The standard of care (SOC) for monitoring patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) is conventional monitoring. Conventional monitoring consists of 2 outpatient visits per year, plus a visit whenever a significant cardiovascular event occurs. Remote monitoring (RM) continuous monitoring and CRT-D adjustments has been shown to reduce mortality and other cardiovascular events. However, it requires additional costs for the equipment and monitoring. Using the table below, estimate the budget impact to Michohio for 2018. Do you recommend adoption of RM?

Population	1,500,000
Prevalence of Cardiovascular Disease	25%
Prevalence of CRT-D	5%
Schedule Outpatient Visit	$150
Unscheduled Outpatient Visit	$5,000
RM equipment	$500
RM monitoring (mthly)	$50
SOC cardiovascular event rate	15%
RM cardiovascular event rate	0%