Remote Care Intel (RCI) is a biweekly intelligence report on all things remote care, published twice every month by Aetonix. It aggregates the latest news on the remote care sector from multiple sources, and offers original takes on them. One can only attend so many conferences, open so many tabs, and talk to so many people to gather an idea of the happenings in this space. But that idea will may not be comprehensive, or up to date. Be sure to check this page for the latest edition of RCI, which rounds up the state of the remote care sector every two weeks. Click on the editions below to download the reports/videos. Subscribe to RCI by clicking the button above.

Edition 17 (March 16th- March 31st)

Edition 16 (March 1st  to March 15th)

Edition 15 (February 16th  to February 29th)

Edition 14 (February 1st  to February 15th)

Edition 13 (January 16th  to January 31st)

Edition 12 (January 1st to January 15th)

Edition 11 (December 7th to December 20th)

Edition 10 (November 23rd to December 6th)

Edition 9 (November 9th to November 22nd)

Edition 8 (October 26th to November 8th)

Edition 7 (October 12th to October 25th)

Edition 6 (September 30th to October 11th)

Edition 5 (September 16th to September 29th)

Edition 4 (August 31st to September 15th)

Edition 3 (August 17th to August 30th)

Edition 2 (August 3rd to August 16th)

Edition 1 (July 22nd to August 2nd)

Introduction 

After the word telehealth entered mainstream lexicon, most hospitals offer services remotely in some shape or form. But its implementation is taking many twists and turns, that is dependent not just on a hospital’s internal situation, but a host of external factors as well from the legal and technological landscape. Remote Care Intel (RCI) is a bi-weekly news report on everything remote care delivery that keeps you updated on what’s happening in the industry on matters of digital care. It includes coverage of all components of remote care management such as patient engagement, care coordination, HIPPA compliant messaging, documentation and execution of clinical workflows, patient monitoring, chronic care management etc. 

 Purpose 

After the word telehealth entered mainstream lexicon, most hospitals offer services remotely in some shape or form. But its implementation is taking many twists and turns, that is dependent not just on a hospital’s internal situation, but a host of external factors as well from the legal and technological landscape. Remote Care Intel (RCI) is a bi-weekly news report on everything remote care that keeps you updated on what’s happening in the industry on matters of digital care. It includes coverage of all components of remote care management such as patient engagement, care coordination, HIPPA compliant messaging, documentation and execution of clinical workflows, patient monitoring, chronic care management, and everything else that gets added to the mix. The information presented on RCI is best suited for those who want to stay up to date with the latest insight on remote care. Unlike our other content, it is not published on our website but distributed to individuals who are in a position to affect patient care management using telehealth. The distribution channels are exclusively email and relevant social media. We hope that readers find the content useful in discerning the ins and outs of remote care, figure out to make it work for them, and stay one step ahead in cognizing its future development. 

Timeline 

17th Edition

See the video.

16th Edition Summary

COVID-19 has a put a damp on all remote care excitement, as everyone is too busy with telehealth. But one must remind themselves, that all good RPM companies come with core telehealth features such as two way or even multiple way video calling. In a strange reversal of order, some organizations like Spartanburg already had RPM, but are getting introduced to telehealth at the moment. But for the majority of the hospital cases, it’s the other way around where they never even considered RPM, but are just dipping their toes into the world of virtual care via telehealth because of COVID-19.  Everyone is helping, whether it be Medicare or private insurances with their telehealth reimbursement or companies like Orion Health, one of many RPM solutions to offer a remote screening solution.  The technology surrounding RPM is becoming more commonplace day by day, whether it be the smartphones or wearable devices, though people tend to transmit more data using smartphones as JAMA found in a study.

March 13th- Orion Health like many other RPM vendors have introduced a COVID-19 monitoring platform whereby physicians can keep in touch with quarantined patients. It offers a regionally configurable online symptom checker and uses AI to understand the risk of each patient and the spread of COVID-19.

RCI Takeaway:  This is very standard news at this time, many vendors are doing something similar including ourselves. To see an early list of all such vendors who have created a distinguishable product for the purpose of screening patients, see our post on the healthcare industry response to COVID-19. RPM solutions are doing what they can, to facilitate the virtual screening process for COVID-19. Both public and private insurers have also come forth to lift most restrictions regarding telehealth reimbursements in this state of emergency.

March 12th- The Journal of American Medical Association (JAMA) found in one if its studies that after hospital discharge, patients with smartphones transmitted data for 32% longer than patients with wearables. 30 day after discharge, there was a 5%-point difference between the two groups of patients, which widened to 10%-point difference after 90 days, and finally a significant 14% difference after 180 days. The study analyzed remote patient monitoring activity for 500 patients enrolled in Medicaid from January 2017 to January 2019. It found that 69.4% of patients transmitted data among the smartphone group compared to 58.9 percent for patients in wearables.

RCI Takeaway:   This is a very interesting study because eventually one modality will win the majority of the market share, either smartphones or wearables. The way things are developing, people are either gravitating towards using their smartphones as it is so convenient and ubiquitous, or they prefer the wearables as you do not have the hassle of connecting measurement devices to your phone or tablet. But there is the strong likelihood, that both modalities will be retained. MHealth, or the use of mobile phones to conduct virtual care, is used by nearly three quarters of hospitals. On the other hand, wearables continue to get better in terms of simplicity and user experience. We must put ourselves in the patient’s shoes. The mobile phone will allow us to communicate with healthcare professionals, so it isn’t going away anytime soon. But either legacy device makers or innovative wearables will accompany smartphones to complete the total remote patient monitoring package.

March 10th- Spartanburg Regional Hospital had developed the Discovery Health remote patient monitoring program all the way back in 2007 with a grant from the Spartanburg Regional Foundation. As of today, all patients receive a scale, a blood pressure cuff and an oxygen monitor to track their vital signs daily. This information is transmitted via Bluetooth to the platform where a nurse can assess the case to see if an intervention is required. Glucose meters will soon be added to the system for diabetes management programs. Video conferencing capabilities will be added as well to enable wound care management.

RCI Takeaway:  Spartanburg Regional Hospital was ahead of its time in deploying such a remote patient monitoring program. It’s quite a surprise that they did not have a video conferencing feature already in place. But it’s also understandable, because you actually do not need video to remotely track vital signs of the patients. Video conferencing or virtual calling is more commonly associated with telehealth, but as most RPM companies have this as a basic feature, the two services of RPM and telehealth are used interchangeably. But to see incision sites or assess rashes or other things of that nature, video or store and forward image capability is a must. So in addition to starting a diabetes program, Spartanburg Regional Hospital must also be looking at conditions the symptoms of which require visuals. 

March 6th- Often in the innovation category, we talk about new products or features in the remote care space. But looking at it from a different perspective, it can apply to novel legislation as well which can completely change the landscape for remote care. Such was the case in this emergency, as the new $8.3 billion Corona Virus funding bill allows reimbursement to all Medicare beneficiaries, irrespective of where they are situated. We cover the changes in more detail on our website.

RCI Takeaway:  Such a move is unprecedented because normally there is a whole host of rules when it comes to payment parity for telehealth, and other requirements such as prior patient relationship and patient consent. With this decree, the floodgates for telecare should open, initially just to manage the potential and confirmed COVID-19 cases, but perhaps to manage other conditions as well once we are in the post COVID-19 era. The requirements for telehealth will be reinstated by then, but there would have been a great culture shift where a large group of people would have been habituated to receiving care remotely, from the privacy of their own homes.

15th Edition Summary

We learn many new things in this edition of Remote Care Intel. We see that while telehealth during emergencies have become the norm over the years, newer technologies have lent it greatly improved capabilities. During crisis, telehealth can be supplemented with remote care for patients who absolutely must be quarantined, but also receive care. In other news, OB/GYN remote care has arrived! Vendors and providers are already making moves, and clinicians are ripe with suggestions as to how care coordination can be improved digitally, not just to result in a smoother patient experience for mothers, but to actually improve health outcomes by avoiding complications, both pre and post birth. Also, we see how it looks like when  skilled nursing facilities decide to adopt remote care. It is imperative to understand who the cost is passed down to, if it’s the patient, their insurance, or if the facility bears the cost itself to provide a greater level of elderly care. We look forward to further developments in all these areas, so see where the chips fall. 

Feb 26th-Excelsior Care Group maintains several rehabilitation centers in New York and New Jersey. They equipped 284 of their sub-acute and long-term patients with a wireless patch from ImagineMIC that tracks real time heart and respiratory rates. After avoiding 30 hospital admissions from a group of 100 potential hospitalizations, Excelsior has set up four new partnerships with facilities in the east coast, using the same wireless patch from ImagineMIC that also serves as EKG tracker for patients. Excelsior Care Group regional administrator Oded Dashiff says that “nursing homes are becoming hospitals and hospitals are coming ICUs”.

RCI Takeaway:  It is important to notice that hospitals and physician clinics are not the only organizations that deploy remote patient monitoring. RPM has found a home in Skilled Nursing Facilities and Rehabilitative Centers as well. While programs like Chronic Care Management exist to ensure hospitals still maintain relationships with their patients, albeit in outpatient setting, what about the large contingency of people who never make it to a hospital in the first place? If more such nursing home type centers can afford a RPM solution for their patients, this can be a sign of things to come. It is yet to be determined how this will impact all other stakeholders.

Feb 25th- In this year’s Society for Maternal-Fetal Medicine Annual Meeting, telehealth and remote care was discussed as a possibility to improve care. Telehealth, more so than remote patient monitoring, is widespread across all health departments, and thus some Ob/Gyn clinicians have already begun to do remote checkups that do not require face to face presence.  But telehealth aside, remote care management use was raised. Tracking the baby’s development between ultrasound was the most desired feature in the sort of pregnancy care that is enhanced by RPM. The connectivity of the RPM platform to a drug database was also in demand, so patients could better choose cold medications and allergy remedies to take while pregnant or breastfeeding. Other uses of RPM in pregnancy care included managing excessive weight gain during pregnancy, and post-partum follow up to control blood pressure.

RCI Takeaway:   We saw OB/GYN’s interest in remote care earlier in this report through Amerigroup’s and Babyscripts’s partnership. We now see potential examples of its application, should it ever face mass adoption as it was the case with chronic and acute care. As the need for digital coordination permeates throughout all of care, there is no reason to believe that it will not.

Feb 20th-Corona Virus has hogged a lot of the news lately. The death toll has surpassed 1000 cases. Telehealth is being touted as the 1st line of defense. With telehealth, those experiencing corona virus like symptoms can gain access to care quickly without being exposed to other viruses or transmitting what they have to others. The patient can be screened remotely and assigned a risk category. Even if a diagnosis over video consultation cannot be confirmed, the patient can be triaged from afar, and the clinician can recommend a next step.  Cases that require more immediate attention can be escalated

RCI Takeaway:  Virus outbreaks such as the Corona Virus remind us how speed of access to care becomes ever so crucial in emergency situations. In natural calamities from yesteryears such as Hurricane Katrina, it was the same situation where the value of telehealth came to the forefront. It is very assuring for the patient to know that they can receive quality treatment wherever they are, no matter how contagious the case may be. And if the right devices can be provided to the patient, they can conduct remote tests as well, replicating a small virtual hospital at their own location.

Feb 18th- Amerigroup D.C, a Medicaid managed care organization announced its partnership with Babyscripts, a virtual care company for managing obstetrics. Under this agreement, Babyscripts will provide prenatal support to Amerigroup’s George Washington University Hospital, Community of Hope and other regional hospitals based in and around D.C.  More specifically, such prenatal support will include access to educational materials, care navigation to identify social determinants to health and remote patient monitoring to manage gestational diabetes and blood pressure. The idea is for Amerigroup’s patients to receive enhanced pregnancy care that results in greater patient experience and positive patient outcomes.

RCI Takeaway:  Chronic, acute and neonatal care regularly make up the majority of RPM’s use cases. Chronic care and acute care especially, comprise of the majority of cases in health systems, so there is no shortage of scenarios where RPM can be applied. But more variety of use cases are emerging, as people are interested in using devices and an internet connection remotely conduct their care plan. Hence, other departments besides cardiology and respiratory (for chronic conditions) are becoming interested, such as OB/GYN in this case. It’s an exciting time for remote care.

 

14th Edition Summary

While RPM solutions continue to expand their range of offerings, hospitals are taking a slower approach, just beginning to experiment with the basics of RPM. As there is so much value to be added just by starting such a program, more organizations can be expected to deploy an RPM solution in installments, where they first confirm the hardline benefits, before including all the add-ons. But that doesn’t stop research and development from continually improving the technology to provide actual procedural remote services such as coronary procedures, that can be conducted 3000 miles away. More such innovations will follow, especially if backed by federal grants. Currently, there is a lot of good work being done in providing internet access to rural areas. Once such infrastructure is fully developed, the next wave of government initiative could involve developing true virtual care where all procedures and tests can be conducted inside homes.

 

Feb 12th- After seeing the cost savings and improved patient outcomes because of remote care in the Veterans Health Administration, the Federal Communications Commission (FCC) is close to issuing its final order for its $100 million Connected Care Pilot Program. While FCC’s other programs in healthcare involve providing high speed internet services to rural hospitals, the Connected Care Pilot Program aims to use telehealth to serve those who are currently underserved, such as low-income individuals and veterans. FCC Commissioner Brendan Carr says that over a three-year period, the funds will be used to support a limited number of projects using RPM via mobile health apps on smartphones or tablets.

RCI Takeaway:  This could be a very important financing source for healthcare organizations that are eligible to apply, if there is such an application process. Apart from the traditional methods of financing RPM Pprograms program such as the annual or department budget, or reimbursements, govt.  funds should always be explored. Especially at a time when the govt. Is increasingly pushing for value-based payment structure, there will be more subsidies or programs for deploying remote care. Even if one is not benefitted directly from FCC’s efforts, the modernization of rural communication infrastructure is something that will indirectly benefit all organizations hoping to provide care to patients in rural areas.

Feb 11th- When we think of remote acute care, we normally think of pre and post-surgery care coordination, not the actual operation itself! Ryan Madder, Section Chief of Intersectional Cardiology at Spectrum Health says that the “emergence of ultra-fast, high-bandwidth networks and advancements in robotic technology in recent years” have made it possible to deal with signal loss and delayed transmissions. He talks about his experience of using 5G connection to manipulate a robotic arm in San Francisco, from Boston. 36 simulations of remote coronary procedures were conducted. Eyeing the future, he speaks of a hub and spoke model, where doctors could perform such operations from a central or hub location for patients in spoke locations.

RCI Takeaway:   As this is the Remote Care Intel, we would be remiss not to entertain the possibility of remote care at a procedural level. Already, there are devices which let you do comprehensive exams from the comfort of your home. It goes beyond just measuring your vital signs, which is already extremely valuable for managing chronic care. Offloading actual surgical procedures on organs as important as the heart to satellite locations will be a giant leap for remote care. As Ryan points out, it would have been unthinkable without the rapid progress of internet connectivity such as 5G. The economics of it all is yet to be figured out. It will be a type of remote care that cannot be transferred completely to a person’s home obviously, they will still need to be taken to a satellite location.

Feb 11th- Children’s Hospital of Richmond found great success with RPM for acute care, particularly post-surgery care. By using the remote care software, they were able to review medications, discuss nutrition, view the incision site and decide on next steps for their patients at home. The results are very positive. No additional clinical visits or hospitalizations were needed, and two probable emergency department visits were avoided. Furthermore, two patients were discharged 12 to 24 hours sooner than usual. User experience wise, 92% of the patients said they felt comfortable using the remote care platform to receive care. Going forward, Children’s Hospital of Richmond plants to integrate patient questionnaires and educational content into the platform, and allow physicians to customize care plans.

RCI Takeaway:  Sometimes, hospitals just need to get started on one thing, and introduce other components of a solution’s package after initial success. Such was the case for Children’s Hospital of Richmond. They achieved their target of reducing rehospitalizations and unnecessary ED visits. Based on the confidence gained from the experience, they are now customizing their platforms further with questionnaires and educational content. Will such additions improve the baseline numbers ever further? That remains to be seen, but theoretically they should. But raw numbers aside, such as discharge times and rehospitalizations, there are qualitative aspects to care as well. Such as patient experience, which is always made easier by keeping them at home while still tailoring their care plans according to their situation. 

Feb 6th- Masimo has acquired NantHealth’s Connected Care assets for $47.25 million, all of which are geared towards the provision of medical device interoperability. Masimo says that the goal of such acquisition is to reduce clinician cognitive overload and errors of omissions via greater connectivity, predictive algorithms and decision support. The transaction is expected to close in the first quarter of this calendar year.

RCI Takeaway:  Almost every edition of RCI, there is an example of different solutions merging together, or one acquiring another, in order to enhance their offering. Such a tradition continues, with Masimo bolstering its core competence of noninvasive medical device manufacturing with the necessary connectivity technology and analytical capabilities from NantHealth. Do not expect such trends of merging and acquisition to stop anytime soon, as vendors race to become full-service solutions. But because healthcare organizations have their own protocols, the need to customize is still an evergreen requirement, and thus no matter how well rounded the product is, it has to make sense to the hospital’s use case.

13th Edition Summary

This edition of Remote Care Intel wraps up the month of January. Like with most editions, we see a trend of hospitals and vendors collaborating to introduce remote care. We see companies expanding their core offerings to include remote care as a part of their service, given all the upward projections the global RPM market is poised for. In a market that is rapidly saturating, it sometimes doesn’t feel like there is room for any new innovations, but this is only because the business models become very predictable. It only takes laser focus on any one aspect of remote care, to develop a new market. Like with the case of Signallamp, there could a huge market developing which simply helps healthcare organizations connect to their patients via the right staff, an invaluable add-on service to take maximum advantage of remote care. Regarding devices for RPM, there could be devices geared solely for the detection of a condition and leave the monitoring to other equipment. All such new developments will only mean more vendor-hospital projects in the years to come. If an offering is not good enough, it will seek out other partners to complete its value proposition. 

Jan 29th- IDTechEx Research says that remote patient monitoring is the future of cardiovascular disease management. It stresses the role of both wearable and non-wearable devices in the management of heart diseases. Wearables such as sensors, skin patches, accessories or smart clothing provide greater convenience and comfort, but only if they are highly flexible and lightweight.  This can be restrictive when it comes to their range of purposes. Non wearable device can be more versatile in the sense that it can combine multiple functions in one product. Cardiovascular diseases such as hypertension, heart failure and arrhythmias have all been treated or managed using RPM. Not only can patients be monitored over the progression of their condition, but they can be monitored to diagnose conditions such atrial fibrillation.

RCI Takeaway:  There is more information in the report published, but it is premium. From the gist of it that is freely available, we see that how cardiovascular departments plan to keep RPM in its long-term plans for the detection, management and treatment of all heart related conditions. We particularly like the focus on devices, because while there is a lot to be added to software in terms of features, it doesn’t mean anything if the patient is not comfortable with the devices on them, wearable or non-wearable. Thus simultaneously in line with software development that finds ways to better integrate patient data into the EHR, hardware development in terms of the most non-invasive and reliable device should also be pursued.

Jan 28th- Colorado’s UCHealth is collaborating with BioIntelliSense on a remote patient monitoring project, that is expected to begin this quarter. BioIntelliSense recently received FDA clearance on the BioSticker, a medical grade wearable body sensor. It has the ability to continuously monitor patient vital signs from home and deliver insights to clinicians. Steve Hess, UCHealth’s CIO, says that UCHealth’s Care innovation Center will use the device on patients with chronic conditions such as diabetes, heart failure and hypertension, in the hopes of timely prevention to deter escalation of such conditions.

RCI Takeaway:   The BioSticker is a small adhesive that can monitor patient’s heart rate, respiratory rate and skin temperature when prescribed by a medical doctor. BioIntellisense founder, James Mault, was a cardiac surgeon, and so it helps to have that clinical expertise when working with large health systems like UCHealth. In fact, Steve Hess says that it was combination of engineering talent and clinical expertise that BioIntellisense provided that swayed the decision in their favor. It goes back to a point we always make in RCI, that no matter how innovative the technology is, the use cases in hospitals have to make clinical sense.

Jan 21st– Drew Kearney, writes a great article on Physicians Practice about fears physicians may have on remote care. The feature talks about overcoming the remote aspect of care, which is addressed by the patient’s ability to call or text a direct clinical contact, their doctors being notified, and their charts updated. It says while providers may be unwilling to cede control by handing over check ins in between visits, it is beneficial for both the patient and the practice. People tend to favor a continuous interaction, and practices have only so much resources to provide care. So it’s not really handing over control, but building a more loyal relationship with each and every patient, where they are remotely monitored.

RCI Takeaway:  Drew Kearney is the co-founder and CEO of Signallamp Health, which attempts to bridge the gap between doctors and patients via nurses. Their nurses are trained to handle all aspects of remote care that can happen in between office visits, such as following specific workflows for providers, educating patients on the care plan and to track their vital signs, encourage preventative screenings and immunizations etc. It is true, that we are at crossroads. If providers want to scale using the new reimbursement codes for RPM, they need help.  While RPM software is a great way to record and monitor patients, trained nurses who are adept at this technology are also very much needed. They can administer the program, thereby increasing revenues and hopefully improve patient outcome as most studies seem to suggest. But they can also generate loyalty for the hospital or practice in question.

Jan 16th- Another player has entered the RPM market. HARMAN, a wholly owned subsidiary of Samsung Electronics Co. Ltd, announced the HARMAN RCP (Remote Care Platform). Powered by Intel, it focuses on multiple use cases for healthcare organizations such as chronic diseases management, aging with independence needs and discovering insights for patient health programs. HARMAN’s core expertise is the IOT space, dealing with anything where there is data and devices involved. Using Intel’s licensed assets for remote patient monitoring, HARMAN expands its offering in the remote patient and elderly care, according to their own words.

RCI Takeaway:  Samsung, which owns HARMAN, makes tablets which are very popular in the implementation of remote care. So, it’s natural for them to expand into the software side of the business as well, as it pertains to remote patient monitoring. It’s not the first time we have seen a company team up or acquire another company to become a more full-fledged RPM offering. Software centric RPM solutions have paired up with companies specializing in medical device management. Telehealth services have rolled out RPM features by collaborating with others. And now, device manufacturers like Samsung have also forayed into this space, by licensing the necessary RPM technology from Intel.

12th Edition Summary

While initially off to a slow start, 2020 has been blown open with the news of telehealth firms now wanting to get in on the remote care act, either by joining other competitors or by joining payers. It only makes sense, as telehealth has traditionally meant only e-visits in pop culture, and yet we know remote patient monitoring is one of the three major pillars of telehealth, the other two being e-visits and store and forward technology. Health insurance companies like Cigna and UnitedHealth, and telehealth firms such as MDLive and Teladoc, all realize the value in changing the habits of their patients. Because ultimately, as with all industries, it all starts ground up from the consumer level. Providers will provide the type of care that the patient wants. But on the face of all this new technology, patient engagement remains a crucial component for success. There is talk of using more cell phones than tablets in what is mRPM, and also experimenting with VR. But patient engagement might not necessarily correlate with new modes of care. It’s an area providers have a lot of insight to offer, dealing with patients on a daily basis.

Jan 13th- MobiHealthNews’s Dave Muoio reports InTouch Health’s acquisition by Teladoc Health for $600 million. Jason Gorevic, CEO of Teladoc health, says ”Today marks a bold leap forward in Teladoc Health’s mission to transform how high-quality healthcare is accessed and experienced, making virtual care available for patients with even the most critical care needs “. InTouch Health had working relations with more than 450 hospitals and health systems. Its offering is more enterprise, compared to Teladoc’s consumer level offerings. It provided support for over 40 clinical use cases.

RCI Takeaway:  This is groundbreaking news to say the least. Teladoc is signaling its intent in the telehealth field. It intends to be one stop shop for all virtual care needs, for patients with symptoms outside hospital settings, and patients already involved in established care plans. This has promise to provide integrated care, no matter if it is everyday care, critical care or chronic care. It has been a common move for telehealth giants to merge with others in their space. American Well had done the same last year. It remains to be seen if any of these firms will acquire remote patient monitoring capability in the future, as telehealth and RPM are so closely aligned.

Jan 13th- University of Wollongong’s Shiva Pedram writes about a study conducted on mining and construction workers, who often receive their mental healthcare remotely. Normally, videoconferencing on apps such as Skype, Zoom and Facetime via their cell phones is how they communicate with counsellors. In this study, they received care via virtual reality, and reported to more freely express themselves without fear of judgement. Compared to videoconference, the virtual reality care sessions scored higher on the level of presence (them being there), level of co-presence (them being together with their provider) and realism.

RCI Takeaway:   This study provokes many interesting thoughts. While VR may become a popular modality of delivering healthcare in the future, it will no doubt pose its own set of problems. One of them is already identified in this article, called the Uncanny Valley effect, where hyper-realistic avatars of doctors can generate cold and eerie feelings. Also, the disease being treated is a major factor as well, and so far, VR has been used to treat anxiety and stress related disorders, phobias, panic disorder and PTSD. But ultimately, going forward one can see this replace the two-way video conferencing capabilities that most RPM solutions come with. It can be a powerful add on feature, if it can drive greater patient engagement.

Jan 13th- Cigna has teamed up with MDLive to introduce the Virtual Primary Care Platform to its 12 million or so members. MDLive’s prior dealings with Cigna involved offering urgent care services through telehealth. But for primary care, studies have shown that the younger generations would much rather seek out such services online rather than develop an in-person relationship. This partnership between the insurance and telehealth giants will also include remote patient monitoring through MDLive’s Sophie Health Monitoring Platform, which enables patients to self-track data and coordinate check-ins and reminders with clinicians. The Virtual Care Platform can also take in lab results, manage referrals and handle annual wellness screenings and checkups.

RCI Takeaway:  Insurance firms such as UnitedHealth and Cigna are making big moves lately. The idea is to add whatever capability it takes to modernize the care experience of their members, while also making it more cost efficient. By digitizing activities such as annual wellness screenings, managing chronic care conditions, ordering labs, and referring to specialists, the idea is for their members to avail the digital option whenever they can. While the primary care activities can be digitized fairly easily, it remains to be seen if acute and chronic care will achieve the same level of cooperation from providers. But with favorable legal changes and social push towards virtual care, health insurance companies are indeed coming for the remote patient monitoring space, expediting the reality of it all.

Jan 5th- Medical Economics’ Harry Soza writes about what is new in Remote Patient Monitoring. To be fair, most of the heavyweight changes that have happened, all occurred in the last year. So 2019 will be etched in the minds of the people as the year where remote care reimbursement was introduced. Besides the economic value the codes provide from a revenue standpoint, the clinical and cost-effective value of mRPM is discussed.  mRPM is just RPM, but delivered via mobile phones. Thus, care management coordination is simplified, as patients are able to communicate and coordinate their care pathways with their clinicians from their cell phones.

RCI Takeaway:  To be honest, mRPM is not a new concept. MHealth already exists, and a big part of mHealth was always managing those patients who are more tech savvy via their cell phones. They would download an app and be good to go. However, as most older patients are not that used to haptics on a cell phone screen, a tablet is more commonly used for them. The article does demonstrate the value of mRPM, where communication and measurement of patient data via push notifications are simplified. This eases the burden on support staff, and makes care coordination a smoother experience. But of course, all of this is dependent on patient engagement.

11th Edition Summary

2019 ended with a whirlwind of news that shows the innovations are collaborations that are possible in the RPM space. Acute care can be siloed into specific operations, and neurological care can be siloed into specific diseases, that goes beyond just treating the odd stroke. Digital therapeutics also made an entrance, as a way to get people to  adopt healthier lifestyles and reduce chances of becoming depressed or obese, conditions that have high correlations to other chronic diseases later on in life. Seeing the greater technical and technological advancements in healthcare, vendors continue to partner, either with each other or with hospitals, to run RPM projects. The RPM space is still relatively new, and so 2020 should be an action-packed year, where more such projects continue to materialize.

Dec 18th- RN Staffing Solutions partnered with ForaCare to pilot a RPM program for hypertensive patients. As the name suggests, RN Staffing Solutions equip hospitals with trained and certified nurses. With ForaCare’s RPM devices and 24/7 HealthView Telehealth Solution, their nurses now have the tools in place to monitor vital signals of their patients remotely. This program for hypertension is just the beginning for them, as ForaCare is one of the leading providers of devices used for RPM. They have the devices for the other major chronic diseases out there such as diabetes and COPD.

RCI Takeaway:  Interesting, as RN Staffing solutions do not merely fill gaps or supplements existing staff, but they now have nurses specialized to take advantage of certain programs, such as the RPM program being one. ForaCare is also increasingly becoming a formidable player as they always had a collection of RPM devices, and now have a telehealth software to go collect readings from those devices. It’s yet another example of vendors expanding their functionalities and partnering to strengthen the full suite of services offered.

Dec 17th- Remote Patient Monitoring was featured as one of the top trending stories of 2019 by mHealth. It recapped the general sentiments throughout the year, the fact that more and more organizations were eyeing RPM as a tool to treat the chronically ill. It talks about how RPM has been clinically proven to be effective in detecting early symptoms. In addition, it talks about chronic disease management strategies. Digital therapeutics is a noteworthy mention, which can be used to change behavioral patterns in obese patients. Cognitive behavioral therapy is used to address anxiety and depression, which is also included as a part of digital therapeutics.

RCI Takeaway:   It’s great when you address the root of the problem. While RPM has been more or less successful in addressing chronic conditions, part of its allure has been early symptom detection, thus facilitating the management of those conditions for the long term. But many of those diseases, though not all cases, are brought about by past or present bad habits. To truly enable a change of behavior, digital therapeutics could be explored.

Dec 16th-Acute care, especially care surrounding an operation procedure has always been a major focus for RPM programs. St. Peter’s University Hospital, based out of New Jersey has teamed up with VOX Telehealth to launch Enhanced Recovery After Surgery (ERAS) for its patients going through C section or hysterectomy. The program provides preoperative education and coordinates pre-screening assessments. It also provides peri-operative and post-operative coordination of care that includes an alert system and medication management system. It’s supposed to help those recovering to gradually wean off the medication.

RCI Takeaway:  Acute care has always been a strong hub for RPM care. It is interesting to see RPM programs being developed for specific surgical procedures. Gone are the days where RPM was only used for post-acute care. These days, the whole patient experience from announcement of the need for surgery to complete recuperation is captured on RPM platforms. When certain procedures are focused on, it also allows the clinicians to build specialized workflows.

Dec 11th- Neurological diseases such as Multiple Sclerosis, Parkinson’s and Epilepsy are chronic in nature, and they impair cognitive and physical functionalities. Avalere, the healthcare consultants, say that such conditions are ideally suited to be treated using RPM as they are ongoing in nature, and require multiple episodes of care to diagnose, treat and evaluate progress. Through wearable technology, one can track mobility by collecting data on seizures, sleep, physical activity and even style of gait.

RCI Takeaway:  Apart from chronic care, acute care and neonatal care, neurological care may be the 4th great area where RPM can be used in a mass scale. There have been plenty of news stories about the first three categories, while neurological care has gotten a lot of attention from telehealth, in what is known as tele-neurology. Such tele-neurology centers bank on quick expert video consultation from neurologists in ambulatory settings.  But a longer term non acute neurological care has not been discussed as much. It could be a fantastic opportunity for RPM to treat such neurological diseases.

 

10th Edition Summary

There is no denying the effect CMS’s new rules have had on remote patient monitoring’s acceptance, as it is now possible to be reimbursed for it separately, and not bundled with other care services. Just as CMS had lead the early efforts in developing value based care programs, it is now making it more financially attractive to provide remote care. Thus payors, providers and otherwise non-RPM vendors are getting into the act. It’s interesting as the video conferencing aspect of telehealth is being insourced due to its level of mass acceptance. Perhaps RPM will undergo the same fate someday, where every hospital will see it worthwhile to develop their own RPM system in-house. But then, there is a lot to be said about device and software innovations as well in the RPM sector. As long as there are new innovations, there will be room for partnerships.

Dec 6th- Orpyx’s SI Sensory Insoles is the latest example of trying to solve a health problem by identifying signs that can be picked up remotely from the human body. It monitors pressure, temperature and movement of the foot to detect Diabetic Foot Ulcers (DFU). It provides real time visual alerts to resolve high pressure areas. Orpyx’s CEO & Co-inventor, Dr. Breanne Everett emphasizes the seriousness of Diabetic Foot Ulcers. 25% of diabetic patients will develop DFU, 40% of first-time cases will develop a second ulcer after the 1st one is healed, and the condition has a 5-year mortality rate of almost 50%. So early identification is crucial, to say the least. 

RCI Takeaway:  With the help of wearables, sensors and patches, the idea of a digital twin is becoming a reality. So many data points can now be collected and managed by physicians from afar. With AI in the mix, predictive analytics can be used to determine the best course of action after collecting all these data points. But one must tread with caution, because ultimately healthcare cannot be micro-managed for you. Even if you were the most willing patient, and be fitted with sensors head to toe, you still need to be accountable for your own lifestyle.  

Dec 5th- The RPM space is really heating up. Provider organizations are adopting it, payers are adopting it, and other companies who do not have the remote patient monitoring function are adding it to their repertoire. HealthSnap is the latest name on this list. Famous for its lifestyle analytics programs in the past which took into account exercise, nutritional and behavioral data, they are now also remotely transmitting vital signs of the patient. The addition is an obvious play to capitalize on the new rule changes that favor building chronic care programs with remote patient monitoring. Furthermore, their Lifestyle Profile™ is more complete with these vital health indicators.

RCI Takeaway:  Other than the vendor-payor collaboration, there is another collaboration trend that we are picking up. It is the feature extension of a digital health service, which may or may not be achieved by collaborating with another specialty vendor. Validic had collaborated with Trapollo to have the RPM feature complement its data analytics feature. In this case, HealthSnap has developed the RPM ability in-house. Having such a consumer-friendly app now have RPM capability is praiseworthy. But not having care pathways for certain conditions could be an issue, which is a feature RPM companies gradually build with experience of working with health systems. 

Dec 4th- When it comes to announcements of projects, there are few journalists better than mHealth Intelligence’s Eric Wicklund. Featured in multiple past editions, he breaks the story of Humana and Phillips collaborating on a project called remote member monitoring. It is an RPM program for some selected Medicare Advantage members that have congestive heart failure. Humana wants to reduce post discharge readmissions for its members suffering from CHF, but also help them manage their daily health needs proactively by sharing data with care managers. 

RCI Takeaway:  In a bid to reduce the $30 billion annual cost of CHF, Humana is partnering with Phillips for this deployment. On the heels of UnitedHealth acquiring Vivify Health for RPM capability, here we see another payor interested in RPM. The reasons given are all textbook RPM sales points, such as helping members be at their homes, thus reduce readmissions, improve patient engagement, and prevent exacerbation. Outpatient care is truly making a name for itself. In an attempt to fix the healthcare system, people have come to one conclusion unanimously. That is, patients who need not be at the hospital, should not be at the hospital. It unnecessarily drives cost and increases resource burden. 

Nov 27th- Global Med’s Patrick LaVoie writes about how insourcing telemedicine is becoming more popular. Many studies cite telemedicine or virtual visits not picking up in pace because of the loss of a personal connection. Indeed, randomly being matched with a doctor for certain conditions through an app seems like fast food health. People doubt the quality of it. But from the organization’s end, they do not want to lose out on the many benefits of virtual visits such as managing capacity and triaging patients from afar. So the standard practice has met both these demands halfway, where patients are still being connected to doctors, but doctors from a certain health system which they can also visit in person if they wish.

RCI Takeaway:  Most people associate telehealth with virtual visits. And why not? It was the first of the three main modalities of telehealth to get traction in pop culture. The other two being store and forward technology (securely exchanging results, reports and messages), and remote patient monitoring (transmission of patient health indicators wirelessly). To this day, telemedicine (or two-way video conferencing, or virtual visits as they are popularly referred to today) will be many people’s only contact with telehealth. For those undergoing chronic care or acute care, remote patient monitoring may be their first point of contact with telehealth. In 2017, 30 million people in USA had virtual visits, whereas 7.1 million people used remote patient monitoring using connected devices.  

9th Edition Summary

The web has been saturated with opinion pieces on RPM, either describing its pros or its cons. This is why we had created the ultimate balance scale, showing all the pros and cons of RRM in one diagram. But speaking of vendors and providers, new developments continue to happen. Big health systems and insurance companies are starting to deploy RPM programs, for many reasons, but to mainly curb costs one would think. They are able to pass some of the savings down to consumers as well. With even newer innovations like AI on the horizon, it will provide more opportunity to slash expenditures. For the time being, we are not there yet. 

Nov 20th-Walmart announced a telehealth program in collaboration with Doctor on Demand, with just $4 co-pay. Not only does it offer diagnosis via video chat, but it offers management of chronic diseases such as diabetes, urgent care and behavioral care as well. The $4 co-pay is much lower than the previous $49 co pay for the program. The program is more than just video conferencing to diagnose seasonal flus, colds or infections, but it can handle more complex situations as well. It can manage chronic conditions like diabetes, urgent care and also behavioral health.

 RCI Takeaway:  We have seen big telehealth companies form partnerships with insurance companies before to serve employees. This is a new gold standard it seems, to have just $4 copay, and even cover services as complicated as chronic conditions. This is possible because of all the consolidation that is taking place. UnitedHealth had acquired Healthscope Benefits, who are the plan administrators of Walmart. They have also acquired Vivify Health, the remote patient monitoring start-up. So they are able to provide chronic care services via RPM to its newly acquired members directly.

Nov 16th-We cannot talk about innovation without talking about AI. As with all other sectors, it has creeped into remote patient monitoring as well. Companies use machine learning algorithms to analyze ECG readings, vital signs and even facial expressions. It helps them to detect anomalies in real time but also track subtle changes over time. The hope is that such intelligent algorithms will be automatically able to detect symptoms and provide diagnoses for diseases, without human error.  

RCI Takeaway:  This is a vastly unexplored space, uncovered hitherto in RCI. It can be argued that the best is yet to come, as most of AI is still concerned with data analysis and detection of any patterns. As it stands, just this much is quite useful to clinicians, if they are able to orchestrate a self-running care plan, that makes updates based on its own findings. Risks are aplenty of course, and as with all disruptive technologies, the organizational change of roles is a significant barrier to rapid adoption. With many startups now offering such AI solutions, it would be interesting to read an academic systematic review on its efficiency as the space matures.

Nov 14th-Ascension Health System operates a centralized call center and virtualized care, which it calls Ascension Connect. It is very similar to how some other health systems have set up centralized virtual centers, where all patients are monitored from one command base, and appropriate actions are taken depending on real time information coming in from the patient. To enable this collection of patient vital signs, Ascension works with Vivify Health, who were recently purchased by UnitedHealth. Mark Steiger, Director of Operations at Ascension Connect,  gave an interview where he described how the operations worked. Main takeaways are that they make the tablets cellular enabled, to which patient data is uploaded from devices and then transmitted over to the clinicians.  8 nurses have deployed 2000 kits in total, each kit consisting of the tablet fitted with the software and vital signs measuring devices.

RCI Takeaway:  Ascension Health System is USA’ s largest non-profit health system, and so it is important to know how they operate, as they look forward to scaling up the current program. Shipping or handing over the kits to patients is a very common business model used by most RPM companies. What’s interesting is Ascension Connect has full time staff dedicated to managing this project, who educate the patients on the procedures of using the tablet, and also set up virtual appointments for them with nutritionists, social workers, pharmacists etc.  So it’s a case of doing everything necessary to prevent readmission and equipping the patient with healthier lifestyle choices.

Nov 11th-Joshua Claman, CEO of Rimidi, writes on the reasons for RPM’s success on Inside Digital Health. The highlights of the article are that 178 million adults own a wearable device in USA, a 350% jump from just 3 years ago, thus making the market riper for RPM adoption. It also says how studies have shown reduced mortality for those on wireless home monitoring than those without it, thus adding to RPM’s clinical credibility. He finishes the article stating what health systems should consider when making a decision. Namely: Support for Multiple Diseases, Continuous Feedback Loop, EHR Integration and Embedded clinical decision-making support. 

RCI Takeaway:  Rimidi manages several chronic diseases like Aetonix does, so it makes sense to hammer home the point about having clinical expertise in creating specific workflows for specific chronic conditions. It is the one differentiator that stands out the most, the rest are user experience related and have become commonplace offerings amongst vendors. From the consumer’s point of view, we are reminded once again how greater cultural acceptance of wearables have pushed the door wide open for managing patient data remotely.

8th Edition Summary

8th Edition Summary 

It has been a resounding last two weeks for remote care. Legislation changes have favored it, physicians are always warming up to it, and payors are also legitimizing the service by buying out successful startups. There are still problems regarding adoption however, and players in the industry have been combining their resources to strengthen their propositions. But unless such propositions address all technical issues such as integrations with IT and the hiring of new staff, the impetus will be stalled. Specializing in one thing and partnering with a hospital to solve the mentioned issues is still a popular approach. It is very interesting to speculate where things will go from here, but thus far, the global remote patient monitoring market seems to be at pace to surpass three billion dollars in 2024. 

Nov 7th- End-to end solutions are quite the proposition in RPM, a field which involves the collaboration of multiple actors to provide one service. There are those who specialize in hardware, more focused on the monitoring devices and the logistics of setting everything up. Then there are those that focus on just the software, more focused on user experience and data analytics derived from patient data. There are also connected health consultancies that bring it all together. So it was a big news when Validic and Trapollo announced a collaboration to offer comprehensive remote patient monitoring services. Validic supports access to data from multiple devices, while Trapollo handles the device provisioning, logistics and other forms of technical assistance.  

RCI Takeaway:  Validic and Trapollo are specialists at what they do. But for that very reason, synergy between them is all the more difficult. While the desire to provide an end to end solution is respected, collaboration of specialists is not the only way forward. A firm can also be built from scratch that provides an end to end RPM solution, by sourcing the necessary devices, and having a best of class software to handle all the patient data management. Such an entity would be very proficient in delivering an end to end solution, as it was made to do just that. Also, contextualities of hospitals are a factor. The same type of operation cannot be enforced upon every hospital. Hence, firms taking a consultative approach by first partnering with organizations is also a consideration. They would know the hospitals’ workflows better than anyone else, and thus could manage the right hardware and software.

Nov 8th- CMS released the final rule for the 2020 Physician Fee Schedule. The changes have been very beneficial for remote patient monitoring. The two major ones are as following. From January 1st, 2020, physicians will be able to bill for an added 20 minutes per patients who require more than the initial 20 minutes of remote care services. Direct supervision has also been changed to general supervision, meaning that physicians or other qualified health professionals can now supervise clinical staff while not being in the same building at the time of the actual service. 

RCI Takeaway:  All the proposed changes have been accepted by CMS in regard to remote patient monitoring. There were initial plans to replace many current codes, but as they would increase administrative burden, all of them have been maintained to give users more time to habituate billing for them. Indeed, chronic care codes have existed only from 2015, and the remote patient monitoring codes since last year. So the changes have either been additions or relaxations of the requirements. But no chronic care management or remote patient monitoring code was displaced. It is important then, for physicians and other qualified professionals to start billing for these codes, as the knowledge to do so already exists out there.

Nov 4th- In a report released by Spyglass Consulting Group, 90% of providers are in the process of developing or have already developed strategies to increase patient engagement. The goal of such strategies has been to make patients, family members and caregivers play a more proactive role in managing chronic conditions. It is said that chronic conditions such as diabetes and hypertension are very costly to manage if treated in inpatient settings. Hence clinicians are turning towards remote patient monitoring (RPM), consisting of mobiles, tablets, and wearables devices to keep the chronic patient outside of the hospital. The major problems faced in doing so is the lack of integration with existing clinical IT systems such as EHRs. Budget and resource limitations are also major hindrances to RPM adoption. 

RCI Takeaway:  As more such reports come out, it further solidifies one’s belief about remote patient monitoring as genuine modality of healthcare. But it also makes it clear that the problems of yesteryears continue to be thorns in RPM adoption today. A great deal of money has been invested into legacy IT systems by hospitals. Deep integration remains elusive to this day. Also, there is much hesitation in hiring resources such as care coordinators or technicians, who would have a part to play in keeping the patient at home. The beauty of RPM is, it can start to provide value at small installments as well. Greater care plan compliance and patient engagement can be achieved at an individual level. But if scaling up, it’s best to ensure satisfactory integrations and the right staff to achieve optimum efficiency.

Oct 30th- In an undisclosed deal, United Health’s Optum have acquired remote patient monitoring firm Vivify Health. Optum is a division of United Health that provides personalized care and pharmacy services to individuals, and technology to organizations. Vivify has been one of the more successful RPM startups in recent times. The health insurance giant United Health have bought many companies before, and this won’t certainly be the last. It makes perfect sense because, as the payor in the healthcare industry, one would want to minimize costs, and RPM solutions is definitely one way to do that. 

RCI Takeaway:  Integrations are nothing new in healthcare. There is great advantage in the consolidation of vertical operations, where healthcare delivery can be streamlined to the end consumer. Previously, integrated healthcare systems have captured a lot of the market share via horizontal integration. By ownership of multiple types of facilities, one is more responsible for the patient’s journey throughout the healthcare system. Vertical integrations take it one step further in the form of the managed care models, where the health insurance companies have contracts with providers. This not only increases the breadth of care coverage, but ensures timely access as well. UnitedHealth’s latest purchase pushes the envelope further.

 

7th Edition Summary

In this issue of RCI, we notice a shift of outlook from providing care to providing empowerment, not that they need to be mutually exclusive of course. Patients have shown signs of accepting more responsibility, such as the willingness to self-diagnose first, use technology to communicate with their physicians, and use more complex devices that allow them to conduct self-examinations under the remote supervision of a physician. As devices and knowledge centers continue to improve, patients are expected to use the greater convenience and transparency to their advantage. For e.g., nano technology may make data tracking as noninvasive as possible, where patients will be quite content in not having to ever visit a hospital, rather relying on the physician’s expert advice from a distance. But amid all this, what is not being considered is what happens when any patient becomes functionally impaired where they need physical help. Home health agencies and chronic care programs designed for the elderly will provide great insights as to how to manage such a population, which will still involve technology but a healthy dosage of reminders, compliance checks and nurse visits as well. 

 

Oct 25th Remote Patient Monitoring (RPM) owes much of its success to the development of technology over time, especially sensors and wearables. The many collaborations between hospitals and vendors you hear about all involve monitoring patients through wearable devices or sensors. RCI has covered many such instances in the past. Virtually every edition features one such example.  Given the popularity of these two modalities, Dr. Tsao, Senior Technology Analyst at IDTechExcovers the history of this whole space very well in this article. She writes how flexibility, comfort, and low power usage are important features which keep improving in these wearables and sensors. The latest examples of RPM technology cited are: invisible skin patches, digital pills, connected inhalers and smart mattresses/shirts.  

 

RCI Takeaway: Dr. Tsao writes that while some of the sensor technology was borrowed from other industries such as health or fitness, more sensors will be designed in mind for particular diseases in the future. Patient acceptance is a major issue here. Part of the reason why wearables are gathering such momentum in the healthcare zeitgeist so rapidly is that it already gained acceptance into popular culture. But although wearables are sans wires, they can still be clunky. Developing micro sensors seem to be the new wave. For e.g., in a chronic disease (one of the applications of RPM) like diabetes, tiny sensors can now be inserted under the skin, where one’s glucose levels can be continuously monitored. But is acceptance will depend on how noninvasive it is, and what level of comfort it provides to the patient. It will also depend on how adamant hospitals are on adopting and pushing it, especially if it is found to result in better clinical outcomes.  

 

October 22nd Sometimes the greatest environmental shifts are the ones in our own minds. The epic rise of healthcare consumerism has broken down many information barriers, where the patients want to research symptoms, providers and prices on their behalf before any consultations or recommendations from others. A recent survey conducted by ResMed shows how far the willingness to engage has come along due to technology. 60% of patients self-diagnose first over the internet, and over 50 % of them claim a better relationship with their primary care physicians because of technology. 68% of them want this relationship to improve further with the real time sharing of medical information.  Over 75% of them say they felt more assured about their health with the availability of access and information.

 

RCI Takeaway: Technology improving patient engagement is not a surprise. But its positive impact on the physician provider relationship is eye-opening. It shows that patients enjoy their freedom in being able to self-diagnose first, and also access education resources throughout their patient journey to heal faster. But all this does not compromise their communication with their primary care physicians. If anything, they want greater assurance or reassurance in case of health status change from their doctors, which can be conducted in faster and more frequent fashion with the availability of remote patient monitoring platforms.  

 

Oct 16th– North Carolina’s Novant Health, an integrated healthcare system, partnered with Tyto Care to provide their patients with the option of remote medical exams. Tyto Care produces a first in industry all-in-one modular device and telehealth platform. TytoHome is a handheld device which is capable of conducting comprehensive physical exams virtually. Its stethoscope and high definition camera enables providers to listen and see multiple areas of the body from afar for a diagnosis. It can also take temperature and connect via bluetooth to other devices that track vital signs. This partnership enables Novant Health patients to conduct virtual examinations during their virtual visits with providers from healthcare system. This is a significant step in enriching the healthcare experience for the patient. Before anything else, one of the greatest boons odigital or virtual care is its convenience. This deal takes convenience to new heights, by allowing the patient to stay at home, and yet be examined the same way that one would normally see in an in-person visit. 

 

RCI Takeaway: Some advancements in remote care make you think if telehealth is still the correct umbrella term to capture its three most used mediums, video conference, store and forward, and remote patient monitoring. RPM already has separate CPT codes which are not treated the same as telehealth CPT codes. Thus, it is not really seen as a tool for just convenience and speed of access, but rather an integral part of the healthcare value delivery model as well. Similarly, now with Tyto Care, it’s almost as if they are replicating a virtual hospital in the home of the patient with so many examination capabilities delegated to the patient.  

 

Oct 13th– Home Healthcare News’ Valerie Arko brings our attention to a whitepaper written by CDW Healthcare, on telehealth’s role in home health’s future. It cites Ohio Living’s best practices in implementing a RPM program for home health. Ohio Living first evaluates a patient’s eligibility for the program and acquires their consent respectively. It then establishes the services at home by educating the patient on how to use the system via nurses. It keeps a line open for patients to provide updates on their condition. Patients who do not enter their values receive a follow-up contact from a case worker. Those who do not comply with updating procedures are removed from the system.  

 

RCI Takeaway: It’s very interesting how home health agencies such as Ohio Living already have a system in place to utilize remote patient monitoring platforms. At a time when hospitals are interested in setting up chronic care programs for their elderly patient population who are eligible, home health agencies are already running similar programs but billing them  under the prospective payment system (PPS), where the agency receives a predetermined base amount that can be later modified  to reflect the health condition of the patient.  

6th Edition Summary

We continue to see the remote care space evolve into a full-fledged service, where no aspect of care is left undigitized. An important consequence of this is all the data spillover. But even out of that, there is the health IT integration sector brewing, which is set to become the new age EHRs. At the patient level, it must be remembered that the overwhelming majority of them are still used to dealing with hospitals as their first point of contact, and rightly so. Generationally speaking, we encounter enough day to day technical issues whereby a trusted institution such as hospital should still be the primary reference. However, to keep up with the increase demands of care, both in terms of quantity and quality, the hospitals should introduce the patients to the different remote facets of care that are available today. The legal atmosphere is certainly conducive to doing just that, as the legislative bodies are making a push for increased coordination. 

 

Oct 11th Healthcare has spread its long tentacles to attract firms you would not normally associate with the industry. Care teams have the ability to order rides for their patients using Lyft in the same workflow as the rest of the care plan.  Salesforce is partnering with health systems to consolidate data such as medical history, insurance, care workflow, and patient preferences under one unified shared viewing experience. Google and Amazon have pledged to increase data interoperability in the industry by way of sharing data using APIs. Healthcare and Life Sciences industry specialists, Ashwini Zenooz and John Fox make a case for more efficient care traffic control in this Harvard Business Review piece. Care traffic control is a term attributed to Beth Israel Lahey Health’s John Halamka, who uses it to mean the orchestration of care into single pane by integrating data across an increasingly diverse and virtualized environment. 

 

RCI Takeaway: Information Technology knows no bounds when it comes to transforming industries. But on the road to making operations more efficient, multiple partners emerge all which provide some type of value, but all which create more data as a byproduct. Such streams of data have no intrinsic value of their own besides their primary usage, unless they can be unified into one comprehensible interface, which physicians can use to make clinical decisions. We are not all the way there yet. The legacy EHR systems will also have something to say about it. Functionally speaking, it makes most sense for the EHR systemes to assume these integration responsibilities. But if they don’t do it, CRM companies are eyeing the space. 

 

Oct 9th The Department of Health and Human Services (HHS) announced their plans to reform Stark Law and Anti-Kickback Statute to facilitate the provision and coordination of value-based care. At first glance, both these laws are terrific at protecting the system from corruption, where quality of care does not take a backseat to business dealings. But such is the strict nature of regulation, that it snuffs out any level of coordination, even if it is to provide better care for the patient at no extra cost. Examples included are: Shared data analytics between the physician and hospital, the hospital providing cybersecurity services to providers that refer patients to them, and provider practices employing home health aides to better educate patients on medicate adherence via smart pillboxes. 

 

RCI Takeaway: There are many who are equally for and against deregulation. But the current administration has taken steps to advance the progression towards value-based care. It all comes down to this one central question: can outcome be improved if the many care practitioners are allowed to collaborate as they see fit? No one is advocating for the annulment of current regulations.  But in scenarios where it can be demonstrated that a potential collaboration can improve care quality with no added cost, should the business model aspect be left up to the different parties involved with minimum interference? 

 

 

 Oct 8th– Video Remote Interpretation (VRI) is an on-demand service that helps limited English proficient (LEP) and Hard of Hearing (HoH) patients communicate with their care providers via a large pool of qualified interpreters well versed in multiple languages, including sign languages for HoH patients. Prior correlation has been established between non-English speaking patients and care dissatisfaction. Communication is a vital piece of healthcare for proper diagnosis, treatment and patient engagement. Patients that have a great communication experience naturally develop better rapport with their care providers, increasing the likelihood of a positive outcome. 

 

RCI Takeaway:  It is fascinating to consider just how many aspects of healthcare are being stripped from being on-site only. Language is obviously crucial in order to make healthcare work, especially as studies have found less communication errors when using a qualified VRI interpreter, as opposed to an untrained or ad hoc interpreter. Thanks to Stratus Video’s awareness piece about VRI in HIT Consultant, we come to know of a very important problem that can often be overlooked or underemphasized because most of the population is expected to be naturalized to English at some level. And yet,  demography is changing at a fast pace in USA, and globalization is only speeding things up, with facilities adopting a global outlook and staying prepared to treat any person, residents and non-residents. It is important then, for remote care technologies to be equipped with a VRI component if they are to claim themselves as full-service remote care suites. 

 

Oct 4th Tennessee’s Maury Regional Health has launched Maury Regional ondemand, a mobile app designed to provide urgent care when the patient’s primary care physician is not available. It is essentially a case of telemedicine, which uses video conferencing to conduct face-to-face visits with physicians contracted from American Well. The ondemand service is offered to patients at $69 a visit, which is advertised as less costly than an ER visit, and boasts average wait times of 5-7 minutes.  Checking for coverage and filing for insurance is left up to the patient. 

 

 RCI Takeaway: Provider organizations partnering with large telehealth marketplaces like American Well is an expected move. Patients are free to avail tele visits independently of course, especially as there is no innovation in the payment, where they are expected to pay for this service out-of-pocket, and bear the responsibility of checking if they are covered by insurance. But the solace gained from familiarity, i.e.,   staying with the same hospital or health system cannot be discounted. For patients who would never consider telehealth, it is the perfect gateway to get them accustomed to receiving care remotely. 

5th Edition Summary

In this edition, we see the growing role primary care is set to play in healthcare conversations in years to come. After all, in a value-based system, every patient is to be treated in one continuum of care throughout their life. They themselves are more willing to be engaged process if such engagement efforts are being reciprocated by hospitals. Regarding the actual implementation of virtual care however, challenges are aplenty. There is the need for proper integration of new CPT codes to optimize the revenue cycle. There is a need for greater transparency. Most important of all, there is need for greater standardization, so the full benefits of any telehealth program can be realized.   

 

Sep 26th– NEJM Catalyst is one of the best sites out there that create a healthy confluence of thought leadership from healthcare executives and clinicians alike. In a survey they conducted recently, 80% of healthcare organizations say they are proactive in treating chronic diseases. But less than a quarter of them say they use telehealth programs to treat chronic diseases. More surprisingly, only 52% of these organizations say that these programs are effective, which leaves almost one half of the users not seeing the value of it. The article cites examples of where telehealth has worked, and each case involves changing the culture and building the necessary infrastructure. Oschner Medical center improved their chronic disease care by introducing the digital hypertension program. It resulted in 79% of patients reaching goal blood pressure in 30 days. The Children’s Hospital Colorado has also developed a centralized program, to treat asthma. They hope to get more responsive feedback regarding the correct inhaler technique. Delaware’s Christiana Care is working to standardize care for a variety of chronic care diseases, namely: hypertension, diabetes, substance abuse, COPD and heart failure. 

 

RCI Takeaway: Wherever providers are adopting telemonitoring programs, its success is backed by adequate centralization and standardization. For organizations who are not seeing value, it may be a case of not going all in, that is not focusing on population health, not developing the right infrastructure and education around the systems in place, and not changing their workflows to account for greater responsibilities certain care providers may have to accept. Organizational change management is not easy. But there are plenty of examples of providers who have set up remote care for success and not allowed it to be an added hindrance. As laws and consumers alike push for more remote care options, it is incumbent upon providers to make the necessary adjustments. 

 

 Sep 24th Jeff Gorke is an experienced healthcare consultant who has been vouching for the use of telehealth. His latest article is a wonderful short read for anyone who have not opened their eyes to telehealth yet. He does a good job describing what it is, and the three mediums that are under the banner of telehealth, namely: telemedicine, store and forward technology, and remote patient monitoring. As highlighted in the previous versions of RCI, he too cites the lack of quality broadband connection in rural areas and the lack of equal payment parity in all states as disadvantages of such programs. Regarding advantages, he cites the usual positives of telehealth which include increasing care coverage, growing patient revenue and reducing unnecessary admissions and readmissions. He also highlights one aspect of revenue growth most don’t consider, which is follow up visits. Telemedicine could be the first point of contact with physicians, for patients who are in immediate need for an answer. It could be used as a relationship building tool as well. On the negative side of things, Jeff reminds us of an important scandal that we may have missed earlier this month, where a telemedicine CEO pleaded guilty to a Medicare fraud scheme. 

 

RCI Takeaway: Introductory articles to telehealth are still very common. Despite telehealth existing for quite some time now, because it is so dynamic, not everyone is bothered to keep tabs on all recent developments. As a result, the list of pros and cons for going remote continue to evolve. A post capturing the breadth of all such reasons is currently in the works.  Certainly, telehealth platforms can be great touchpoint of care for the patient. It ties back to our point earlier on primary care, where there is a demand from the new generation to avail primary care remotely. Going forward, one must also be wary of fraudulent schemes that involve vendors working out deals with physicians to order unnecessary procedures to defraud insurance companies. One must proceed cautiously. 

 

Sep 23rd– As fee for service payment model is still dominant, it ultimately boils down to the CPT codes. Countless of articles have tried to raise awareness on the three new CPT codes introduced this year, which allow chronic care remote physiological monitoring to be reimbursed. We also addressed this in our article on how physicians can get reimbursed for providing remote care using these new codes. What is less discussed is how these rules came to be finalized. There was an uproar about the codes not being a part of Incident To billing, which allows the same reimbursement for non-physician services as physician services. So it was modified to such that the RPM services could be reimbursable if auxiliary personnel were under direct supervision of the physicians. However, other chronic management codes allowed reimbursement for chronic care services under general supervision, which does not require the physician and auxiliary personnel to be in the same building. To resolve this contradiction, there is a proposed rule for the 2020 Physician Fee Schedule that would delegate the general supervision status to the existing RPM codes. 

 

RCI Takeaway: The introduction of the three new remote physiological codes in 2019 was a big deal, and it can be argued that the care organizations still have not gotten used to it. There is a period of aftershock as people adjust and plan for the new billing opportunities. So it will be very interesting if this proposed rule is finalized and put into place by CMS in the 2020 Physician Fee Schedule. Expect to see a flurry of articles on this subject from all players in the industry, as the new rules makes it an even a more attractive proposition to bill for remote care. 

 

 Sep 19th Sometimes we get so caught up in talking about digital remote care solutions, that we forget a crucial element that is needed for any such program to be a success, i.e., patient engagement. Once, a formidable standalone market by itself, its core functionalities have since been assumed by other sectors emerging out of health IT. Such as: patient portals, RPM, patient analytics etc. There is more focus on outpatient care in recent times, however the fee for service model by its very nature would want people coming in through the hospital doors. But as with all industries, rise of consumerism have resulted in a lot of changes. In a recent report from Ernst & Young, it was found that three quarters of large employers are offering telehealth coverage. More than half of patients and physicians say that smartphones will be the main conduit of healthcare in the coming years. More than half of patients are willing to visit nontraditional care centers for non-urgent needs. 

 

RCI Takeaway:  The introduction of the three new remote physiological codes in 2019 was a big deal, and it can be argued that the care organizations still have not gotten used to it. There is a period of aftershock as people adjust and plan for the new billing opportunities. So it will be very interesting if this proposed rule is finalized and put into place by CMS in the 2020 Physician Fee Schedule. Expect to see a flurry of articles on this subject from all players in the industry, as the new rules makes it an even a more attractive proposition to bill for remote care. 

 

Sep 16th The virtual visits giant, Doctor on Demand has joined the Patient-Centered Primary Care Collaborative. The PCPCC is a coalition to advance a health system built on a foundation of primary care and patient-centered medical home model. While such concepts may have been new in 2006 when the coalition was first formed, most of the public know these things to be part of patient centric value-based care today. Doctor on Demand becomes the first virtual care provider to join the PCPCC. Earlier this year, Doctor on Demand had partnered with the health insurance firm Humana to launch Synapse, a virtual platform for providing comprehensive primary care, complete with ongoing visits, an expanded care team, low monthly premiums and no copay. 

 

RCI Takeaway: It is surprising that no telemedicine company had joined PCPCC before. Changing the healthcare model to be more patient centric fits well with the strategic intent of such telemedicine companies. They too strive to empower the patient whereby they have more choices and quicker access to care, right from their smart phones. In the wake of Doctor on Demand, other companies in the telehealth space, not just restricted to virtual visits, but remote patient monitoring as well, may join the coalition. As PCPCC specifically focuses on primary care, the telehealth vendors perhaps did not want to be pigeon-holed into just one primary care, especially as it represents just 5% of total Medicare spending. But capturing this market is important because it’s a crucial entry point to a new segment of patients who are being introduced to healthcare for the first time. 

 

4th Edition Summary

There is a lot of think tank activity happening right now. Ultimately either the insurance agencies or the government will have to start implementing some of these accountable measures to take the pressure off hospitals. Providing such leadership would help to thaw a convoluted space which any stakeholder is fearing to change at the moment. The payers must use their clout to enact some changes, which once made will be irreversible and etched into the new standard of healthcare operations. From the chronic care angle, the rising elderly population also puts emphasis on the demand for such new patient centric measures. As it stands, the industry keeps coming up with new devices which specialize in the tracking of vital signs, but also the measurement of data concerning certain diseases. They are in a place to scale up if need be. But the government should also make sure that all current regulations are followed, and new regulations are put in place to protect the patients in light of such new telehealth technology. Afterall, one of the big patient centric outcome measures is the safety of the patient. If adequate safety measures are integrated into new patient centric outcome measures, then that would be the ideal scenario. It would ensure that the rapid change that is happening  is not offset by a disregard for safety. 

 

 Sep 12th Duke’s Margolis Center for Health Policy is a perennially top 10 ranked public health school in USA. They recently released a concept paper on the future of Patient Centered Outcome Measures (PCOM). While there has been a lot of talk about how to move forward on increasing accountability of care, things have not moved as fast as people would expect due to many reasons. Chief among them are are: the lack of outcome measures themselves, the lack of systematic approach to retire low value measures, existing focus on point of time estimates and not longitudinal assessments, and lastly unfair and undue burden on the providers to do it all. The concept paper breaks each point down into further details and is a must read for all public health enthusiasts. 

 

RCI Takeaway: The fee for service (FFS) model is not going away anytime soon. It can be argued that in some instances, the model is necessary. But everything that is going on with the development of alternative payment models is to address the very inefficacies of the FFS model. In particular, Centers for Medicare and Medicaid Services’ (CMS) Meaningful Measures framework contains 6 priority domains which should be scrutinized. It provides a great starting point for the categorization of PCOMs in the future. The 6 domains mainly talk about reducing the burden of care, achieving cost savings and improving communication and coordination of care to achieve greater outcomes and access. 

 

 Sep 10th There are many components to remote care. But the most exciting one is technological capability for a lot of people. For a moment, one can let their imaginations run wild and just envision what can be achieved remotely via technology. The Center for Bio-Integrated Devices at Northwestern University are doing some incredible research in this field, and two examples of their work for local hospitals is shared in the Chicago Health Online magazine. The first is the epithermal sensors which are used to monitor patients recovering from stroke. The band aid like sensors attach to the skin and are able to monitor all vital signs, plus motion and speech. The second is the ultrathin waterproof sensors which are used in the Neonatal Intensive Care Units to track vital signs of babies, without the hassle of any wires attached to them. 

 

RCI Takeaway: Such advancements tie back to the usability aspect of RPM devices, regarding how they must be tested for human factors. Indeed, it’s seen that the less invasive a particular device is, the better it is for both the patient and clinician. Not only does it enhance the ease of care deliverability, but it removes the social stigma outside hospital settings, where one may not want to be seen with very visible medical devices on them. More advancements will sprout in the future for sure. This isn’t the first time such news is shared on the RCI. More bio integrations will be the order of the day. 

 

Sep 9th More interesting projects on remote care delivery between university health centers and the industry continue to happen. Brigham Young recently conducted one such study on home care patients which found that they slept better and were more physically active than patients in a hospital.  But just as the lack of rural access to reliable and speedy internet is a hindrance for remote care, so is the user experience gap. Senior Human Factor Engineer Katie Cornish informs us of such a concern surrounding RPMs, which is their usability. It is amazing to learn the concept of Human Factor testing, and just how many variables have to be taken to account when designing a medical device that will not result in errors or negligence due to human use. Socioeconomic intelligence factors such as social acceptability and learning curves, direct user experience factors such as dexterity and vision, and environmental factors such lighting, temperature, and humidity levels all need to be taken into account. 

 

RCI Takeaway: While RPM steamrolls ahead with more deployments seeking to monitor different types of patient data, it is important to remember all the dangers that could make such experiments problematic. There are always two sides to a story, and Aetonix believes in transparency while depicting the full picture. An article listing all the disbenefits of telehealth is in the works. But every area of concern is an opportunity to fix the chinks in the armor that currently exists in the delivery of virtual care, and provide a solution that will more readily be acceptable by all. 

 

Sep 5th Suffering with chronic ailments can be difficult enough, but the seriousness of the situation is felt more by those living in rural areas. Healthcare Informatics consultant, Reza Chouddani reminds us of one of the greatest drivers of growth in this sector, i.e., the need for serving rural communities. Rural areas have a shortage of physicians. Remote care thus helps connect patients to physicians via virtual visits and follow ups. For the elderly, for whom commuting to critical access facilities can be challenge, remote monitoring enables them to stay in their private homes or nursing homes, where a nurse can visit and coordinate care for them with the physician. Additionally, many of the RPM solutions have some sort of fall detection feature, as wandering and falling are common risks associated with the elderly who may be suffering from dementia and lack of mobility respectively. In such situations, a readymade turnkey solution to connect them to care as soon as possible is helpful. 

 

RCI Takeaway:  From a provider’s perspective, it should not matter where the patient is located if a robust RPM strategy is in place. A city dweller could just as easily take advantage of the service, as could someone residing in a rural area. It’s just that rural areas have poor connectivity to the internet. This is where the governmental communications and healthcare bodies need to collaborate. Federal Communications Commissions (FCC) chairman Ajit Pai have been very vocal on his part, to ensure that telehealth coverage is increased in rural areas. Task forces to better understand broadband connectivity have been created. 

 

 Sep 4th More research has come out confirming what we already know to be true for the elderly population residing in USA, that they are set to further fuel the demand for chronic care. Berg Insight is a Swedish market research firm that specializes in technology. They forecasted the growth of chronic care management at 18.3% per year, for the next 6 years. Out of the 117 million adults suffering from one or more long term chronic care diseases, Remote Patient Monitoring (RPM) is set to reach 47.4 million users by 2024. The next two largest segments are the medical alert response systems and medication management, which are set to reach 4.3 million and 3.2 users respectively. We are informed of these numbers thanks to a press release from MobileHelp, where these statistics from Berg Insight are cited. MobileHelp is one of many companies in the sector who provide all three services of RPM, PERS (Personal Emergency Response System) and Medication Management or Adherence solutions. 

 

RCI Takeaway: Indeed, tracking of vital signs, medical alert systems in the form of personal emergency response systems (PERS), and medication management features have become essential in every RPM solution. It’s usually the case of the respective vendor having a software to manage the application of such functions, and hardware in the form of wearables to capture patient data, and a tablet to run the software. The three aforementioned functions have become the bare minimum constituting the core functionalities of most solutions in this space. 

3rd Edition Summary

We see that everybody, from big tech companies, to device manufacturing specialists, and also academic institutions are interested in a slice of the virtual care market. And why not, since it’s still an area where there is much exploration left to do. Medical device makers are continually adding features to their products which transform them from transactional to relational. University medical centers are on the lookout for collaborators in the form of these companies, who seek to optimize care for a patient population by remotely tracking their life forces. Large tech companies are interested in releasing products that impact the way people think about health, where everything begins from a prevention perspective. There is still room for further collaboration between interested bodies. As it stands, it is still a very fragmented industry. Once the discovery stage is over, there shall be more consolidation.   

 

Aug 30th Another area of care that has been adopting more remote care solutions is Otolaryngology, particularly ear care. Hearing aid devices have gained mass popularity over the years and have become a staple of ENT care. Thus, it’s a natural development in this area to enable those hearing aids to be equipped with tracking ability, which not only enables hearing but collects bio signals from the patient to better monitor the situation. Prime example is Widex Remote Care’s EVOKE, which enables the wearer to optimize their listening experience by comparing and selecting different versions of sounds in real time.  In a study involving 9 countries, and 118 participants, people reported greater satisfaction in their listening experience with EVOKE in different listening circumstances. In this sponsored article by Widex Remote Care in the website Audiology Online, the connection is made between increased satisfaction levels of patients and greater referrals to the care practice. 

 

RCI Takeaway: Thus far into the third edition of RCI, we come across different care departments, and how they are adopting remote care in their operations. Following that same though current, it’s interesting to notice that hearing aid technology is not just being left up to the consumer anymore. Rather it is being used as a hub for two-way communication between the patient and the ENT doctor. Hearing aid as a device is perhaps not associated with remote care as much as some other devices are, because it is perceived as aid and not care. But in the future, if certain breakthroughs are made in this field, where hearing can not only be salvaged, but improved, then the potential of hearing aids as remote care devices will shoot through the roof. Such an occurrence will further necessitate the communication between the patient and doctor, and the earpiece will be the focal point of care. 

 

Aug 28th There are many academic-industrial partnerships fostering when it comes to the testing of RPM solutions. Just as we saw with the partnership between Stanford and Apple, Atlanta’s Emory University and California’s VIVALnk are working together to deploy an ECG patch. The objective is to monitor patients who have undergone coronary angiography outside the hospital in 72 hour stretches. The rechargeable ECG patch is the size of a small bandage. It features an electrocardiography sensor and accelerometer to capture various electrical activity and thereby improve care for coronary artery disease.  This project is a follow up on the finding that lower heart variability causes subclinical myocardial ischemia. 

 

RCI Takeaway: Despite the large tech entrants into the space to reduce costs and standardize care as we saw earlier, wanting to improve patient outcome is just as important trigger when it comes to the adoption of remote care solutions. It is also an area where there is greater convergence of interest among universities and hospitals, as the former seeks to publish papers in this field, and the later seeks to use the evidenced based studies on its patient population to achieve better outcome. It’s not that other companies could not have done what VIVALnk did, but it’s that VIVALnk cared enough to position themselves in the cardiology sector, thereby building the type of relationship that it with cardiology practitioners in healthcare. The future development of such particular care areas will be fascinating, as further studies reveal new insight, and newer RPM deployments in turn act on those very studies to unearth new findings, thus continuing the cycle of evidence and practice. 

 

Aug 26th The U.S. Food and Drug Administration (FDA) has cleared Biobeat’s patch and watch which track vital signs and upload them to an app through which they be accessed by appropriate healthcare providers. Biobeat’s devices allows for the tracking of temperature, blood volume, electrical conductance of the skin, blood pressure, arterial pressure, pulse and respiratory rate, etc. via continuous and real time measurements.  The Israeli company considers the FDA approval as a significant step to its expansion in the USA. Arik Ben Ishay, founder and CEO of Biobeat, is excited about the “tremendous opportunities” this “clearance opens up”. 

 

RCI Takeaway: It is interesting, that every now and then, there is news about the FDA clearing a RPM solution. But unlike HIPPPA, one does not see a FDA approval being included in a company’s promotions as much. It seems then, that most of the RPM solutions that are out today are approved, but not cleared. An approval is sufficient for marketing purposes inside USA. It includes a premarket approval, which demonstrates that a device is safe,  or a Humanitarian Device Exemption (HDE) which demonstrates that a device is intended to benefit patients in the treatment or diagnosis of a rare disease or condition that affects not more than 8,000 individuals in the United States annually.  As chronic disease is not rare by any means, I believe most RPM companies out there have the premarket approval, through which they make the list of approved medical devices.  Very few of them however, have a clearance, for which one must prove that a medical devices is substantially equivalent to a device already existing in the three device classifications. Thus, a clearance is worn like a badge of honor. 

 

 Aug 22nd  Versatile Med’s Lisa and Jerriene do a great job at picking out some eye-popping stats from Deloitte’s recent report titled Accelerating the Adoption of Connected Health. Connected Health of course is yet another name for telehealth, with virtual care, digital health, mhealth, and remote care all being similar monikers. It would be great to make an infographic one of these days highlighting the nuances and definitional coverage of each.  But whatever it is, remote patient monitoring stakes out a very important place for itself in the grand scheme of telehealth. Over the next quarter of the century, remote patient monitoring is expected to save $200 billion in healthcare costs globally. Pertaining to inside USA, federal healthcare spending is fast approaching 20% of GDP. Chronic care accounts for most of this spending, with it being 3.5 times more expensive than other forms of care and the leading cause of hospital admissions at 80%. As more RPM programs are projected to be deployed over the next few years, the article makes a strong case for analytics being a major component of the respective programs. 

 

RCI Takeaway: Telehealth is not just one device, or one type of technology. It’s a paradigm shift, and thus pulls with it an ecosystem of products and services that all complement each other. As hospitals are hiring an ever-increasing number of analysts, not just to analyze revenue cycles and reimbursements, but also patient populations, having the right tools in place will become very important to achieve accountability for these programs.  Where there is general consensus building up that telehealth can drive improved patient outcomes, this proclamation still needs to be supported by monitoring certain data from the patient population. As RPM companies mushroom to counter the rising costs of chronic care, they must also be fitted with proper analytic capabilities to show improvement. Or, such a gap in the market will be filled by healthcare analytics vendors, who exclusively analyze data but do not provide the software or hardware through which RPM takes place. 

 

Aug 19th Due to rising healthcare costs, the mega tech companies of USA have swooped in to make a splash in the healthcare industry, trying to win a chunk of its business. Standford University’s Alyssa Rapp covers the most noteworthy activities of such tech giants, as technology and healthcare fuses together to drive down costs. Amazon’s voice assistant Alexa is now HIPPA compliant, and that means patients will be able pull up medical records, and schedule doctor visits or appointments on voice command. The Apple Watch 4 can detect atrial defibrillation and is an example of the latest on wearable technology. It is not an untested feature either, Apple had collaborated with Stanford University in a study involving 400,000 participants. It was determined that Apple can reliably identify heart rate irregularities.  Google for its part, has the Cloud Health Care API, a highly interoperable EMR system based in the cloud. Having such a system based in the cloud comes with all the benefits that we know cloud architecture to have, i.e., ease of access and collaboration amongst various healthcare practitioners. 

 

RCI Takeaway: Three of the Big 4 tech companies of USA, have been making some sort of noise in telehealth, using their respective strengths. The day may soon come when Facebook also decides to get in on the act. It has already dabbled in mental health aspects in the past, attempting to prevent suicides and tackle opioid use. It seems that any company out there with any type of technology clout will have something to say about the rapidly evolving field of telehealth. What ultimately gets traction is dependent on many other things such as the legal and cultural landscape. But because virtual care is a product of the advance of technology, it is only natural for companies who have tech as their core competence to be interested. 

2nd Edition Summary

It has been an eventful two weeks. There is pressure to innovate, from other health systems, from smaller health companies, and even from the government. Whether that innovation takes shape in the form of remote care or some other technology remains to be seen. Video visits have gained popularity in no time, and other technology such as patient engagement and remote care monitoring are hot on the heels. But depending on the exclusivity of the functionalities each product offers, there may be a call for greater consolidation and standardization. But even if that were to happen, there would be smaller clinics and unorthodox healthcare organizations filling in the vacuum of specialized care that consumers seek. The type  that can be only provided by using new age tech services. Perhaps the healthcare model can accommodate all these different players, but the coordination a patient’s journey can be left up to the hospital, which is a huge task onto itself, but a valuable one. 

 

Aug 13th This change of legislation is pertinent to one state, New Hampshire, but it signifies a larger trend that may well unfold in the future. New Hampshire’s Medicaid program expanded its coverage to primary care providers and pediatricians. Previously, it was restricted to specialists. Governor Sununu signed the law which will go into effect in 2020. New Hampshire joins 20 states whose Medicaid programs reimburse for remote patient monitoring, and 11 states who reimburse for Store & Forward. If you are curious about the third major type of telehealth visit, all states’ Medicaid programs allow reimbursement for video visits, except Massachusetts. These numbers were collected from the Center of Connected Health Policy. 

 

RCI Takeaway: One of New Hampshire’s cited motivations to do this was that it wanted to keep up with the  rest of the states. This signals strategic intent, as for Remote Patient Monitoring and Store and Forward mediums of telehealth, the majority of states’ Medicaid programs have still not come on board. And yet, New Hampshire recognizes that this will happen sooner rather than later.  They sense that the further thawing of the regulations seem to be on the horizon, not just because the administrators want to increase the quality of care, but because they want to cut costs as well. Wherever the tax payer’s money is involved, the government is always under pressure to be accountable.   

 

Aug 12th New studies are always coming out on telehealth. It’s apparent that people want to scope the market that exists currently, and its future potential. One of the best companies producing such efforts is Definitive Healthcare who routinely conduct research on hospital executives. They have some eye-popping numbers to report in their fifth annual inpatient telehealth study. 70% of all healthcare facilities (includes, hospitals, health systems and academic medical centers) are using two-way video technology, mostly between physicians and patients, a 23% jump from 2016. Population management tools such as SMS text and remote patient monitoring also grew, albeit more slowly. 12% to 19% and 8% to 14 % in the last three years. Patient portals market shrinked from 48 % to 40% in the last 4 years, probably due to patient engagement software substituting some of the same core functionalities offered by these portals. One other important finding is that while less than 10% of organizations have telehealth facilities like the virtual centers previously discussed in this report, another 10% of organizations are currently building such a center or are looking to do so in the future. 

 

RCI Takeaway: It is apparent that hospitals are feeling the heat from the vast e-visit marketplace, and hence why video technology received such a great boost in uptake from past years. For other remote offerings, the climb is still slow but steady. There don’t seem to be any triggers yet that may expedite the process. Especially as patient awareness about telehealth services among consumers is still low. But if innovative providers backed by physicians strategize to educate the patient on such services, then it may cause a chain reaction where other bigger health systems do the same. Investment on standalone telehealth centers seem to be the endgame, but it must start with using more of patient engagement and remote monitoring software. Once the staff feels comfortable enough in integrating such services into their healthcare practice, only then will the conversations swing to centralizing the management of all these technology in one place  

 

Aug 12th This piece of news is very timely, as it is yet another example of a hospital that is innovating on the virtual front. Much like Mercy launched its 4 story Virtual Center 4 years ago in Missouri, CHI Franciscan has launched what it is calling the Mission Control Center” where virtual care is being assigned a separate facility. Located away from all other hospitals in the CHI Franciscan system, the facility is situated in Gig Harbor, Washington. It’s a glass walled room with a wall of twelve screens facing rows of computers, in what resembles an actual mission control center, like the ones NASA operates. What CHI Franciscan is doing is truly unique, as they are not trying to solve just a remote care need, but solve an operations problem. For large health systems such as CHI Franciscan, coordination of operations between multiple healthcare facilities of various sizes and multiple healthcare providers of various specialties is crucial. Thus, there are tremendous efficiencies to be gained, if such coordination is centralized, which is exactly what the Mission Control Center at Gig Harbor aims to do. There are wall tiles showing patient flow, bed capacity, and care progression. The idea is to be patient centric where each patient’s journey through the health system is tracked as they wait for imaging, procedures or services.  According to Mission Control Center Director, Jessica Schlicher, the end goal is to increase care capacity, decrease wait times and enrich patient experience as they interact with the system to get the care they need. 

 

RCI Takeaway: Often in conversations about reaching patients, we get lost in translation about how it all relates to operations. Technology helps bridge the gap between patients and physicians, but does it complicate or simplify healthcare operations? That is the question CHI Franciscan answers with their design of the mission control center at Gig Harbor. While they built the whole thing to solve an operational need, they also have staffed it with nurses and physicians with over a decade of experience, ambulance dispatchers and transfer managers. So it is possible to remotely on board a patient, get the clinical expertise that is required, and formulate and execute a care plan for a patient. So it’s an instance where operations is simplified while still extending the hospital’s reach. It definitely is a model worth watching out for in the future. 

 

Aug 7th It is interesting to hear how telemedicine improves patient outcome as a whole. But companies are not just specializing in remote care, which by itself would be a unique selling point perhaps a decade ago, but they are now positioning themselves as experts in certain clinical areas. One such company is Seattle’s Gennevea telemedicine clinic for menopause. Eye-opening is the fact that menopause care can be expensive. HIT Consultant’s Jasmine Pennic writes that it can cost on average $20k for 4-10 years of menopause care for women going through that phase. So then, Genneve has found a great market segment to provide value-based care to. It charges $65 and $45 for doctor and nurse practitioner consultations respectively. Insurance is accepted for prescriptions only at this time. 

 

RCI Takeaway: Where there is a market, the demand will naturally dictate things. Thus, if patients see that traditional hospitals are not valuing certain conditions the same way that they do, they will look to receive that care elsewhere. Services that add value to the community, such as Genneve’s free access to physician informed blogs, enhances that reputation of the care giver in the eyes of the consumer. Healthcare seems to be getting more and more decentralized. Hospitals must find a way to reach patients, and not make assumptions on the level of care that is sought. After all, treating menopausal symptoms costs $248 a year, excluding prescriptions. But it seems that the actual patients themselves seek a level or personalized care that can easily surpass that price tag.    

 

Aug 3rd There are many providers launching virtual care facilities. Anne Zieger has been reporting on healthcare for three decades.  She has covered Missouri’s Mercy Virtual Care Center, Intermountain Healthcare’s Connect Care Pro, and LifeBridge Health’s Virtual Hospital in Baltimore as prime examples of virtual facilities expansion in the past 4 years, with LifeBridge Health as the most recent case. LifeBridge Health’s Sinai Hospital in Baltimore uses clinical call centers to deliver patient care. Nurses and practice providers staff the call center in Maryland, and two international call centers handle the more administrative related tasks such as prescription refill requests, scheduling appointments, and transportation. Video conferencing allows nurses to conduct triage screening, while doctors simultaneously attend to the patient and use e-portals to request and review tests, access nursing notes and develop care plans. Using videoconference, e-portals and call centers not only increases care coverage, but has increased patient throughput as well. Jonathan Thierman, CMO of Sinai Hospital, says that the virtual care program sees 1000 patient cases monthly.   

 

RCI Takeaway: From Anne’s past and most recent post, there seems to be two ways of going about integrating virtual and hospital based cared. You can do what Mercy did, and offer a full-fledged virtual care center which is a hospital without beds, and yet operates an e-ICU, a Telestroke department, an e-visit department and a home monitoring department. Or you can do what Intermountain did by introducing 35 telehealth programs for all its hospitals in Connect Care Pro. They supplement the system’s existing care options, so patients could have access to more specialized care on demand, especially in rural areas. This LifeBridge Health Sinai Hospital example seems to be somewhere in the middle where the technology used does not have a separate building to manage it as with Mercy’s Virtual Care, but they are not treated as add-ons to existing care as with Connect Care pro. Rather Sinai Hospital’s Virtual Hospital integrates technology to its existing hospital infrastructure and operations.   

1st Edition Summary

This edition’s news timeline shows that there are a multitude of survey studies coming out on telehealth which report increasing signs of adoption, albeit at a slow pace. The two areas where the intake is a bit faster than others is in remote patient monitoring(RPM) and chronic care management (CCM). The thought leaders seem optimistic enough by the sector’s growth potential, and this is further corroborated by the state and federal legislatures who are continuously pushing for more remote care integration into mainstream healthcare. However, for the aforementioned bodies, it is more about reaching the underserved populations and less about innovating digital care. Healthcare marketing has a huge role to play as well about educating the masses about availing and maintaining care from afar. 

 

July 31st- J.D. Power, the market research company conducted a survey on telehealth consumers as a preparation for a much larger benchmark study on telehealth satisfaction later this year. They found that young female patients aged 18 to 24 used telehealth services more than any other group, at 13.1%.  40% of consumers wrongly said that their providers do not offer telehealth, and 34.6% of them said that they weren’t sure. Only 17% of consumers were aware that their providers offered such a service. 

 

RCI Takeaway: Fears of errors, access, privacy breaches, state licensing are all supply side issues that are limiting the access of remote care currently. But from the demand side of things, it is the lack of awareness that is holding telehealth back. 

 

 

 

July 29th There is much noise on coordinated care these days, especially from the more complicated diseases that require such type of care management. Cancer Treatment Centers of America joined in on the chorus by putting a comprehensive care plan for cancer on its website.  It introduces the various aspects of the treatment journey a patient may experience via the care manager. It is interesting to observe the patient’s journey through the point of view of the care manager, who is the designated go to person. 

 

RCI Takeaway: Care coordination has a major role to play in delivering the healthcare of the future. Different departments may have different approaches to it. With the advent of technology, it is easier to assign one person to be a patient’s point of contact where that patient may be transferred to other care givers seamlessly. 

 

July 26th The MD Magazine interviewed Tabassum Salam, MD, American College of Physicians (ACP) vice president for medical education. She lauded the use of telehealth practices. Arguing for telehealth’s ability to reach the most at risk patients, she said “It’s a physical or emotional strain to leave the home and go to a doctor’s visit and the likelihood of those patients adhering to those appointments is low.” 20% of ACP physicians used video visit technology weekly, compared to 50% of them who reported using remote patient monitoring weekly. Adoption is not  any faster due to fears associated with the technology. Manish Shah, MD,  Vice Chair of Emergency Medicine Research at the University of Wisconsin-Madison School of Medicine and Public Health, spoke of high intensity telemedicine. In such scenarios, to mitigate the fear, technology would be coupled with technicians who would record the necessary information from patients by going to their house and using the monitoring devices. 

 

RCI Takeaway: Remote care management via telehealth is a potential hotbed of innovation currently. The main barriers that exist are related to mistrust of technology due to errors or uneven access. But as technology improves, the basis of such fears seems to be dissipating.  Especially, in remote patient monitoring which has become an integral component of healthcare, both in inpatient and outpatient settings. 

 

July 25th The Bipartisan Policy Center is a think tank based out of Washington DC that promotes bipartisan policies, generating consensus by pooling the best ideas from both sides of the aisle. It has been actively fighting for those with chronic care ailments. In its latest health policy recommendations to congress, it proposes specific policies that would enable greater integration between Medicare and Medicaid, so those dually eligible beneficiaries suffering from chronic ailments can get the care they need.  They want individual states to be able to retain a greater share of Medicare savings that is attributable to the integration of services, which would incentivize greater collaboration between the two CMS programs. In addition, congress had approved the Medicare Advantage insurance plan to offer special supplemental benefits for the chronically ill (SSBCIs), starting in January 2020. The Bipartisan Policy Center recommends that necessary materials are made to educate providers on SSBCIs. 

 

RCI Takeaway: While healthcare policy has been slow to take effect, the noose around telehealth services, especially as it pertains to treating chronic ailments, is loosening day by day. All arrows point towards a more integrated healthcare system, where governmental agencies work together to provide care to whomever is in most dire need of it, and provide it in adequate amounts where the patient can live their lives in a healthy manner. 

 

July 22nd FAIR Health, a non-profit organization focusing on healthcare transparency, released a white paper on telehealth. It had some very interesting findings. While telehealth grew by 624 % from 2014 to 2018, the majority of it was accounted for by non-hospital based provider to patient telehealth, at 84 %. Acute upper respiratory infections was the most common reason cited for seeing a non-hospital based provider. In the same period from 2014 to 2018, the 31 to 40 age bracket were the largest users of telehealth, at 21% of all telehealth claim lines. However, for post discharge provider to patient cases, 82% of the claim lines consisted of those 51 and older. 

 

RCI Takeaway: We can infer that Telehealth’s popularity is mostly due to providers directly providing care to patients, creating a virtual market outside the hospital. But as patients grow older, they have a higher likelihood of coming into contact with hospitals, and remote care delivery post discharge might be an essential component of their care plan.