Abstract Body (Do not enter title and authors here): Background: Accountable Care Organizations (ACOs) assume financial risk for total cost of care under value-based payment models and require scalable interventions to reduce high-cost utilization. Remote patient monitoring (RPM) has demonstrated potential to decrease emergency department (ED) visits and hospitalizations in single-disease cohorts, but real-world economic evaluations within fully risk-bearing ACOs remain limited.

Hypothesis: We hypothesize that ACO patients enrolled in an RPM program will experience significantly lower per-member-per-month (PMPM) healthcare expenditures, reduced utilization of high-cost services (including ED visits, inpatient admissions, and readmissions) compared to ACO patients not participating in RPM.

Methods: We conducted a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries attributed to the Mount Sinai ACO between January and October 2024. Patients with ≥2 structured RPM encounters in Epic (n = 255) were compared to non-RPM controls (n = 4,245) over a 12-month follow-up from each patient’s index date. Outcomes included mean annual claims expense per patient, PMPM costs, and utilization-driven cost components (ED visits, admissions, readmissions, length of stay).

Results: RPM participants incurred a mean annual claims expense of $3,223.90 versus $4,333.93 for non-RPM patients, yielding $1,110 (26%) savings per patient-year (p<0.001). On a PMPM basis, costs were $268.66 (RPM) versus $361.16 (non-RPM), for a $92.50 monthly savings (p<0.001). Utilization analyses (per 1,000 patients annually) showed ED visits decreased by 13.3% (452.5 to 392.2), inpatient admissions decreased by 44.7% (198.6 to 109.8), readmissions decreased by 36.0% (24.5 to 15.7), and average length of stay decreased by 11.0% (5.25 to 4.67 days). Preventable ED visits rose by 27.6% (67.4 to 86.0).

Conclusions: RPM enrollment was associated with significant reductions in annual and PMPM healthcare expenditures, driven primarily by fewer hospitalizations, and ED visits. These findings support RPM as a scalable, evidence-based strategy to enhance patient engagement and curb avoidable costs under value-based care.