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Getting Closer to Virtual Care

by ndrao | December 08, 2015

datalinkFrom a technology perspective, the US healthcare system’s shift towards population health management (PHM) is built on a central premise: By collecting and analyzing data across a defined population, healthcare systems can deliver more targeted patient care, enabling better clinical and financial outcomes. Today these efforts are not real-time, as they rely largely on retrospective claims data (and more gradually on clinical data) to assign people to risk-stratified programs, call lists, or other outreach campaigns.

Beyond using analytics to understand what’s happening among a cohort of patients, healthcare organizations (HCOs) are showing interest in adding a layer of hardware to gather new data that provide more timely insight and ultimately enable proactive interventions when necessary. This notion of a connected health model represents the next iteration of progress towards real-time, cost-effective management of complex, chronically ill populations.

For our forthcoming report on connected health and remote patient monitoring (RPM), Chilmark Research has simply defined Connected Health as the use of technology to connect the various pieces of the healthcare system (people, tools, facilities, and so on) in a way that enables delivery of ongoing, virtual care as needed across a patient population.

Over the last several months, we looked into various models of remote patient monitoring that have shown successful outcomes, clinical and financial. We also spoke with over a dozen stakeholders from the healthcare system, including payer, provider, and technology organizations. Our research suggests that while there are definitely signs of progress, the market as a whole is very much in its infancy.

Progress is Apparent

A survey last month suggests that up to two-thirds of provider organizations have made use of RPM to some extent. Results from pioneers like Partners Healthcare, Mercy Health, Banner, and a growing list of others shows that with the right approach, sensors can be effective in monitoring patients. The various layers of technology that comprise a connected health model are all maturing in their own right – from data-driven BI and analytics to identify patients who would most benefit from digital interventions all the way to a rapidly evolving fleet of sophisticated sensors – wearables, peripherals, implanted devices, adhesives, and more.

The transition to value-based payment is in full swing, with proper financial incentives beginning to align with care delivery. In short, the market has gotten everyone excited, from medical researchers to Wall Street analysts.

A Market in its Infancy

Though things are moving forward beyond any doubt, the market for RPM is years from maturity. What does that mean?

  • On the buy side, while providers are beginning to use new tools (the two-thirds figure above may be a bit high), but nearly every vendor we spoke with insisted that payers remain the dominant purchaser at this stage. How will this evolve alongside the emergence of value-based models?
  • Pricing models and price points remain highly variable – by patient population, by payer, state, vendors, and other factors. This is not likely to change in the next few years, as technology is evolving quickly. So, too, are payment models – what will happen to prices if a large HCO was willing to sign a deal, enterprise-wide, for a multi-year RPM program?
  • On the sell side, the vendor market is a crowded mess of solutions involving built and partnered combinations of software and hardware players from Fortune 50 companies down to early stage startups. All run the gamut of healthcare stakeholders – medical device manufacturers, enterprise software vendors, mobile app developers, pharmaceutical companies, and many more.

Immaturity in a market is not always a bad thing. We are in the midst of a phase of experimentation, piloting, and learning. In our research over the last several months, we’ve been encouraged by the early signs of progress being made by HCOs, even simply in testing technology in new models of disease management or new programs centered on reducing readmissions. In a handful of occasions, we were quite impressed with the advances in areas of data management, services integration, and patient engagement.

We are looking forward to sharing these and other findings in our forthcoming insight report. Please stay tuned for details.


2 responses to “Getting Closer to Virtual Care”

  1. Sue Ann says:

    The problem with “value-based care” is that it is code for “we’re not going to pay you” care. Doctors and hospitals know this, and it hits mostly primary care, which is already low on the totem pole.

    Insurance companies are not paying for on-call services now that are available by phone anywhere, anytime. Why? because it hits their bottom line.

    If your doctor is paid to do a telemedicine or a remote or a virtual visit, it’s easier for the patient to get to the doctor or contact the doctor. That results in more outlay by the insurance company.

    Maybe there is a desire for virtual care, but there is no will to pay for it — not by the insurance companies/government or the businesses who buy the insurance for their employees, or the patients.

  2. ndrao says:

    Sue Ann, thanks for commenting.

    I see what you’re saying from the standpoint of an individual doctor. Yes, moving away from FFS means that there are going to be less transactional payments – I think everyone agrees to that. My dad is a PCP who’s been in the game for just over 30 years now – his attitude is one of shrugging and following orders until he retires in the next year or two. I suspect there are thousands more like him, and I understand why.

    From a system perspective it will take more than cramming doctors into an ACO to deliver value. I’d also agree wholeheartedly that a strategy that starts and ends with primary care is ultimately not going to work. But some initiatives are going beyond that – like Maryland’s All-Payer model, where the state has set global rates for hospital payments. Another example might be Medicare’s CCJR model (time will tell).

    Suffice to say that re: Value-based care, we’re definitely at the beginning of a long transformation process. Primary care will get hit hard as you point out – it will be up to the large health systems to make sure that these arms of the care system to make sure they’re paid appropriately for the value-added things (keeping patients in-network, filling generic rx, etc. – things that mostly go unrewarded today.

    Also, the workload/burden of the PCP and other outpatient care providers (RN’s, LPNs, PA’s, CM’s) is not supposed to remain the same as it was – we’re supposed to be moving towards team-based models, that are able to leverage tech. In theory things like the new CCM codes from Medicare are supposed to act as a FFS glidepath to help these providers from feeling the pinch as we transition towards different models (of care delivery & payment.) In theory.

    As far as your comment about payers, I’m not sure where you’re getting your information – Insurers and Employers have shown they’re more than willing to cover telehealth benefits. The vast majority of remote patient monitoring pilots have been paid for by payers as well.

    But we hear you loud and clear…the story we’re often force fed from up on high is not as pretty as advertised. Certainly these changes are not going to happen overnight and it’s easy to be skeptical about progress to date (we’ve got our fair share of skepticism here at CR).

    Thanks again for sharing your impressions.

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