Rethinking Kidney Care: How Remote Monitoring & CCM Support Nephrology Success

Chronic kidney disease (CKD) affects over 37 million Americans—and many don’t even know it. As one of the fastest-growing public health concerns in the U.S., CKD demands consistent, coordinated care. But today’s healthcare system, built around sporadic in-office visits, simply isn’t enough.

Traditional nephrology workflows are overwhelmed by the complexity of CKD management. At the same time, value-based care (VBC) models like Kidney Care Choices (KCC) are setting a new standard—emphasizing prevention, outcomes, and coordination.

Tellihealth makes it possible to meet these goals with remote care solutions tailored for nephrology.

The Problem: Why CKD Care Is So Fragmented

CKD isn’t a linear journey. Patients often live with the disease for years without clear visibility into their status between appointments. Providers are left trying to:

• Monitor lab values, vitals, and symptoms
• Coordinate with PCPs and multiple specialists
• Manage comorbidities (like diabetes or hypertension)
• Educate patients on lifestyle changes, dialysis, and care planning

But the tools for doing all this are siloed, disconnected, and reactive. Most care is still episodic—focused on managing crises instead of preventing them.

Common Challenges in CKD Care:

• Siloed systems – Disconnected EHRs and care teams
• Episodic interventions – Escalations, not prevention
• Lack of real-time insight – No continuous monitoring
• Overburdened clinics – Providers stretched thin

The Shift to Value-Based Kidney Care

To address these gaps, CMS launched the Kidney Care Choices (KCC) model—a VBC initiative that rewards providers for reducing hospitalizations, delaying dialysis starts, and improving patient satisfaction.

But nephrology practices need the right infrastructure to succeed. That’s where remote patient monitoring (RPM) and chronic care management (CCM) come in.

Remote Care Works in Nephrology—Here’s Why

Although often associated with primary care, RPM and CCM are a perfect fit for nephrology. CKD and ESRD patients benefit immensely from ongoing, between-visit support.

Remote Care Tools Help Nephrologists:

• Detect early warning signs (e.g., sudden weight gain or BP changes)
• Keep patients engaged and supported
• Coordinate across primary and specialty care
• Improve treatment adherence
• Reduce emergency visits and avoid hospitalizations

Plus, RPM and CCM services are Medicare-reimbursable, making them both clinically and financially smart.

Tellihealth: Remote Care, Built for Nephrology

Tellihealth supports nephrology practices with a fully integrated care platform that fits into existing workflows.

What We Offer:

• Monthly CCM outreach with nurse-led touchpoints (via signalCCM)
• Real-time vitals tracking from connected RPM devices (via accuRPM)
• Custom clinical insights to support shared decision-making
• Support for VBC models like KCC with aligned reporting and KPIs

All without disrupting your current operations or overwhelming your staff.

Remote Care in Action: Outcomes That Matter

When CKD care becomes continuous instead of episodic, the impact is clear:

• Earlier interventions reduce unnecessary hospitalizations
• Improved adherence leads to more stable lab values and better disease control
• Patient relationships become stronger and more trusting
• Care coordination reduces duplication and closes gaps

It’s not just better for patients—it’s better for clinicians and practice sustainability.

FAQs About Tellihealth + Nephrology

▸ How does Tellihealth support CKD/ESRD patients?
We combine RPM devices and CCM workflows to deliver proactive, in-between-visit support for high-risk nephrology patients.

▸ What makes Tellihealth different from other vendors?
We integrate devices, data, and clinical support in one platform—so you get real-time insights and fewer handoffs.

▸ Are your services reimbursable?
Yes. We align with CMS codes (e.g., 99490 for CCM, 99457 for RPM) and support compliance for Medicare billing.

▸ Can nephrologists use Tellihealth for specialty care?
Absolutely. We support CKD, ESRD, hypertension, diabetes, and more—via customizable remote care pathways.

▸ How fast can we go live?
Most clinics launch in 30–60 days. Our team handles onboarding, training, and EHR integration.

The Bottom Line: Nephrology Needs Remote Care—Now

Nephrologists face more demands than ever, but they don’t have to face them alone. With the right remote care tools, practices can finally scale support for patients who need it most—without sacrificing quality or burning out staff.

Tellihealth’s remote care model is proactive, scalable, and built for VBC success.

Ready to transform nephrology care?
Book a demo to see how Tellihealth supports smarter kidney care.