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June 4, 2021

Win-win-win: How RPM Benefits Patients, Providers and Payers

Commentary
Alette Brinth
&

Remote patient monitoring (RPM) can empower the healthcare industry to realize the elusive “Triple Aim”: improved health outcomes, reduced cost of care and improved patient experience. While a lot of focus has been on the uptake of telehealth more generally during the pandemic [See: The Telehealth [R]evolution], a key component of this has been the adoption of RPM solutions. 


In the last year, the RPM market has been buzzing with activity and huge transactions including the blockbuster USD$18.5 billion acquisition of chronic care company Livongo by Teladoc, setting a new record high in digital health history. Pharma, MedTech and Tech companies all invested heavily in RPM: AstraZeneca built AMAZE (a chronic care management platform) with BrightInsight,  Philips acquired BioTelemetry and Microsoft released their first update to “Microsoft Cloud for Healthcare”, unveiling RPM features that support data exchange from connected devices, 


With global vaccine roll-outs now well underway and lockdown measures beginning to ease, speculation has begun as to where the “new normal” will settle in the balance between virtual and in-person care. Weighing up the benefits, here we uncover the clinical and financial benefits of RPM in cardiac care and respiratory diseases.

(Source: The Kinetix Group)

Follow your heart: RPM in CVD


The benefits of RPM in the cardiac care space have been known since long before the global pandemic made “virtual care” a household phrase. In 2016, the @Home pilot by Capital-Blue Cross for Heart Failure patients demonstrated a whopping 30 % reduction in hospitalizations and savings of $8,000 per patient. In the same year, Kaiser Permanente introduced a telestroke program to increase administration of  Alteplase, the gold-standard pharmacological treatment for ischemic stroke. Alteplase is commonly underutilized because of the need for speed: AHA guidelines recommend “door-to-needle” times of 60 minutes for patients to receive infusions. Crucially, Kaiser’s telestroke programme reduced the average time to administration from 66 to 55 minutes, resulting in a 73% increase in life-saving Alteplase administration. Access to care has a huge part to play in healthcare inequality, and with their telestroke program Kaiser is tackling this by offering access to stroke specialists for patients in rural settings.


A key risk-factor for stroke is hypertension, and the clinical benefits of RPM on both systolic and diastolic blood pressure are well-documented. Hypertension self-management programmes by the likes of HelloHeart neatly administer the triple aim with a 65 % reduction in blood pressure and heart risk, a cost-saving of $486 per user through improved clinical outcomes and an annual 34% reduction in medical claims after only 12 months. This is just one example - a quick scan of the literature shows similar results across the board highlighting the huge benefit of RPM for blood pressure control.

(Source: HelloHeart

In the case of AFib patients, who often have anxiety around their fibrillation events, the use of RPM to manage their heart patterns through mobile ECGs is arguably a must-have rather than a nice-to-have. Mobile ECGs can help physicians quickly see the need for intervention or medication change without an in-clinic visit, empowering patients to find renewed confidence in their disease management program. In fact, the benefits of mobile ECGs start long before treatment in the AFib patient journey. A UK study using AliveCor’s Kardia Mobile for AFib diagnosis demonstrated impressive results: an estimated net benefit of £968 per patient, potential ROI of 666 % for the NHS and a 84% reduction in hospital admissions.

Breathe Easy: RPM in Respiratory Diseases

Respiratory disease is emerging as a newer field for RPM with great potential and is often cited as one of the therapeutic areas for most cost-effective health intervention strategies. This is with good reason: chronic respiratory conditions like asthma and COPD reportedly cost the US healthcare system a whopping $130 billion annually and more than 35 million Americans have a preventable lung disease. 


Asthma and COPD are effectively managed with inhalation therapy, and a lack of medication adherence and incorrect inhaler technique are huge cost-contributors. According to the CDC, if all COPD patients were compliant with their medication, it would save $4 billion a year and reduce complications by 25-30%. And smart-inhalers are getting even smarter: beyond the clear benefits of dosage reminders and tracking usage, smart-inhalers can now even alert patients if left behind while asthma management solutions by the likes of Keva Health can alert patients to pollution and pollen in their environment,


Respiratory diseases are unique in that exacerbations cannot be measured by a lab-test and are largely dependent on patient reported outcomes. This builds a strong use case for RPM in symptom tracking, and a recent study on COPD patients showed how the use of RPM for daily symptom surveillance could significantly lower disease exacerbation, reducing hospital readmission rates by 40 % and improving inhaler technique with a 75 % reduction in errors. Tackling the need for objective respiratory disease measures is an exciting growth area where digital health companies such as Sonde Health are developing vocal biomarkers for the early detection of respiratory diseases such as asthma, COPD and Covid-19 using AI-powered voice detection technology.

(Source: Sanofi

The future of RPM: connecting patients with data


Real-world data (RWD) gained from connected devices such as smart-inhalers not only benefit the immediate patient outcomes, but is also a rich data source for the development of new treatments. Sanofi recently launched REGAIN, an 18-month study tracking asthma patients that will combine clinical, molecular and real-world data and apply machine learning to discover how a patient's body responds to treatments.


With RPM technologies well-established in the cardiac space, it’s an exciting field to track next-level developments and a natural place to start for providers rolling out formal RPM programs. We’re already seeing movements in this space with Mayo Clinic recently announcing the launch of their Remote Diagnostic and Management Platform for AI-powered data analysis and decision support. With the continuous feedback of RWD from RPM devices into drug development and decision support algorithms, new innovations in this space promise to deliver on ever-improving patient experiences, clinical improvement and financial gains.


RPM solutions are significantly benefiting patients in the cardiovascular and respiratory space with both improved financial and clinical outcomes. While RPM adoption is unlikely to continue at pandemic levels, stakeholders across the healthcare industry have now seen the value of RPM in delivering on the “Triple Aim” in real-world healthcare. Some hurdles do remain with the likes of clinical workflow integration and reimbursement challenges among the key concerns that need to be addressed. As we look to the future of RPM in a post-pandemic era, the question is: who will see the most value and where will the most fruitful partnerships form between payers, providers, startups, pharma and medtech companies?


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