Wellness Oasis: Transforming the Medical Home

Introduction

With more companies designing devices and implementing programs for remote patient monitoring (RPM), reimbursement is one of the challenges these companies have to face. The good news is that both Centers for Medicare and Medicaid Services (CMS) and private payers are allocating more attention to companies involved in home care and RPM, which ultimately translates into increased care for patients and lower costs for the healthcare industry.

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Home care and remote patient monitoring

RPM is a sub-category of Telehealth that manages patients’ health data from electronic devices. This data is collected, transmitted, evaluated and communicated to a healthcare professional in real time with the help of healthcare technology.

Remote patient monitoring is also a set of activities that meets the following criteria:?

• patients’ data is collected remotely (without requiring the supervision of a healthcare professional);?
• the data collected is sent to a healthcare professional which is not on site;?
• after the data collected is evaluated, care providers are notified, if needed;?
• HCP (Healthcare Providers) communicate to patient's relevant insights resulting from the collected data and perform or recommend interventions to patients, when needed.?

Wearable technology is gaining ground in RPM

Health wearable technology refers to electronic devices that patients can wear. Smartwatches, wearable sensors, Fitbits, handheld instruments or implanted equipment being a few. These wearables collect data about the patients’ health and exercise and promote behavioral changes that lead to a decrease of first-time visits and readmissions to the hospital caused by improper management of personal health. The increased use of health wearables is influencing the decisions of insurers, HCP and employers.?

By covering wearables, insurers can reduce the cost per patient as the customer life value increases. For HCP, monitoring patients’ health remotely, with the help of devices these patients wear, means more than diminishing the risks associated, amid COVID environment, with in-person visits: - it allows them to make recommendations or prescribe treatments and prescriptions from any corner of the world.?

Companies are aware that it’s important to provide their employees with risk-free, remote solutions to manage their health as a healthier corporate culture improves staff turnover.

What payers are willing to reimburse

The increased demand in recent years for virtual care has prompted the Centers for Medicare and Medicaid Services (CMS) to extend reimbursement for RPM in order to support providers.

Amid COVID-19 pandemic, Medicare coverage has been expanded to cover remote patient monitoring including for patients with?acute conditions?and?new patients as well as existing patients. Little by little, payers have shifted their attention towards home care devices, which can decrease the demand for healthcare services.?

For a four-year period, the US Veterans Health Administration has conducted a large-scale study regarding the use of home care devices. The study, which included 30,000 participants, proved that use of home monitoring devices has decreased the number of visits to ERs, has diminished the number of hospitalization days and of readmissions and has reduced mortality.

Payers will be interested to reimburse the cost of these devices, which is a lot lower compared to the costs of hospitalizations or expensive treatments.

Another element that needs to be taken into consideration is the proof that supports the efficiency of these devices. In a relatively new and fragmented market, it’s difficult to provide this type of proof. Difficult, yet not impossible. That is why having studies to support the claims made by home care devices is helpful in gaining payers’ attention and of course, reimbursement.?

Creating re-usable or disposable devices at lower costs is also a proper strategy to attract reimbursement, especially if it’s needed to meet a specific timeline or a regulatory requirement.?

Partnerships between home care devices designers and healthcare professionals can provide payers with insights regarding the medical response of these devices to high amounts of data, so this is also a potentially successful strategy for home care companies to be reimbursed for their products.

How to create devices that will be reimbursed by payers

Make them user-friendly

Patients and HCP are already accustomed to devices with intuitive technologies, easy to use and that meet their needs. They expect nothing less from home care devices and that is a critical point that manufacturers of these devices can turn into an advantage. Equipping regular consumer electronics with home care monitoring functions is also a winning bet: smartwatches or wrist bracelets that can measure ECGs, for example, are already part of the RPM reality.?

Wearables take one step further and bring new medical devices to patients: Philips for example has created a wearable biosensor in the form of a patch that can collect data regarding the temperature, movement, heart and respiratory rates of those who wear it and who can move freely whilst this data is collected.?

Know your target clients

When we say, “smart devices” we expect tech-savvy millennials to be the pioneers in embracing them. Yet, the senior citizens are the target segment taken into consideration by designers when creating, testing and integrating devices for home care. With more than 700 million people in 2019 age 65 or older and estimations that this number will double by 2050, creating home care devices suitable for them is a strategy that will pay off. Life span has increased in the past decades and that means that in the last years of their lives, often affected by frailty, senior citizens need support and assistance in managing their health and having satisfactory life conditions. Many senior citizens affected by reduced cognitive or motor functions or even infirmity or illness are transferred to various retirement homes, depending on the type of care they need. Several surveys have indicated, however, that senior citizens’ transfer to such retirement facilities has been associated with anxiety, insomnia or depression. The same studies have concluded that seniors want to remain in their homes, independent, for as long as they can. And that is where companies that create home care devices interfere. By designing trackers, cameras, sensors or any other in-home devices, adjusted to senior citizens’ needs for care, companies make it possible for elderly people to age in the comfort and safety of their own homes. These devices also enable cost savings for healthcare system - which is one of the main criteria payers are looking at when it comes to reimbursement - as a result of fewer hospitalizations, reduced number of first-time visits to ERs or re-admittance to hospitals or even expenses on medication.?

Create solutions for important problems

It is estimated that technology can save between $100 and $300 billion in healthcare from proper administration of medication. That is the cost that the healthcare system must support from people who do not take their medications as prescribed. But this goes beyond cost: medication non-adherence can result in 100,000 deaths every year, deaths that can be prevented with the help of smart home care devices. “Smart” pill bottled that light up, text messages or even devices connected to the internet are just few examples of how home care companies remind their clients it’s time for their scheduled medication and how they prevent them from getting (more) sick.?

Put the right people on the right tasks

In many cases, there are not enough physicians to monitor health data received from various home care devices, which makes the collection of this data an expensive process whose benefits are lost due to lack of follow-up. However, inventive companies have figured out that the key is not to place all the responsibility in the hands of physicians, who should be focused on something else anyway, but to identify and use the proper support based on the RPM’s specifics. For example, pharmacists can be enrolled in monitoring programs, since they already did it.?

Specifically, with the help of a digital program, pharmacists have monitored remotely the blood pressure of 6,000 patients at high risk. Following up with these patients by text messages or e-mail resulted in a high number of patients reaching their blood pressure targets. It’s important to have the right professionals in key roles so that complex tasks can deliver outcomes that can be later used as proofs for home care devices, services or projects’ efficiency especially in negotiations with payers.

Design devices that blend into homes

Devices with designs that fit into homes are equipped with features that monitor, collect and transmit users’ data to medical professionals. Devices that look like printing cylinders measure in just a few minutes important indicators such as number of lymphocytes, of white blood cells or neutrophils from a drop of blood placed on special test strips. The science behind this type of devices is a valid argument for reimbursement and hence a successful approach for companies who want to create similar devices.?

Others – like the smart toilet seat – focus on more specific health areas, such as cardio activity. The smart toilet seat monitors cardio health with a photoplethysmogram, an electrocardiogram and a ballistocardiogram. Data like blood pressure, blood oxygenation levels and heart rate is collected after just 90 seconds of skin contact and a report is sent to a cardiologist who determines if and what kind of intervention is required. The best thing about this device is that it doesn’t require any behavioral change since it is part of regular habits of people everywhere and that its cost will be significantly lower compared to a heart-monitor implant.

Smart mattresses are another example of objects that blend into homes and that collect data regarding the respiration, the quality of sleep and heart rate without any effort from these devices’ users.???

Medical devices that blend into homes will represent a first choice for many patients, especially since they don’t imply home re-decorations, behavioral changes or expenses to support any of these or both. And once these devices are on a high trend of demand, payers will want to reimburse them.?

User behavior is the key

Knowing the behavior of target clients is crucial in the high-competitive market of medical devices. Users’ feed-back has become so important in designing new products and in improving existing features that many home care companies have built it into their business models. Several home care companies use their own customer service centers (rather than outsourced) to communicate with their clients, to assist them in fixing the bugs, in improving their user experience and in adjusting the devices’ settings to better meet users’ behavior and needs.?

Conclusion:

Home care has been a promising trend of the healthcare industry and has accelerated with the Covid pandemic for design, testing, implementation and integration of home care devices. These benefits include improved diagnosis and treatments, healthcare costs savings, remote monitoring of chronic diseases, improved care for patients anywhere. Home care will deliver innovative products that will ultimately provide advantages to all stakeholders in the healthcare industry.?