Originally published in S&P Global
Healthcare providers and insurers are turning to at-home devices and monitoring tools to care for patients and make use of fast-evolving telehealth technology.
Spurred by lower costs for care and more payment flexibility from the U.S. Centers for Medicare and Medicaid Services, healthcare providers are increasingly offering remote monitoring options to patients. Hospitals and doctors are making the push as the COVID-19 pandemic continues to restrict in-person care in many circumstances and prompts migration to telehealth services.
Medtech startups are also interested in shifting care away from hospitals in favor of increased at-home care and monitoring, with 70% of diagnostic startups in accelerator MedTech Innovator's 2021 database offering products that allow patients and physicians to get real-time results, according to a survey by consulting firm Deloitte.
The federal government and health insurance companies such as UnitedHealth Group Inc. and Humana Inc. have also been key drivers in the adoption, offering greater coverage for wearables and other tools for remote monitoring. Companies like Apple Inc. are offering heart rate monitoring and electrocardiograms in wearables sold directly to consumers.
"Everybody is heavily incentivized for everybody's well-being, financial or healthwise, not to go back to the hospital. And one of the best ways of doing that is to have some kind of continuous monitoring for a limited period of time," Brian O'Rourke, Internet of Things senior analyst at 451 Research, said in an interview.
How remote monitoring is used
In an April survey on consumer wearables by 451 Research, 15% of consumers said their doctor had provided them with a portable medical device over the last 12 months, compared to 11% in the same survey fielded a year earlier.
Of these consumers who received a portable medical device from their healthcare provider, 37% were using it for monitoring diseases such as diabetes, hypertension or COPD. Monitoring such conditions is now the leading reason why respondents are using the devices. Just a year ago, more people were using them for fitness tracking. Of the total number of respondents, who could give multiple answers in the survey, 24% were using the devices for post-surgical monitoring.
Acute care needs often take the form of monitoring a patient after surgery or another hospital visit, 451's O'Rourke said.
"You can keep a close eye on patients and have kind of an early warning system," O'Rourke said.
Monitoring chronic conditions
At the start of the pandemic, remote patient monitoring tools helped doctors keep patients out of hospitals as COVID-19 cases were rising and also helped monitor patients inside the hospital who were taking medications for the virus that could impact patients' hearts. While these tools may still serve those purposes today, they are also beneficial for keeping readmittance into the hospital low, thus reducing costs for patients and providers.
Hospital readmissions may cost Medicare as much as $26 billion annually, with $17 billion of that attributed to potentially preventable reentries, according to estimates. Readmissions may also lead to fines and penalties for hospitals, and insurance companies may face more costs.
In December 2020, digital therapeutics company Biofourmis Inc. launched a national rollout of its Biovitals Hospital@Home program, which it co-developed with Brigham and Women's Hospital for Brigham's Home Hospital Program. Under the program, patients wear biosensors at home that feed data to physicians to detect potential issues sooner.
Hospital and healthcare facilities operator Geisinger Health System was approved for the CMS program Acute Care Hospital at Home program in January. Geisinger at Home allows Medicare members with difficult-to-manage conditions, such as kidney disease or cancer, to receive treatment from medical professionals in their homes. The team expanded its use of remote monitoring devices in response to challenges caring for COVID-19 patients sent home early from hospitals or emergency rooms, said Anthony Wylie, senior medical director for the program.
AliveCor's technology is primarily used in the home, as clinicians can only get a snapshot of patient vitals in a physician's office, said AliveCor founder and Chief Medical Officer David Albert. It is especially important to have a device that connects the medical information with a physician, Albert said.For patients with chronic conditions such as heart disease or diabetes, remote monitoring devices from companies including AliveCor Inc., TytoCare Ltd. and Withings SA also offer new opportunities for care. AliveCor's KardiaMobile range of products, for example, are portable, digital devices that collect medical-grade electrocardiograms of a patient's heart rhythm, which can be uploaded to the patient's phone and sent to clinicians.
"You can't treat yourself. You can live better, but you can't treat yourself," Albert said.
The growth of at-home monitoring devices has created a corresponding market for mediators of the data produced, 451 Research's O'Rourke said. Physiq, Inc.'s pinpointIQ solution, for example, uses artificial intelligence to collect and analyze vital signs data from patients' wearable biosensors before sending the relevant information to their physicians. The software is used by both healthcare systems and payors to try to create the best health outcomes for patients and members.
The goal is to flag to physicians which of their patients could be at risk for deteriorating before reaching that point, said Gary Manning, physIQ senior vice president and general manager of healthcare delivery.
"[Physicians can] have the patient living at home, in the comfort of their own home, feeling still connected to the clinician in a much lower-cost environment," Manning said in an interview.
Insurance coverage
In March 2020, CMS announced that telehealth visits would be reimbursed at the same rate as in-person office visits. In November, the organization said it was enacting the Acute Care Hospital at Home program, allowing hospitals to have more flexibility when treating patients where they live.
Insurance companies have been just as interested in remote monitoring tools, physIQ's Manning said.
In 2020, UnitedHealthcare launched a digital health therapy for type 2 diabetes patients called Level2. It combined wearables, clinical coaching and continuous glucose monitoring devices with a goal to expand to other illnesses. In February, Humana announced a partnership in some states with Dispatch Health to provide at-home care for Humana members that combined in-person visits and remote monitoring tools.
"We've been really excited about the engagement from payors, where they are truly trying to manage their patients properly and their members in a high-quality manner, and almost partnering with companies such as physIQ to be able to do that," Manning said
451 Research is part of S&P Global Market Intelligence
John Varaklis: January 27, 2023
Matt Pipke: January 3, 2023
physIQ: December 16, 2022