Digital Health · Retrospective
The 2022 Remote Patient Monitoring piece was one of our most confident investment theses: "CMS's heavy investment into RPM services, combined with positive reactions from patients and physicians, make it clear that RPM is among the most important trends shaping the healthcare industry in the 2020s." Four years later, this conviction has been validated — but the form RPM has taken, the companies that have won, and the clinical workflows that have proven most transformative look meaningfully different from what a 2022 analysis could have projected.
Three forces have redefined the RPM landscape since that original piece: the AI integration of monitoring platforms, the explosion of consumer-grade continuous monitoring devices (particularly for glucose and cardiac rhythm), and the GLP-1 revolution, which has created a massive new chronic disease management population that RPM is uniquely positioned to serve.
The original piece correctly identified CMS reimbursement expansion as the key structural driver of RPM adoption. This has played out precisely as predicted. The RPM CPT codes (99453, 99454, 99457, 99458) that were established and expanded in 2019–2022 have driven health system and physician group investment in monitoring infrastructure. Medicare's Remote Therapeutic Monitoring (RTM) codes, added in 2022 to cover musculoskeletal and respiratory conditions, have further expanded the billable universe.
By 2025, CMS estimates that RPM services are delivered to over 8 million Medicare beneficiaries annually — up from fewer than 500,000 in 2020. The chronic disease management market that RPM serves — hypertension, diabetes, heart failure, COPD — represents the highest-cost patient populations in Medicare, making RPM's cost-reduction case compelling even beyond its clinical evidence base.
The 2022 analysis focused on traditional RPM (physiological measurements — blood pressure, weight, pulse oximetry). The 2022 addition of Remote Therapeutic Monitoring (RTM) codes extended coverage to non-physiological data: therapy adherence, pain levels, musculoskeletal function. This opened RPM economics to orthopedics, physical therapy, and behavioral health — markets the original analysis didn't address. Companies like Liminal, Keet Health, and Hinge Health have built substantial businesses on the RTM code structure.
Nothing in the 2022 RPM piece could have anticipated the speed with which continuous glucose monitoring (CGM) would transition from a prescription-only diabetes management tool to an over-the-counter consumer wellness product. In March 2024, the FDA cleared Dexcom's Stelo — the first OTC CGM — without a prescription requirement. Abbott's Lingo followed shortly after.
These clearances fundamentally changed the RPM market structure. A CGM worn by a non-diabetic for metabolic wellness is not billable under RPM codes — it's a consumer product. But it generates the same continuous glucose data that RPM platforms previously required clinical prescriptions to access. The line between consumer wellness monitoring and clinical RPM is blurring in ways that CMS's reimbursement architecture was not designed to handle.
The single biggest unforeseeable catalyst for RPM adoption in 2022–2026 was the GLP-1 revolution. The rapid clinical adoption of Ozempic, Wegovy, Mounjaro, and Zepbound — GLP-1 receptor agonists for diabetes and obesity — created tens of millions of new chronic disease management patients with specific monitoring needs: weight progression, A1C levels, blood pressure changes, and GI symptom tracking.
GLP-1 virtual care companies have become among the fastest-growing healthcare businesses in history. Hims & Hers, Noom, Teladoc's BetterHelp division, and dozens of GLP-1-specific platforms (Calibrate, Found, Sequence) all use RPM-adjacent monitoring to track patient progress. The intersection of GLP-1 treatment and remote monitoring has created a new category: metabolic health management platforms that sit between traditional RPM (clinical, CMS-billed) and consumer wellness apps.
The 2022 RPM piece noted that monitoring provides "a more constant stream of patient health data, leading to improved diagnostic accuracy." The AI developments of 2022–2026 have transformed what "improved diagnostic accuracy" actually means in practice. Modern RPM platforms don't just alert when a measurement crosses a threshold — they use ML models trained on millions of patient trajectories to predict clinical deterioration days before it becomes symptomatic.
BioIntelliSense's BioButton wearable and Current Health (acquired by Best Buy Health in 2021 and subsequently rebuilt as a hospital-at-home platform) use continuous physiological monitoring with AI-driven early warning systems specifically designed to prevent post-discharge readmissions — one of CMS's highest-priority cost reduction targets. Withings' clinical devices integrate with EHRs and use AI to flag cardiac anomalies in continuous blood pressure monitoring streams.
Apple's role in this market has grown far beyond what was visible in 2022. The Apple Watch has accumulated FDA clearances for AFib detection, irregular rhythm notification, and — as of 2024 — sleep apnea detection. The anticipated Apple Watch CGM integration (expected to reach market in 2027) would make the world's most widely distributed consumer wearable into a comprehensive metabolic monitoring device.
RPM's investment thesis remains intact and has expanded. The CMS reimbursement infrastructure is established and growing. But the companies winning in 2026 are not the pure-play RPM vendors of 2022 — they are AI-powered monitoring platforms integrated into EHR workflows, GLP-1 virtual care companies with monitoring components, and consumer wearable companies accumulating FDA clearances. Epic's Cheers RPM module and Oracle Cerner's integrated RPM workflows are also capturing share from standalone RPM platforms — a consolidation trend that will continue. The most durable RPM investment is not in device manufacturers (commoditizing rapidly) but in the AI clinical workflow layer and the monitoring data infrastructure that makes physiological signals clinically actionable at scale.