Providence RPM Leader Describes Scaling Up With Partner Cadence

A collaboration between remote care delivery company Cadence and Washington-based Providence health system to address chronic disease was recently highlighted in NEJM Catalyst. Kenneth Kooser, M.D., medical director for remote patient monitoring for Providence Health & Services, recently spoke with Healthcare Innovation about the implementation, the results of the study, and next steps. 

More than 2,500 patients across four states and nine Providence markets were enrolled in Cadence’s program, which is integrated directly into Providence’s Epic EHR, operated by a physician and NP team available 24/7, and financially supported by fee-for-service RPM CPT codes. 

Healthcare Innovation: Dr. Kooser, could you talk about your role at Providence and how  you got involved in this remote patient monitoring work?

Kooser: I’m a family practice doctor by training. I'm an area medical director, so I oversee a few of the primary care and specialty care clinics here in southwest Washington near Olympia. Three years ago, I was asked to help pilot the Cadence remote patient monitoring program at our clinic here in Lacey, Wash. Dr. Eve Cunningham was our chief medical officer at the time, and she encouraged me to be the RPM medical director. So basically, once the pilot was successful, I helped roll out the program from there. I've been in that role as the medical director of RPM for Providence for the last three years. I basically work hand in hand with Cadence to help get the program launched throughout Providence. 

HCI: One of the things the press release about the NEJM study notes is that this isn't the first attempt at RPM, but it's one of the only times that it's worked at scale. It said many prior efforts have fallen short because they created more data than the clinicians could manage, or they increased the physician burden or lacked financial sustainability. I was wondering if you could talk a little bit about those challenges and whether Providence has firsthand experience of those itself trying to do RPM.


Kooser: One of the big challenges is scaling the programs, because it does require a lot of personnel power. In order to run an RPM program successfully, you have to be able to react to all the data. You have to have a computer system or AI or people actually going through the data to find out what's important, what are considered abnormal vitals that are urgent and need to be acted upon immediately. And it has to be monitored 24/7, because patients take their vitals in the middle the night sometimes, and you have to be able to respond to those when they happen. 

I think one of the challenges we ran into at Providence, growing our own program, was how to scale that up. Maybe you can do it in one region. But since we're a multi-state organization, how do we take what worked in Southern California and expand that to Western Montana, where it's a really different sort of setting? We needed a program that was able to expand across the various regions and across different types of settings. The personnel issue is a huge piece. Also, you can't ask the clinicians who are going to order an RPM to be the ones reviewing all that data coming in and making decisions. They would rather just see the patient in clinic and do it the traditional way, because it's more efficient than having to go through all this data.

HCI: So how do you solve that too-much-data problem? 

Kooser: Having an external partner has been really helpful, because they have platforms able to filter through the alerts and figure out which are the red alerts and which ones just need to be watched as a trend.  

Our model is set up so that our partner actually does medication titrations and adjustments with the patients. Only the things that are either outside of what Cadence is managing or if patients have multiple medication titrations and are still not reaching their goal, then they might bring those back to the primary care provider who ordered the original RPM. 

That way, the person who’s ordering the RPM is not responsible for managing each little step on the way. The external team manages most of the medications, the interventions, the discussions with the patients.

HCI: The paper mentions levering a nurse practitioner-led team of multidisciplinary clinicians who act as an extension of the primary care clinicians. Are those NP-led teams Cadence employees or Providence employees?

Kooser: Those are Cadence employees. 

HCI: Would it sometimes make sense for it to be a specialist, such as a cardiologist or a nephrologist, that they're an extension of, rather than the primary care physician?

Kooser: For sure, yes. We do have a couple of cardiology clinics live and we are trying to grow more in cardiology, because obviously one of the health conditions we help manage is heart failure, and that’s often better managed through cardiology. We have a couple of nephrology clinics that have come on board in the last few months as well, because they do a lot with complex hypertension, and sometimes simple hypertension gets referred to them. We started with primary care, but we definitely think there is a lot of value of using RPM through the specialty care clinics, and having it embedded in some of our heart failure clinics, which need to have that extra level of monitoring for patients.

HCI: Which conditions were included in the study in the New England Journal of Medicine? 

Kooser: The three conditions are hypertension, diabetes and heart failure. We have quite a few hypertension and heart failure patients. Some of them are managed by primary care, and some of them are managed by cardiology.

HCI: The paper also mentions that these run under existing RPM billing codes, making it viable in fee for service. Are those fairly new, or have they been around for a while? Has that change allowed more of these efforts to go forward?

Kooser: I don’t know the exact year those codes went live, but I think they've been around since 2020 or so. Having those codes live has enabled this work to be financially sustainable.


HCI: The paper did also mention that there was a drop in inpatient admissions among these patients. So maybe it also helps in some of the value-based care arrangements that Providence is in if you're improving people's care and cutting unnecessary admissions to the hospital.

Kooser: Yes, definitely. The total-cost-of-care analyses have been favorable. Even including the cost of RPM, when you count outpatient visits and hospitalizations, it reduces total cost of care for patients.

HCI: Can you mention a few highlights from the paper in terms of outcomes? 

Kooser: One of the big ones was that we saw a 43% relative increase in blood pressure controls. These are patients who were not under control and who now are under control. 

I think that's huge, because the way we set up RPM within our Providence system is that there are patients who are out of control for their blood pressure to begin with. So these are not the easy patients, necessarily. These are patients who are already enrolled in our clinics, but have not been able to get their blood pressure under control for whatever reason. So to get another 43% of them under good control is actually pretty significant. 

The article also mentioned a $203 total-cost-of-care reduction per patient per month. When you start multiplying that by the thousands of patients enrolled, it is a pretty substantial number. We've done a couple of other analyses internally, and the studies that we've done have correlated. Cadence also did a broader study across their other partners that also showed lower total cost of care. 

The other big win directly related to reducing that total cost of care, especially for our heart failure patients, is getting patients on the right guideline-directed medical therapy. I think that being able to frequently reach out to the patients and get them on the right medications and then titrate those medications to an effective dose can be done easier through RPM, rather than bringing the patient in every couple of weeks.

HCI: You mentioned these patients not being the easiest patients — some of them have had trouble with their blood pressure control for a while. Does Cadence or Providence do an assessment of whether they're likely to be successful in an RPM program and willing to follow through with the blood pressure readings? 

Kooser: it’s done on a couple of levels. One is that usually the provider who's ordering the RPM knows the patient. You kind of have a sense as a provider whether this person is engaged in their care and wants to get better, and they'd be willing to check their blood pressure on a regular basis. Some patients are not super engaged, although most patients, surprise you, too. You sign them up and this is what triggers them to get more engaged. 

Also, when we do sign an order, Cadence will reach out to the patient and have a conversation about what this program entails and what it is going to involve them doing. Probably 40% to 50% of the patients that we sign orders for end up getting signed up for the program, but some of them opt not to. 

Once we've determined they are eligible but not interested, that also gives us a pool of patients that perhaps we can try some other intervention with as well. Maybe we enroll them with our pharmacists. So even though some patients choose not to participate in RPM, we are able to use that list for other things.

HCI: Are there plans to scale this up even bigger now across Providence?

Kooser: The short answer is yes, we are. We are not live in all of our primary care clinics yet, so that's one of the big goals of 2026 — to try to get live in all of our primary care clinics. And as I mentioned, another big area is going live in our cardiology clinics, especially our heart failure clinics, because they are doing some version of having to monitor these patients’ vitals pretty closely, so they need some version of RPM to keep some of their patients out of the hospital. 

The other big push that we're looking at is being able to enroll the patients upon discharge from the hospital. So maybe they went into the hospital for a heart attack. They now have heart failure, and they're being discharged. Can we get them enrolled in RPM right away, so that somebody's monitoring their vitals from almost day one of them leaving the hospital, so that they don't bounce back to the hospital? Those are probably the big areas that we're looking to grow the program.

HCI: From a data-sharing perspective, let's say I'm a emergency room physician in Providence, and one of these patients shows up in the ER, do I see in the EHR that the patient is in this RPM program, and maybe some data that's valuable to me about that?

Kooser: Yes, there’s a web app that's embedded in in our EMR so that it basically is highlighted in the patient information section. It says, “Cadence, RPM enrolled.” Then it's easy for the ER staff to be able to see if patients are enrolled. They can click on that. It opens the web app, and it will show them their vital sign trends. It'll show them everything right there in a snapshot view for them. That was one of the things we insisted on when we first launched. It's great for me as the primary care doc to be able to have access to the data. But when my patient goes to the ER, I also want them to be able to see that same data.