in their healthcare while reducing in-person office visits. This study estimated healthcare utilization and costs after the implementation of a RBPM program in a large US integrated healthcare system.

METHODS: We conducted a retrospective cohort study among patients who were enrolled in the Kaiser Permanente Southern California RBPM program between November 2019 and June 2022. We estimated implementation costs (in 2020 US dollars), and hypertension-related healthcare utilization and costs before and after 12 months of program implementation using electronic health records. We compared outcomes between patients actively participating in the program (Intervention Group, IG) and those who abandoned it prior to participation (Usual Care Group, UCG), applying inverse probability of treatment weights to adjust for baseline demographic and clinical characteristics. Implementation costs included contacting eligible patients, an enrollment visit, the blood pressure device and cuff, and shipping. Healthcare utilization was measured in terms of office visits and virtual encounters. We employed a difference-in-differences (DID) analysis to estimate average differences in outcomes associated with the RBPM program.

RESULTS: The study population included 3574 patients (2123 in IG, 1451 in UCG). Implementation costs averaged $114 per patient. The DID analysis revealed small, yet statistically significant, reductions in average number of hypertension-related office visits and associated costs (DID: -0.04, -$5.39, p-value: 0.022) and blood pressure clinic visits (DID: -0.09, -$2.41, p-value: 0.001), alongside an increase in hypertension-related virtual encounters (DID: 0.40, $11.99, p-value: <0.001).

CONCLUSIONS: This analysis provides insights into the costs and resources necessary for implementing an RBPM program in an integrated healthcare system. It also indicates a slight shift in healthcare utilization from office to virtual encounters. Future analyses should focus on the program's effectiveness in health-related outcomes and its cost-effectiveness.