Perceived barriers and facilitators of structural reimbursement for remote patient monitoring, an exploratory qualitative study

Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reimbursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations. This is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed. Multiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme. Our interviews found barriers and facilitators concerning structural reimbursement of RPM in hospital settings in the Netherlands. Our results emphasize that the successful integration of structural reimbursement requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers. The COVID-19 pandemic has demonstrated the strong potential of consultation and monitoring patients at a distance. Remote patient monitoring - the use of information technologies for monitoring patients at a distance - is seen as a potential solution to urgent challenges in the healthcare system. Nevertheless, embedding remote patient monitoring innovations into routine healthcare is often challenging, partly due to difficulties in reimbursing these initiatives. Barriers to reimbursing remote patient monitoring included organizational factors, no uniform quality and outcome indicators, and difficulties using different payment models. Perceived facilitators included an increase in the total number of patients per project, better interdisciplinary cooperation and transparency, and help from the Dutch Healthcare Authority. Introducing these insights into healthcare policy dialogues could support reimbursement of remote patient monitoring and stimulate the collaboration of healthcare stakeholders responsible for implementing and scaling up remote patient monitoring projects.