Michael Dalton, CEO and founder of Ovatient
Photo: Ovatient
Editor's note: On Dec. 18, it was reported by STAT that UnitedHealthcare will hold off on its RPM coverage policy change.
There's good news and bad news for remote patient monitoring in the year ahead. One piece of bad news is that UnitedHealthcare, the largest private health insurer in the United States, is moving forward with its plan for a significant rollback of its RPM coverage, starting in January. It will end coverage of RPM for chronic conditions such as general hypertension and Type 2 diabetes.
But there's some good news, too – namely in the form of a report this past summer from the U.S. Department of Health and Human Services' Office of Inspector General (OIG). It found growing use of RPM in Medicare – more than $500 million in payments in 2024 – and saw evidence that use of such services, with additional CMS oversight, "has the potential to greatly expand in the future."
A shot across the bow
"On the one side, you have UHC, which has taken a very aggressive coverage position and really serves as a shot across the bow," said Michael Dalton, CEO and founder of Ovatient, a developer of Epic-based telemedicine services including virtual primary, urgent and integrated behavioral health care.
"Its policy – effective Jan. 1, 2026 – limits RPM coverage to just two indications across its Medicare Advantage, commercial and Medicaid lines of business: chronic heart failure and hypertensive disorders during pregnancy.
"From the research I have read and from my own experience building and leading a virtual chronic disease management program that included RPM, that assertion raises several concerns, such as relying heavily on small, lower-quality studies while discounting the broader body of trials and real-world programs showing benefit for conditions like hypertension and diabetes," he continued.
From a regulatory standpoint, time – and maybe the courts – will tell, but this appears to be a rather aggressive view of what Medicare Advantage plans can do, he added.
On the other side, there's the OIG's snapshot on RPM, which tells a more nuanced story, finding that RPM use in Medicare continued to grow rapidly in 2024, with payments for RPM across Medicare and Medicare Advantage reaching about $536 million in 2024, a 31% increase over 2023.
Virtual chronic disease management
"An effective RPM program is not simply about sending a device and receiving readings from patients," Dalton noted. "RPM is the technology, and is just one, albeit very important, component of a larger virtual chronic disease management program.
"To that end, the OIG's recommendations are about targeted oversight and better alignment with clinical value," he continued. "It urges CMS to educate providers, monitor high-risk billing patterns and identify companies that specialize in RPM so bad actors don't distort a tool that can otherwise deliver real benefit."
So the big question is: How will these factors shape RPM in 2026? Dalton expects three main effects in 2026 and beyond.
"The first is the further recognition of and focus on high-value RPM," he said. "For high-risk cardiac patients, heart failure and high-risk pregnancies, RPM is likely to be reinforced and possibly expanded, because the evidence and cost-offset story are strongest.
"For conditions like general hypertension and diabetes, RPM will still be available to most patients," he continued. "But it will also increasingly live inside value-based arrangements – ACOs [Accountable Care Organizations], capitated and advanced primary care models, risk-bearing multispecialty groups – rather than just as a widely reimbursed fee-for-service layer."
What organizations must show
RPM vendors and provider organizations that thrive and grow will be the ones that can show a clear, guideline-based clinical protocol; rigorous documentation of monthly treatment-management time and outreach; and internal monitoring against the OIG's red-flag patterns, Dalton added.
UHC's policy already is being framed by legal experts as a test case for how far MA plans can go in limiting a covered Medicare service by diagnosis rather than by individual medical necessity.
"Between that pressure and advocacy from RPM and digital health coalitions, I think we'll see regulatory guidance or enforcement that clarifies how MA plans can treat RPM, and more explicit expectations that MA coverage decisions should be consistent with both the statute and the emerging evidence base, not just payer-specific 'evidence reviews,'" he predicted.
Getting its groove back
Overall, 2026 will be the year virtual care "gets its groove back," said Dalton.
"First, the Rural Health Transformation Program is designed to drive statewide care redesign in rural America, and the only realistic way to hit its access and quality targets is through virtual care," he explained. "RHT dollars are meant to stabilize rural hospitals, extend scarce workforce capacity, and address specialty and behavioral health deserts – problems brick-and-mortar expansion cannot solve quickly or affordably."
Virtual care can become a force multiplier for rural clinicians and a way to build reliable access pathways without adding fixed overhead, he added.
"And second, as federal support for Medicaid tightens and states face higher uncompensated-care pressure, safety net and rural health systems must stretch capacity, divert avoidable ED and inpatient utilization, and maintain access for patients who are most likely to churn in and out of coverage," he said.
"Virtual care is one of the few levers that can lower marginal cost per episode while expanding reach," he concluded. "In short, Medicaid tightening makes telehealth adoption less about innovation and more about operating out of necessity."
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