Higher Patient Engagement, Adherence, and Care Quality: One Practice’s RPM/CCM Experience

Nine Questions for Christine Onstott, Director of Operations at Cardiac Solutions, an Arizona-based cardiology practice

Christine Onstott, AAS-N, BS, is the Director of Operations for Cardiac Solutions, a comprehensive care practice with three locations in Arizona’s West Valley area and 22 board-certified cardiologists. The practice, which continually explores new approaches to provide high quality care at lower costs, recently partnered with MD Revolution to implement RevUp, a Chronic Care Management  (CCM) and Remote Patient Monitoring (RPM) program.

Now, only 14 months since implementing RevUp, Onstott says the solution has increased patient enrollment and engagement in the practice’s RPM and CCM programs (including among the practice’s older patients) and led to higher patient adherence to treatment plans and better outcomes, without increasing the workload of providers and staff. In fact, she says, because of the solution, providers and nursing staff are experiencing a record low number of alert escalations that require their review.

In this Q&A, Onstott shares more about the solution’s impact on the practice and their patients. Get access to the full editorial here.

We wanted to reach a larger percentage of our patients, not just those with a history of heart failure who come into the clinic regularly. Population health management is important to us, we wanted to reach patients with other chronic disease states and provide them with quality care in-between their already scheduled in-office visits with their Cardiologists. Keeping a patient out of the hospital is good for the patient, insurance providers, and hospitals.

Once patients are enrolled, they see the benefits of the program and see the value of constant medical supervision. The patients I have personally spoken to, including my parents, love the service.

The product is easy to use, and patients interact with the RevUp application on a regular basis which is amazing given our practice’s patient median age of 80.

We’re encouraging our patients to engage in their own care by using RevUp. In healthcare we often tell patients what they need to do, but that doesn’t mean they will follow through.

Enhancing access for patients with hypertension is a good example. These aren’t necessarily patients with a history of heart failure, but simply those with a condition that we can monitor remotely with the use of blood pressure equipment. RevUp helps monitor the patients pressures in-between visits to the office and alerts us if there are abnormal readings that would warrant a sooner visit to the office.

We looked at several companies, but eventually heard about RevUp through our EMR partner, which made integration easier, almost seamless. We also wanted customization, which they were able to do, and their easy-to-use interface was a no-brainer.

We knew that provider adoption would be a huge aspect of program success. We can put anything into place, but if our cardiologists aren’t referring patients, our patients and our practice won’t experience the benefits. Integration, however, made adoption easier because we were able to pull patient information directly out of the EMR, including their CCM category, and even how to best engage the individual patient, whether it be via text, email, or phone call. The integration support was essential in the adoption.

We have never looked at the product as two separate solutions because we believe they work together. The CCM component provides us with the personal clinical touchpoints we want our patients to experience, sort of like a concierge service, and the RPM component allows us to monitor blood pressure which is a health component that CCM can review with the patient. They go hand-in-hand.

We meet with our RevUp partners monthly and review patient enrollment, engagement and how many alert diversions we were able to make. We continue to perfect the services we are providing by looking at patient outcomes and most recently, working on how to track hospital readmissions.

After answering some of the initial questions our staff had – and after the MD Revolution team helped patients learn how to use a blood pressure cuff – we had much fewer headaches and more accurate billing. That’s huge. Also, there are differences between insurers and what they will cover, and that must be explained to the patient by our staff. Not every patient has the same copay; there are many Medicare plans, which means the copays fluctuate and must be communicated to the patient.

One of the biggest changes we were able to make after implementation was the way we handled our patient alerts at night and over the weekend. These alerts are now handled by the RevUp team in the same way our staff would take care of them during the business day, taking the burden off the on-

call physician which was huge. Working out those sorts of workflows simplified the process and ensured that the patient received the appropriate care quickly.

Because implementation is so important, it’s essential to bring physicians into the decision-making process. The solution must be thoroughly explained to the physicians, and staff needs to be ready to evolve their workflows. It’s also important to bring patients into the process by helping them understand that your practice is HIPAA compliant and not selling their information. We explain MD Revolution’s relationship to Cardiac Solutions – that they’re contractors we’re using – so there’s no patient confusion on their integrity.


Identifying superusers throughout the practice and other experts who can quickly answer questions about the solution is also key. I have 198 employees, and we have over 500 patients come through the doors daily. Recently we have added a device representative in our offices Monday, Wednesday, and Friday who is available to speak to patients face-to-face and answer questions. We’ve also identified superusers throughout the practice, not just our individual offices, who spearhead the CCM and RPM program and answer questions from colleagues.

Yes! It is affecting our patients’ health in a very positive way. They see us taking care of them with these additional and frequent touchpoints, while enabling us to have a handle on their wellbeing even when they’re not here seeing us physically. This is helping us provide our patients with high quality, concierge-like care. It’s something that no other cardiology practice provides.

RevUp Messaging Platform Remote Patient Monitoring

MD Revolution delivers the solutions and platforms to practices that want to improve operational efficiencies and increase revenue opportunities at scale.

MD Revolution’s Care Management platform RevUp is a service-model software that integrates with EHRs to support the management of remote patients for practices and health systems with their own dedicated care teams. MD Revolution further supports virtual care initiatives with RevUp programs, which cover patient services that include care managers, clinicians, and communication provided by RevUp.

Interested if RevUp is a good fit for your practice? We pride ourselves in setting straight-forward, attainable goals for each of our partnerships, customized for your practice’s Medicare population. Contact us today for a picture of sustained program success and a tailored practice pro forma.

Comprehensive technology and clinical programs as a service

RevUp delivers solutions to monitor and manage care for patients living with chronic conditions.  With comprehensive technology and clinical programs as a service, your practice can reach more patients in less time, without disrupting current workflows.

Through our robust, universal EHR integrations, practices and health systems have access to the uniquely comprehensive features of RevUp’s remote care programs, like telephonic patient enrollment, a dedicated team of health coaches, cellular connected devices, and automatic claims creation. RevUp allows programs to get off the ground seamlessly with fast reimbursements – all while living in your EHR environment.

Run and monitor the program directly from your Electronic Health Record:

Remote Patient Monitoring

The RevUp Remote Patient Monitoring (RPM) program uses a wide selection of compatible cellular-enabled devices to collect vitals and other health data from your patients.

Connected devices monitor key vitals and health indicators, which are stored and shared automatically through our RevUp application and universal EHR integration. Threshold alerts and actionable data are transmitted to care teams in real time. Providers and loved ones can view the information they need most in a convenient place they can access anywhere.

RPM is a value-add for your practice, providing additional care and attention to a larger number of patients outside the clinic while minimizing the load on your clinical staff and increasing revenue. RPM codes provide reimbursement for one-time patient education (CPT 99453), monthly device connection and transmission of data (CPT 99454), and monthly clinical monitoring and support (CPT 99457).

Remote Patient Monitoring Devices

Cellular-connected home hub device provides configuration free device connection, on demand support and 24/7 emergency response.

Kit includes hub, emergency response pendant and one or more prescribed devices, including blood pressure monitor, pulse oximeter, spirometer, glucometer, weight scale, and non-contact thermometer.

RevUp’s integrated and fully featured platform can be deployed in days, not weeks, to any practice with no upfront capital expense from the practice, and with no requirement to purchase equipment to provide RPM services.