Population and Condition Assessment
We help identify patient groups and use cases that may be appropriate for remote monitoring.
Remote Patient Monitoring
Turn readingsinto action.
Connected devices can extend clinical visibility beyond the facility or exam room. But data alone does not manage a patient.
MatterCCM operates the workflows that connect devices, patients, care teams, clinical decisions, documentation, and program performance.
An RPM program is not a shipment of devices.
A device must reach the right patient.
The patient must understand how and when to use it. Data must transmit correctly. Adherence must be supported. Readings must be reviewed within a defined workflow. Thresholds must reflect clinical requirements. Exceptions must be recognized. Patients must receive appropriate communication. Clinical concerns must be escalated. Activities must be documented. Program leaders must know what is and is not working.
Without that operating structure, devices create data but not necessarily care.
We manage the structure around the signal.
What the Research Shows
Devices alone do not move the number.
6.1 mmHg
lower systolic blood pressure at 12 months when home monitoring was combined with intensive clinical support. Monitoring alone showed no significant effect. Pooled data from 15 trials.1
View source (opens in a new tab)43%
of Medicare enrollees receiving remote monitoring in 2022 did not receive all three of its components, as enrolment grew tenfold from 2019.2
View source (opens in a new tab)
Sources
- Tucker KL, Sheppard JP, Stevens R, et al. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLOS Medicine 2017;14(9):e1002389. doi.org/10.1371/journal.pmed.1002389↩
- U.S. Department of Health and Human Services, Office of Inspector General. Additional Oversight of Remote Patient Monitoring in Medicare Is Needed. OEI-02-23-00260; September 2024. oig.hhs.gov↩
Published industry research, not MatterCCM program results. Outcomes for any organization depend on its population, implementation and program design.
Full-Service RPM Scope
Program and Device Strategy
Device categories, logistics, workflows, monitoring protocols, responsibilities, and escalation structures are aligned with the participating organization.
Patient Onboarding
Patients receive program education, device setup support, usage guidance, and communication regarding their responsibilities.
Device and Connectivity Support
Operational workflows address delivery, activation, connectivity concerns, replacement needs, and common patient-use barriers.
Adherence Management
Patients who stop transmitting or use devices inconsistently can be identified for appropriate follow-up.
Data Review Workflow
Incoming readings are organized for review according to established clinical and operating protocols.
Threshold and Exception Management
Readings or trends that meet predefined criteria can be routed for attention according to client-approved workflows.
Patient Communication
Care teams can engage patients regarding device use, observed patterns, care-plan follow-through, and concerns requiring additional attention.
Clinical Escalation
Clinical decisions remain with qualified professionals. MatterCCM routes relevant findings to designated personnel based on approved escalation pathways.
Documentation
Patient communication, review activity, exceptions, and other program actions are documented within the agreed operating model.
Billing-Readiness Controls
Service activity and documentation can be evaluated before information is coordinated with the responsible billing operation.
Program Analytics
Clients receive visibility into activation, participation, transmission activity, adherence, exceptions, escalations, and operational performance.
Device-Agnostic Positioning
The appropriate model may include connectedThe device should fit the patient and program—not the other way around.
- Blood-pressure monitors
- Weight scales
- Glucose-monitoring devices
- Pulse oximeters
- Other clinically appropriate devices
Device selection and program configuration depend on the conditions being managed, patient capabilities, care environment, clinical objectives, logistics, payer requirements, and applicable regulations.
CCM and RPM Together
See the reading. Understand the patient.
RPM
RPM can identify a physiologic change.
CCM
CCM can provide the broader context around that change.
A rising blood-pressure pattern may relate to medication adherence, diet, stress, access to prescriptions, a recent specialist recommendation, or an incomplete care transition. Combining monitoring with structured care management can help connect the signal to the patient’s larger care plan.
MatterCCM can operate RPM independently or as part of a coordinated CCM and RPM model.
Care Environments
RPM programs can be configured for:
Build the care operation around the device.
Request a structured assessment of your population, use cases, clinical workflows, device requirements, staffing needs, and program economics.