Remote Patient Monitoring Works. UnitedHealthcare’s 2026 Rollback Ignores the Evidence, and Patients Will Pay the Price.
TAMPA, Fla.--(BUSINESS WIRE)--The following is an opinion editorial provided by Casey Pittock, CEO, Smart Meter:
UnitedHealthcare’s decision to sharply limit remote patient monitoring (RPM) reimbursement beginning January 1, 2026, to heart failure and hypertensive disorders of pregnancy, is a disservice to clinicians, patients, and the healthcare system at large. It contradicts federal momentum to modernize chronic care and misrepresents the weight of current evidence on RPM’s clinical value for common conditions like hypertension and diabetes. If implemented, this policy will widen health disparities, undercut value-based care, and raise avoidable downstream costs. [1, 2]
Let’s begin with the facts. UnitedHealthcare’s policy asserts that RPM is “not reasonable and necessary” for a sweeping list of indications, including diabetes and non-pregnancy hypertension, citing “insufficient evidence of efficacy.” At the same time, Centers for Medicare & Medicaid Services (CMS) has moved in the opposite direction. In the 2026 Medicare Physician Fee Schedule (MPFS), CMS finalized new codes that expand flexibility for shorter monitoring periods (2–15 days) and recognize briefer, but clinically meaningful, patient engagement time, explicitly to bring RPM in line with real-world use and outcomes. That is federal reinforcement, not retreat. [3, 4]
The evidence base for RPM is broad and growing. In heart failure, the one condition UnitedHealthcare will continue to cover, multiple systematic reviews and meta-analyses show reduced hospitalizations and, in many programs, mortality benefits. A 2025 meta-analysis of randomized trials and cohorts reported a significant reduction in heart failure–related hospitalizations (RR≈0.80) and a modest mortality benefit, with both implantable and noninvasive RPM modalities such as a cellular-connected blood pressure monitoring device contributing. Program components matter (daily data capture, blood pressure monitoring, responsive workflows), but the direction of effect is clear. [5]
Hypertension is where UnitedHealthcare’s decision is most out of step. The payer’s stance overlooks robust literature demonstrating that connected blood pressure monitoring, when coupled with timely titration and coaching, improves control and reduces acute utilization. CMS itself has acknowledged these real-world gains by making RPM more adaptable to variable adherence and shorter episodes of care (e.g., medication titration), exactly the scenarios where home blood pressure data drives earlier, safer changes in therapy. [3, 4]
Diabetes is similarly miscategorized. While not every RPM program delivers identical results, the arc of evidence, especially when RPM is integrated with medication management and education, shows improved glycemic control and fewer emergency visits compared with usual care. In fact, a study that Smart Meter conducted with Howard University showed that cellular connected glucose monitoring devices, when used by high-risk patients over a 12-week period, reduced the average A1c of 70% of participants by 2.8 points. Policymakers and payers should be encouraging standardized, high-quality RPM models, not eliminating coverage. [6, 12]
Critics often point to older trials that failed to move “hard endpoints.” Those studies are instructive, and a foreshadowing. For example, the BEAT-HF study performed over 10 years ago that incorporated telemonitoring, coaching, and home blood pressure devices did not reduce 180‑day all‑cause readmissions after discharge; however, it improved quality of life at 180 days and exposed operational lessons, like alert burden, variable clinician responses, and the need for clearer action protocols. In other words, it showed how to do RPM better. Modern programs have incorporated those lessons, streamlined alerts, protocolized titration, and daily measurements, yielding the stronger outcomes observed in recent meta-analyses. [7]
In a 2025 study published in the American Journal of Managed Care, deployment of an RPM program in Medicare patients with concomitant care coaching was associated with statistically significant reductions in both elevated BP readings and the presence of stage 2 hypertension. 1,594 Medicare participants were actively engaged in the program for 1 year. Of these, 652 had stage 2 hypertension. The initial mean SBP/DBP ratio for those with stage 2 hypertension was 152/85 mm Hg, which decreased to 132/74 mm Hg by month 12. At baseline, 100% of these 652 patients met the criteria for stage 2 hypertension, but by month 12, this percentage decreased to 25%. [13]
Even in conditions where evidence has been mixed, like COPD, reviews suggest RPM is safe and acceptable and, when paired with regular clinician feedback, can reduce COPD-related admissions. UnitedHealthcare’s blanket exclusion reads as a dismissal of nuance and an invitation to perpetuate avoidable hospitalizations among high-risk patients. [8]
From an economic lens, RPM is increasingly cost-effective when evaluated from the payer or healthcare sector perspective, especially in cardiovascular disease. A 2023 systematic review found that RPM can be cost-effective in the long run, two cost-utility analyses even met conservative $50,000 per QALY thresholds, while model-based studies consistently supported long-term value. The path to affordability is not to cut coverage; it’s to pay for the right RPM programs tied to outcomes. [9]
To be fair, concerns about payment models are legitimate. The Peterson Center on Healthcare has argued that “forever codes” and indefinite RPM billing, regardless of benefit, could drive waste. But their recommendation is performance-driven coverage, not eliminating coverage for most chronic conditions. UnitedHealthcare appears to have jumped from critique to curtailment, without building the outcome-linked alternative that stakeholders actually need. [10]
Meanwhile, CMS is modernizing RPM valuations (using OPPS geometric mean costs) and codifying shorter episodes and briefer management time, aligning reimbursement with software, cloud, and security realities of digital care and rewarding proactive engagement. That policy trajectory supports agile, episode-based RPM that aligns payment with clinical impact. UnitedHealthcare’s rollback would strand providers between progressive federal policy and regressive commercial coverage, sowing confusion and undermining care continuity for millions. [3, 4]
What Patients and Providers Will Lose
- Earlier interventions. RPM brings the clinic to the home, catching health decline before an ED visit. Daily blood pressure or weight changes, paired with clinician action, prevent crises – as documented across heart failure and hypertension programs. Removing coverage will delay adjustments and invite avoidable hospitalizations. [5]
- Medication optimization. The precise, short-duration codes CMS just finalized are tailor-made for titration periods, and for ongoing management of chronic disease. Eliminate RPM payments, and you force clinicians back to guesswork between visits, especially damaging in hypertension and diabetes where therapy changes hinge on recent home data. [3]
- Equity. RPM reduces barriers for rural and mobility-limited patients. Coverage cuts will disproportionately harm those who rely on home monitoring to access timely care, widening gaps CMS has been trying to close with telehealth flexibilities. [11]
A Better Path: Pay for Performance, Not for Absence
As a company whose FDA approved devices and private data network power RPM programs nationwide, Smart Meter supports accountable models. We believe payers should:
- Tie reimbursement to program design features linked to outcomes, like daily measurements where indicated, responsive workflows, clinician review time, and documented actions (e.g., meds titrated). Meta-analytic data show these components matter. [5]
- Use episode-based payments AND long-term chronic condition management regardless of duration but aligned to clinical goals (e.g., post-discharge windows, titration periods, individual patient needs), with extensions contingent on measured benefit. This mirrors CMS’s shift to shorter monitoring codes where appropriate while still supporting longer-term chronic care management utilizing affordable and efficient RPM technologies. [3]
- Require transparent reporting and standardized economic methods, as urged by recent reviews, to compare value across vendors and programs. [6]
UnitedHealthcare’s role, as the nation’s largest private insurer, should be to lead in building outcome-linked RPM coverage, not to indiscriminately slash it. The company’s 2026 policy will drive patients back to reactive care, increase readmissions, and ultimately cost more. CMS has given us the framework to do RPM right. Let’s use it.
Our Commitment
Smart Meter will continue partnering with RPM companies, chronic care management platform companies, and providers to implement evidence-based RPM. With daily BP monitoring for hypertension, weight and BP monitoring for heart failure, daily glucose monitoring for diabetes, and integrated workflows that prioritize actionable alerts and timely, perhaps proactive, health mitigations. We will continue to publish outcomes, support independent evaluations, and align with emerging payer requirements that reward programs demonstrating real clinical impact.
RPM is not a panacea. It is a set of tools whose effectiveness depends on design, adherence, and clinician response. But when done well, it saves lives and dollars. Rolling back coverage for the conditions that burden our patients and our system the most is the wrong answer at the wrong time.
UnitedHealthcare should not be shortsighted and cheap. Instead, UnitedHealthcare should reconsider, and join clinicians, patients, and CMS in moving chronic care forward, not backward.
Call to Action: Policymakers and payers must align coverage with
evidence, not arbitrary exclusions. Join Smart Meter in
advocating for outcome-driven RPM reimbursement that protects patients
and promotes value-based care.
Sources:
- HealthExec reporting on UHC’s RPM rollback across Medicare Advantage and commercial plans (Nov. 7, 2025). [healthexec.com]
- FierceHealthcare analysis of UHC’s policy and contrast with CMS expansion (Nov. 7, 2025). [fiercehealthcare.com]
- Nixon Law Group summary of CMS’s 2026 MPFS RPM updates. [nixonlawgroup.com]
- Kencor Health overview of CMS final RPM codes (Nov. 18, 2025). [kencorhealth.com]
- Meta-analyses and reviews on heart failure RPM outcomes. [pdfs.seman...cholar.org], [academic.oup.com]
- The State of Remote Patient Monitoring for Chronic Disease Management in the United States. [jmir.org]
- BEAT-HF trial and qualitative EMPOWER study lessons. [jamanetwork.com], [bmccardiov...entral.com]
- COPD RPM systematic review. [bmchealths...entral.com]
- Economic evaluations of RPM in cardiovascular disease. [cambridge.org]
- Peterson Center recommendations on performance-driven coverage. [petersonhe...thcare.org], [medicaleconomics.com]
- CMS telehealth/RPM guidance and flexibilities. [cms.gov]
- Diabetes Care Solution Demonstrated to Help High-Risk Patients LowerHbA1c levels in Howard University Study. [biospace.com/smart-meter-iglucose]
- Effect of Remote Patient Monitoring on Stage 2 Hypertension. [ajmc.com/view/effect…]