Home Sweet Home: How Remote Patient Monitoring Can Help Sustain the Shift from Brick and Mortar to Remote Care
Nearly 90%. When it comes to investing in remote patient monitoring (RPM), 88 out of 100 clinical informatics and health IT thought leaders expressed interest when surveyed for a Spyglass study conducted at the end of 2019.
The impetus at that time related to aligning with the shift to value-based care.
“88% of providers surveyed have invested or are evaluating investments in RPM technologies to support high-risk chronically ill patients whose conditions are considered unstable and at-risk for hospital readmissions,” the study concluded.
Then, COVID-19 hit and the healthcare system was turned completely on its head.
Faced with the need to provide care for non-COVID patients without exposing them to the virus—while also reserving in-patient resources that were in limited supply—RPM and other telehealth technologies quickly became the temporary backbone of the healthcare system for providing remote care.
But will these advancements stay temporary?
As the Spyglass results indicated, the shift to value-based care already had healthcare organizations on the hunt for innovative ways to meet the Triple Aim of improving the patient care experience, improving population health management, and reducing the costs to do both.
When the pandemic hit, the scramble was on to do what was needed to meet patient care needs and keep everyone safe.
That meant a number of regulatory and reimbursement changes for the duration of the public health emergency (PHE) that blew the telehealth door wide open and changed the way providers and patients engaged with each other—perhaps for good.
More recently, the U.S. Centers for Medicare and Medicaid Services (CMS) signaled an even greater penchant for home when it launched its Acute Hospital Care at Home program.
When you add moves like those to the aging of the massive baby boomer generation; a rise in chronic diseases; a looming shortage of physicians; and a growing array of remote patient monitoring technologies—RPM becomes an appealing option for healthcare leaders.
However, it will take more than mere interest to make the most of all that RPM offers within the momentum toward home.
Defining Telehealth and Remote Patient Monitoring
To lay a telehealth foundation, we start with Dr. Joseph Kvedar, a Harvard Professor, Senior Advisor, Virtual Care at Mass General Brigham and Chair of the Board for the American Telemedicine Association (ATA).
In Telehealth: Where it Works and Where it Doesn’t, Kvedar defines telehealth in the context of a “two-by-two grid” with several dimensions.
— Bill Russell (@BillRussellHIT) March 1, 2021
When it comes to defining RPM, one way to do so is by apply components of the ATA’s definition to commonly asked questions about this specific type of remote care:
What is remote patient monitoring?
According to the ATA, “Remote patient monitoring is the collection, transmission, evaluation, and communication of individual health data from a patient to their healthcare provider or extended care team from outside a hospital or clinical office (i.e., the patient’s home) using personal health technologies including wireless devices, wearable sensors, implanted health monitors, smartphones, and mobile apps. …”
How does remote patient monitoring work?
As the ATA definition indicates, what differentiates remote patient monitoring from other telehealth applications is the use of some type of “personal health technology” to collect patient biometric data outside of traditional healthcare settings and then transmit that data to clinicians to provide insight into a patient’s status to inform the plan of care.
Why is remote patient monitoring important?
The ATA puts it this way: “…Remote patient monitoring supports ongoing condition monitoring and chronic disease management and can be synchronous or asynchronous, depending upon the patient’s needs. The application of emerging technologies, including artificial intelligence (AI) and machine learning, can enable better disease surveillance and early detection, allow for improved diagnosis, and support personalized medicine.”
Keys to the Success of Remote Care
Telehealth and remote patient monitoring also fall within the even broader category of digital health.
In Making Digital health Gains Last, Dr. Kaveh Safavi and Brian Kalis of Accenture shared results from the consumer-focused research they did regarding digital health adoption both pre- and post-COVID.
“What we found was that COVID forced a surge of adoption and the use of technology to help people with their health care. …And that was really because of necessity. People needed to shelter in place and stay safe in their homes. As a result, you were seeing clinicians recommending a set of digital technologies as a way to diagnose and treat as well as manage their health,” Kalis said.
Commenting on the previous plateau in digital health use, Safavi said their study actually identified three specific variables that influenced this dynamic:
- User experience: “If you have a bad experience, you don’t use it again.”
- Physician recommendation/adoption: “If your doctor doesn’t recommend it…you don’t use it.”
- Trust in privacy and security: “If you don’t trust who has the data,” you don’t use it.
In terms of what will make digital health adoption stick in the days to come, Kalis said leveraging on a variety of fronts will be essential.
“One key thing we need to do to make a digital adoption stick is really leverage the trust of clinicians to get those trusted recommendations to consumers. What we found prior to COVID is that a majority of people really wanted their clinician to recommend quality solutions,” he shared.
Safavi said another key factor is providing solutions for physicians that are helpful for them. Physician recommendations for use can be very important for the adoption of digital tools like remote patient monitoring.
“If there’s no natural way to fit it into the day, then it becomes a distraction to the way the doctors are working. …So the more we can address those [issues], the more likely it is that they’re going to use it,” he said.
The patient experience is also key. Seamless devices and technologies that help, rather than hinder, the remote care experience will go a long way toward adoption by both patients and providers.
In the past, remote care enabled by virtual technologies has often been viewed as a “nice to have,” rather than an essential component of providing quality care. But now, COVID-19 has changed everything.
“Physical distance as a requirement and a benefit is now in the calculus for virtual. It used to be that you thought about virtual healthcare and you have to do a return on investment and it was strictly either access, preference, or financial. Now safety is a new return on investment calculus because I think our society is now accustomed to the concept because of this pandemic,” Safavi said.
They both noted that increasingly incorporating digital into the model of care will lead to challenges as well. As they pointed out, it will be important to address the “digital divide” among consumers, who are not benefiting evenly from digital health due to limited access to broadband and various technologies.
Kalis sees the opportunity to “lead the way” in terms of digital disruptions in healthcare as coming from “incumbent health organizations” that are taking current lessons learned and using them to rethink care models in terms of both delivery and financing.
“In many cases that will also [happen] through collaboration with many of the non-traditional entrants that are entering into the market as a way to complement to create a new ecosystem,” he said.
Supporting Care in the Home
In Supporting Care in the Home, Edwards described Quil as offering a consumer engagement platform for Comcast subscribers that’s available on televisions, tablets, phones, and through the web.
“What we do is we help consumers and the caregivers who support them organize and navigate their health life. But we do it in partnership with provider organizations and payers. So our clients include large health systems and large payer organizations. We’re putting the platform to use in bringing turn-by-turn directions to the consumer as they’re navigating different episodes of care in their health life,” Edwards said.
She said when the pandemic first hit, her organization stayed true to its “How can we help?” mentality—which fueled a sense of purpose to do what was needed to support the shift to home in a variety of contexts.
#Leadership during #Covid is grounded in a "how can we help" mentality. For Quil, helping is more than just tracking symptoms — it's also advocating #selfcare and #mentalhealth as we navigate the immense changes around us. –@cedwardski on @ThisWeekinHIT https://t.co/X72sSNljq9 pic.twitter.com/urUM0yGx1N
— Quil (@QuilHealth) November 20, 2020
Discussing the explosion of devices and shift to providing care in the home, Edwards said:
“I think COVID accelerated the use of digital technology beyond the virtual visit. The virtual visit is nice…[but] how does it actually integrate to the workflow? And then how do you monitor populations at scale?”
In this light, Edwards underscored the need for devices that simplify these processes, support scalability, and can be easily integrated into clinician workflows to optimally support patients.
Noting that technologies that support remote care have undergone rapid changes in response to the pandemic, Edwards said it’s essential that issues such as security and data privacy are adequately addressed.
In this excerpt from her interview, Edwards offers further insights into how their program works.
Remote Care Needs Value-Based Care
One incumbent health organization that’s taking lessons learned and using them to rethink care models is Geisinger. There, innovation efforts are led by Dr. Karen Murphy, Geisinger’s Chief Innovation Officer.
In How COVID-19 will Influence Digital Strategy Post-Pandemic, Murphy discussed the keynote address she gave at the HIMSS Accelerate Health Series about the four lessons healthcare systems have learned during the pandemic:
- We’re more flexible and resilient than we thought.
- Innovation can be achieved in hours and days, rather than months and years.
- The importance of data, predictive analytics, and other digital strategies to enhance response.
- Shifting from fee-for-service to value-based payment models is essential.
Murphy said digital tools such as virtual health and remote patient monitoring were key to helping to transform care in a way that made it possible to stay in touch with patients, particularly those with chronic diseases.
“I think after the pandemic we are going to have to really think about [identifying] the value and identify where the value is.”
She explained how her past experience as a policymaker verifies the need to do so.
“We really have to demonstrate in the post pandemic world, where does virtual health sit? Where does it produce the greatest outcomes? Where does it lower the total cost of care?”
When it comes to remote patient monitoring, Murphy emphasized the need to be selective in how these technologies are applied.
“We shouldn’t monitor every patient just because we can. We have to figure out what type of remote monitoring transforms care and delivers higher outcomes,” she explained
Referencing the potential for remote patient monitoring applications, she said a critical factor that will help optimize its use is the shift to a value-based payment model: “We have to have value-based payment to move to the home. …We have discovered that a very high intensity of services can be rendered in the home. So I think if we move to value we will move. We will move more patients home and prevent those hospitalizations.”
Murphy said that moving care outside of the traditional brick-and-mortar higher-cost setting of acute care to the lower-cost setting of the home will include optimizing virtual care and helping payers across the board understand the value it offers.
“We’re going to have to accelerate to value much faster by all payers, not just by public payers,” she explained.
Home is Where Patients Want to Be
In Adapting Your Health System Post Pandemic, he said that one reflection of changing views about care settings may be reflected in construction projects for healthcare organizations.
“I think one thing we’re going to be thinking about post pandemic is not building these acute care facilities quite as much because we’re going to be more focused on the outpatient ambulatory care at home environment [and] remote patient monitoring…so we are thinking about new ways we can deliver care, even in the hospital setting.”
Noting how regulatory changes fueled the explosion of telehealth in the past year and the recent increase in flexibilities by CMS to enable more care in the home, Sturman agreed that the same momentum could apply to the growth of care provided outside hospital settings in the future.
“I think hospital-at-home care is absolutely something that we, as well as everyone else, puts on their radar. We’re going to make a tremendous investment this year in remote patient monitoring and look at the different tools [available]. We’re piloting this for some of our population health value-based care programs right now. So absolutely, hospital-at-home is where things are going,” he said.
Optimizing RPM Involves Action and Risk
While RPM shows great promise on many fronts, Ed Marx, the Chief Digital Officer at Tech Mahindra Health & Life Sciences, believes action must be taken and risks must be tolerated to optimize its potential.
In Truveta, Patient Data, and Remote Patient Monitoring Marx commented on the “big bump” in telemedicine, saying that “RPM has taken off as well,” though at a slower pace, since “use cases aren’t quite as strong yet for RPM.”
“It’s something definitely to keep your eye on,” he said. “Especially with COVID. …That’s a very popular, simple use case, but even better use cases are for acute care conditions, like maybe congestive heart failure.”
Noting that “those sort of acute care conditions are really prime,” Marx predicted they are just the beginning: “I really think you’re going to see the shift. …While the penetration isn’t the same as it is with a telehealth or a visual visit, it’s going to start creeping in and essentially, I believe, go past that because of the hospital at home.”
Referencing CMS’ Acute Hospital Care at Home program mentioned earlier, Marx said, “They’re testing the waters right now. We’ve seen this before with CMS. They test the waters, they make some adjustments, and then pretty soon it goes back. I think that’s really mainstream.”
Describing the hospital-at-home model as daily visits and daily encounters, “but with the appropriate technology,” he said the “early results are that the patients and families are happier because no one wants to be in a hospital. The financials on it can be up to 50% less cost. And the clinical outcomes appear to be the same or better. …So I think you’re starting to see it build up.”
Remote patient monitoring is a key component of this satisfaction, according to Marx. He also underscored the need for healthcare IT leaders to look to the future and continue to plan and partner with your teams and physicians to keep your organization abreast the innovation.
“Because I believe that in the future, hospital care as we know it will be only for the very, very sick, high-acuity surgical patients, high-acuity patients that need an ICU. But other than that, people, patients will convalesce at home,” Marx said
In light of these dynamics, Marx said healthcare organizations that want to remain in the game need to take action and be willing to take risks.
Primarily, Marx said the important thing is to get started, even if it means starting small.
“Then you take a demonstration project or find your clinicians who are really progressive, and there are those sorts of clinicians everywhere. In fact, they’re usually waiting on it and they get frustrated and go out and do their own thing. So find them, partner with them, start doing things, and then collect the metrics.”
Like Murphy, Marx emphasized the importance of being “metric-driven” to make progress in optimizing RPM.
“The more you can measure, the better evidence you have and the better you can make your arguments for additional funding,” he said.
Once the funding starts to roll in, he said RPM efforts can then be ramped up.
“If you wait, it’s too late. You’ve got to take risks. You’ve got to push the envelope.”