The United States spends more than $3.5 trillion dollars per year on our broken health care system. This equates to almost 20% of our country’s GDP. There is no debate about how unsustainable this is, especially as the population continues to age, but there is meaningful debate about how to control it. Importantly, there is a consensus among all stakeholders that there is a problem and it needs to be fixed. Fortunately, all parties will simultaneously benefit from a solution if one can be found. We all like win-win situations, is there one to be had in this case?
The good news is that there is an obvious solve. Better care! Patients deserve better care, which improves quality of life. Providers want to provide better care, so they can make their patients healthier, which now makes them more money. And finally, payors want better care, so outcomes improve, and total patient spend goes down. So, if there is an obvious solution to an obvious problem that obviously satisfies all parties involved, what is stopping us from solving for “better care”?
There are three key players in the care continuum. Patients, providers and payors. Payors carry the stick and are the glue in the value chain, luckily, they completely support the idea of better care. Value based care has officially replaced fee for service, and the benefits have been tremendous. This fundamental shift in incentives has motivated the right changes in our health care system. We are still in the early innings of this philosophical transformation in reimbursement practices, but payors have forced the providers’ hands, and they have responded. Now we just need that to trickle down to the patient population.
Better care is tangible, measurable and repeatable. However, better care is only possible if patients are willing to change their behavior. If patients are willing to change their behavior and provide practitioners with more frequent data, practitioners can build better care plans.
With more frequent data, care plans can be amended in real time, instead of at the next office visit. The healthcare system suffers from a lack of on demand data. The only time practitioners receive feedback is when their patients are already sick or just happen to be in the office for a routine visit. This reactive care is plaguing the system and needs to be fixed.
Interestingly, we find ourselves in a situation where those that will benefit most from behavioral change are exactly those that need to perform that change. Patient behavior modification is the tip of the spear. What will motivate patients to take the necessary steps to alter their behavior? If patients won’t change their behavior, better care is not a possibility. Behavior modification requires a few critical things to succeed.
Patients need to believe there are benefits
Patients need to understand what behavior changes are required
Patients need to feel and see the tangible benefits of their changed behavior
Patients need to stay motivated to form the necessary habits that sustain change
To date, most behavior modification efforts have focused on rewards and coaxing strategies to entice compliance. While these approaches are working, a deeper understanding of “why” change is beneficial will make patients become self-motivated, which will create lasting change.
Change is never easy. Asking those that will benefit the most from this behavioral change to take the first step, increases the chances of its success. There is an obvious cohort that logically should be the most open minded to embracing this change. There is an ever-growing population of patients that are considered chronically sick. These chronically sick patients are ripe for change management because they know they are sick, and they know that they need help. They also have closer relationships with their care teams because they are unfortunately in need of direct care more frequently than the average population.
There is a long list of chronic conditions. The below list only includes a few of the larger disease states that impact millions of patients. These patients consume a disproportionate share of overall healthcare spend and represent a great place to start. If patients with cardiovascular disease, diabetes, cancer, pulmonary disease……. were to embrace behavior change, the benefits would be immediate and tangible. Patients would live longer, improve their quality of life, spend less on care and most importantly do their part to positively impact the rest of the care continuum.
What patient behavior changes will have the highest potential impacts?
1) More frequent patient participation in the care plan in-between visits
2) Consistent collection of vital signs for transmission to the care team
3) Nutrition and activity tracking
4) Medication adherence
5) Question based feedback
6) Targeted content consumption that increases awareness and education
These changes in behavior will directly benefit patients by raising their level of awareness, empowering them to take more control of their care and by giving their care team the data and insight they need to make better care decisions on their behalf.
Behavior modifications that provide more frequent and more relevant qualitative and quantitative data to caregivers is the objective. This data helps practitioners identify trends, spot inconsistencies, and identify critical information that will lead to better care and better outcomes.Practitioners typically rely on in office data collection to diagnose and treat patients. This interaction typically takes place after a problem already exists and symptoms are already presenting. Asking questions, collecting vitals and reviewing historical data from the patients’ EHR provide the care team with on the spot data they use to make care decisions. Patient mood, white coat syndrome, doctor work load and disparate EHR systems all can impact the quality of these interactions. Ultimately, the care plan that the practitioner concludes is best for the patient at that time is often based on less than ideal data.
After a care plan is established and the patient leaves, the care plan is not easily managed. The feedback loop to gauge plan efficacy, compliance and ultimate outcome is uneven and disjointed at best.
A well-crafted remote patient monitoring (RPM) system can help resolve a lot of the deficiencies that currently plague the healthcare system. Providing patients and practitioners with a set of tools that bridge the gap between visits, collects and transmits vital signs, tracks nutrition and activity, provides medication reminders, poses easy to understand questions that then tailor content distribution for targeted consumption will give patients the incentives and convenience they need to change behavior.
This same remote patient monitoring system will give the care team the inputs they need to build more informed, preventative care plans that can be managed in real time between office visits. Care plan efficacy, adherence and ultimate outcome management will be easier to monitor. Patients and practitioners will gain the ability to have more meaningful interactions more of the time. As patients and their care providers have more opportunities to interact with meaningful data, both parties will be more prepared to play their part in producing better outcomes.
Rewards and incentives will continue to play an important part in shaping behavior. Over time though, as remote patient monitoring solutions prove their worth in the field, tangible improvements in patient outcomes will be all it takes to gain compliance. Patients, caretakers and payors all benefit from better patient outcomes. Motivating the patient to give their care team the data they need to do a better job will result in better care plans. Better care plans will drive better health outcomes which ultimately reduces overall spend. That is a win/win solution!
What are the attributes of a successful remote patient monitoring platform?
A successful RPM platform must be patient focused. The patient has to embrace the platform and want to use it consistently. Without patient buy-in there is no chance that a platform will succeed.With this in mind, articulating patient benefits has to be top of mind.
What are the most relevant patient benefits?
Better health and improved quality of life
Peace of mind
A proactive role in self
Happiness and longevity
The “why” is pretty clear, the “how” needs to be just as straight forward. Functionality and content have to be outstanding.
The right remote patient monitoring system will be incredibly easy to use. It needs to be intuitive, convenient, interesting and interactive. Beautifully designed senior friendly graphics, interactive charting, progress reporting, two-way communication capabilities, compelling content and personalized coaching will increase perceived value and drive patient compliance.
The dashboard needs to be bright and bold, the devices need to just work, connecting right out of the box. Readings need to show up in real time. Graphs need to be easy to understand. Trends should pop off the page. Descriptions need to be clear. Connectivity with the care team should be on demand, from any screen. Content should be customized and dynamic.
It has been proven that step count can be gamified. The benefit of adding steps is implied and assumed. The benefits of improving vital signs is real and tangible. A well-crafted scoring system will create stickiness and an obsession with becoming healthier. The best executed remote patient monitoring systems will be the win/win solution we have been looking for.
Better care is achievable. Better data is the easiest way to get there. The right RPM solution is the best way to collect better data. RPM is in its infancy. Medicare’s decision to unbundle and increase the number of CPT codes for reimbursement in 2019 was a huge step towards broad adoption. We expect to see an influx of solutions over the coming years. Innovation will follow and better care will become a reality.