Page 20 - HME Business, August/September 2019

“Historically, each one of the device manufacturers had a proprietary piece of software that they were trying
to get the clinic to download to be able to view the data just off of their device. And as you could imagine, just wrangling that many different pieces of software to get at data in a unique silo isn’t very valuable.”
— Russ Johannesson, Glooko
in just weeks or months to better understand patient populations and what best practices can guide HMEs and others in helping more patients get on and stay on therapy long term,” he adds.
To give you an idea of the pace of growth, in 2015 market research firm Berg Insight reported the global number of remotely monitored patients grew by 51 percent to 4.9 million. Now, in 2019, ResMed is reporting that it alone has
10 million users of its cloud-connected devices. At the outset of 2017, ResMed reported that
1 billion nights of sleep data had been down- loaded using its AirView. Now, two years later, it has a database of 4.5 billion nights.
Moreover, that’s just one vendor. Factor in all the CPAP makers, and you can quickly get an impression of the scale involved with only the sleep segment of remote monitoring. RPM has approached ubiquity in sleep therapy; it’s morphing from a value-add to an expectation.
“The industry itself has really taken advan- tage of the ability of this kind of technological advancement, has matured dramatically to leverage that capability, to manage patients remotely,” Philips’ Murphy says. “Through auto- mated and cloud-based technologies, to deliver a better outcome that each constituent can see and can act on a common set of information and notifications that are based on that individual patient’s experience — that’s really, kind of, a standard of care on the sleep side.”
Integrate that sleep scenario into the bigger picture of connected health, and it’s a pretty thrilling landscape for homecare, ResMed’s Dench says.
“I think it’s all part of a healthy and exciting movement toward getting a holistic picture of patients’ health and making fast and informed decisions based on that information,” he explains. “The more health information a provider is able to access and incorporate, the more informed that provider’s care decisions and the more personalized that patient’s care will be. Additionally, the more a person can engage with their own health and health data, the more conscious, engaged, and accountable to themselves they’ll become. Wearables and
tracking apps can remove barriers to consumers engaging with their own health data and sharing that data with their providers.”
OXYGEN: THE NEXT FRONTIER?
On the face of things, remote patient monitoring seems like a “natch” for portable oxygen. RPM would help providers watch their units in the field and the prospect of watching how long- term oxygen therapy patients use portable oxygen concentrators has some appeal from a clinical standpoint.
To that end development of remote moni- toring for portable oxygen concentrators has been a work in progress for a few years. The first forays into remote POC monitoring came with devices that were largely founded on the concept of fleet management: providers would remotely monitor POCs to ensure they were being used and that they were functioning properly. Moreover, depending on the situation, providers could remotely diagnose problems.
Initially, the POCs offering fleet manage-
ment functionality used a variety of technology approaches for the connectivity, but increasingly POCs with RPM are starting to gravitate toward connecting with apps on users’ smartphones via Bluetooth.
But that soon gave way to the notion of moni- toring usage, and thusly patients. For example, let’s say a patient has an oxygen concentrator
in his home, and is prescribed to use it for X number of hours a day at X setting. Remote monitoring could show that, for some reason, the patient is either getting more oxygen than was prescribed, or perhaps not getting the correct duration of usage.
However, it became obvious that if that data could be collected, then it could be managed in the same way as sleep and diabetes devices do.
Collecting patient POC usage seems like
a good idea. In an outcomes-oriented reim- bursement environment, remote monitoring becomes indispensable because it allows those referral partners to work with HME providers
and patients to optimize outcomes. In turn, the provider becomes a champion to both its referral
partners and patients, and benefits from an ever-growing reputation for effectiveness and forward-thinking care. That’s a hard value propo- sition to ignore.
But let’s reiterate that: RPM for POCs seems like a good idea. Is it? You might have noticed
in the previous usage-data scenario that there was a component of the current sleep equa- tion missing — the payers. Compliance data would immediately bring in payers and Victoria Marquard-Schultz, esq., CEO of oxygen manu- facturer Applied Home Healthcare, which makes the OxyGo, a Bluetooth-enabled POC.
“When you talk about remote patient moni- toring and you compare it to something like sleep — where sleep has that compliance aspect — it’s something that we’ve talked to our providers about,” she says. “Something that we’re very conscious of is that compliance and that ability to have that in [RPM] technology also ties really heavily into reimbursement. It can be an issue.”
It’s safe to say that when it comes to sleep therapy, reimbursement and RPM are joined
at the hip. We’ve all seen high-profile stories
in consumer media about payers declining to reimburse patients’ CPAPs because they flat-out refuse to use them. This can sometimes even lead to the provider recouping the device so that they don’t lose on the device cost. In the world of long-term oxygen therapy, particularly in a Medicare context, such a scenario is a non- starter. POCs are expensive and LTOT patients are typically patients for life.
“When you transition that around to the respi- ratory side, what I really think you need to focus on, and what I think there’s lessons learned, is there are a lot of things that now that you can do —we can build a lot of things,” adds Philips’ Murphy. But where is that really delivering value to the key constituents that are serving patients, and the patient themselves?
“Where you do create value?” He asks. “That value is really in the improvement of the clinical outcome. The improvement to the efficiency, and cost-effectiveness of care ... Versus an approach that would say, ‘Well, if we can do it, we should build it and we should offer it.’ And then getting people to run towards it when maybe, it’s not really matching that overall value. I think that’s the key learning curve.”
But the fleet management aspect of RPM probably sits right inside safe territory for POCs. Logging into a system that lets a monitor see all of its POCs in the field; see which ones are throwing up error codes, which ones need to have their sieve beds replaced; which ones aren’t being used — these are all very useful piece of information for a provider to have, Marquard-Schultz says.
20 HMEBusiness | August/September 2019 | hme-business.com
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