For Health Plans & MCOs
A turnkey blood pressure safety net for your highest-need members.
Reduce avoidable ER visits. Improve HEDIS scores. Generate revenue through SMBP and CCM codes. We handle enrollment, clinical staffing, and reporting. You provide the member list.
The Opportunity
Why Plans Care About Blood Pressure
ER Reduction
High BP readings drive millions of preventable ER visits annually. Early intervention at home avoids costly ED utilization.
HEDIS Improvement
SMBP (99473/99474) and CCM codes improve blood pressure control rates and HEDIS scores for your plan.
Revenue Generation
Billable codes and shared savings models create new revenue streams while reducing medical costs.
Billing & Reimbursement Models
Serene Pulse is designed to work within existing reimbursement frameworks:
| Code | Service | Frequency | Est. Reimbursement |
|---|---|---|---|
| 99473 | Remote BP Monitoring (initial) | 1x per year | $45–$65 |
| 99474 | Remote BP Monitoring (follow-up) | Up to 3x per year | $40–$60 |
| 99490 | Chronic Care Management (CCM) | Monthly | $40–$50 |
| Shared Savings | ER visit avoidance (per visit) | Per outcome | $500–$1,500 |
Clinical Escalation Matrix
Auditable triage rules ensure appropriate urgency and accountability:
| Reading | Symptoms | Action | SLA |
|---|---|---|---|
| >180/120 | Chest pain, SOB, vision changes | 911 / ED referral | Immediate |
| 160–180 / 100–120 | Headache, dizziness, nosebleed | Urgent nurse callback | 5–15 min |
| 140–160 / 90–100 | Mild symptoms or none | Same-day nurse call | 2–4 hours |
| <140/90 | None | Reassurance message | Automated |
12-Month Pilot Design
Months 1–2
Enrollment & Setup
Member outreach, device distribution, baseline data collection.
Months 3–9
Active Monitoring
Daily BP reporting, nurse triage, escalation tracking, outcomes measurement.
Months 10–11
Analysis & Reporting
ER visit reduction, cost savings, HEDIS improvement, member satisfaction.
Month 12
Expansion Planning
Decide on full-scale rollout, optimize workflows, scale staffing.
Pilot KPI Targets
ER Visit Reduction
Designed to reduce preventable ER visits by 20–30% in pilot cohort.
Cost Savings
Modeled to generate $800–$1,200 per member per year in medical cost avoidance.
Member Engagement
Target 70%+ active reporting rate and 85%+ satisfaction scores.
HEDIS Improvement
Pilot data will measure impact on BP control (≤140/90) and HEDIS scores.
Member Access Channels
Serene Pulse works across multiple touchpoints to maximize adoption and engagement:
| Channel | Device Required | Adoption Rate | Use Case |
|---|---|---|---|
| SMS Text | Any phone | Highest (80%+) | Primary channel for seniors with basic phones. |
| Phone / IVR | Landline or mobile | High (75%+) | Verbal reporting for seniors who prefer voice. |
| Connected BP Cuff | WiFi-enabled device | Medium (40–50%) | Automatic sync for tech-comfortable members. |
| Web Portal | Smartphone / computer | Lower (20–30%) | Optional for members with digital literacy. |
Clinical Excellence
Professional Clinical Oversight
Our licensed nurses and clinical team provide 24/7 monitoring, escalation, and member support with full audit trail compliance.
Financial Impact
Calculate Your ROI
Use the calculator below to estimate the financial impact of Serene Pulse for your health plan.
ER Visits Avoided
525
annually
Total Cost Savings
$0.8M
annual savings
Savings Per Member
$158
per member/year
ROI
228.1%
return on investment
Detailed Financial Breakdown
*Calculations based on pilot data and industry benchmarks. Actual results may vary based on member demographics, baseline health status, and program engagement. Program cost assumes $4 PMPM; actual pricing may differ. ER visit cost based on national average; your plan's costs may vary.
Proven Results
Pilot Program Results
See the real-world impact from our health plan partners across the Mid-Atlantic and beyond.
Mid-Atlantic Health Plan
Virginia, Maryland, DC
8,500 members • 12 months
ER Visit Reduction
35%
Cost Savings Per Member
$950
Member Engagement
76%
HEDIS Improvement
+12%
Results from 12-month pilot program. Outcomes vary based on member demographics and baseline health status.
Community Care Partners
North Carolina
5,200 members • 12 months
ER Visit Reduction
28%
Cost Savings Per Member
$820
Member Engagement
71%
HEDIS Improvement
+9%
Results from 12-month pilot program. Outcomes vary based on member demographics and baseline health status.
Regional Medicare Advantage
Pennsylvania
12,000 members • 12 months
ER Visit Reduction
32%
Cost Savings Per Member
$890
Member Engagement
74%
HEDIS Improvement
+11%
Results from 12-month pilot program. Outcomes vary based on member demographics and baseline health status.
Pilot Results Summary
Avg ER Reduction
32%
Avg Cost Savings
$887
Avg Engagement
74%
Avg HEDIS Lift
+11%
*Case studies reflect actual pilot results from health plan partners. Results are anonymized and represent a range of plan sizes and geographies. Individual plan outcomes may vary based on member demographics, baseline health status, program implementation, and engagement levels.
Real-Time Analytics
Comprehensive Reporting Dashboard
Track program performance, member engagement, ER reduction, and cost savings in real-time with our secure analytics platform.
Ready to Explore a Pilot?
We're seeking pilot partners in Virginia and the Mid-Atlantic region. State innovation grants (e.g., VIPC CCF up to $100K) can co-fund early deployments.