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Medicare created a $30 billion market overnight – now we must get it right

We’re facing a healthcare challenge we’ve never seen before: a growing senior population, explosive Medicare spending, and the sickest generation in the history of the U.S. It’s the pandemic inside the pandemic. Longstanding chronic conditions like obesity, diabetes, and heart disease all contribute to the death toll the coronavirus has taken on older Americans.

At the same time, the pandemic has accelerated already recognized trends that offer solutions, like telemedicine and remote patient monitoring (RPM). I’d argue that the latter will more profoundly change healthcare. Telemedicine is an excellent evolution of an existing tool, physician face time. Most telemedicine calls serve as a primary care solution to treat acute conditions, like a sore throat or fever.

On the other hand, RPM is a completely new tool addressing more complex and more expensive chronic conditions. It provides physicians access to previously untapped data – in real time – giving them the ability to intervene immediately and avoid an expensive emergency care visit or alter care paths to improve outcomes. And Medicare is recognizing this potential by reimbursing RPM, making it a potentially $30 billion market.

The idea is simple: doctors identify high-risk patients in their practice and distribute connected medical devices to them. The devices capture physiological data and send it securely to the doctors, enabling them to monitor and engage with patients in between office visits, thus preventing more and expensive care later.

RPM is clearly a long-term Medicare investment, and it’s proven to be successful in reducing emergency room visits by up to 92% and readmission rates by up to 40%. The potential cost savings to our healthcare system are in the billions.

The big question is, how do we achieve, or better yet accelerate, adoption? The goal is to connect everyone who needs RPM to accessible technology solutions, and along with that comes several important considerations:

  1. Doctors are not equipped to purchase, set up or manage RPM devices.
  2. Seniors face significant technology barriers.
  3. RPM will require constant patient engagement.
  4. Access and reimbursement need to incentivize wide adoption.

The first is perhaps the biggest obstacle. Thousands of connected devices are available that can compliantly send data to physicians. We need a platform that connects them all, in a central dashboard with the ability to send alerts, escalate potential issues, and truly monitor the whole patient. Doctors simply don’t have the time to review thousands of individual data streams.

The second challenge is to ship, set up and connect devices for patients who are older, less financially sound, often sick and tech challenged. We need to create solutions that are plug and play, with no network connection set up required. Prescribing a device and expecting Medicare patients to connect it to a network is a recipe for failure.

The third challenge, patient engagement, has been around since healthcare has existed. How do we get people to adhere to monitoring and engage in improving their health? A possible solution is using Artificial Intelligence (AI) to create more touchpoints with patients. AI has the ability to remind patients to monitor and give them feedback on their progress and monitoring results, similar to the way that a physician can but without relying on overworked clinical staff. It won’t substitute for clinical care but will improve it.

Finally, doctors need to be fairly paid for RPM services. Thankfully Medicare, who services the vast majority of chronic disease patients, now reimburses RPM. That said, Medicare reimbursement is difficult and time-consuming enough to create potential barriers. Any RPM platform must also solve for the billing aspect. We need to take the data and work done by the physician and create a process so that a bill can be generated, and Medicare can fairly pay them.

Addressing these obstacles today is imperative to not only wide RPM adoption, but also to ensuring equal access for our most vulnerable patients and the sustainability of smaller and mid-sized physician practices.

Large hospitals or integrated delivery networks have the scale to invest and tackle these challenges in a silo. But the fact is, more than half of physician practices have a patient population well under 2,000 patients, representing a significant portion of Medicare-covered lives. They simply don’t have the scale to take this on. And for them, it could mean a significant loss of future income. The average physician practice with about 800 Medicare patients could see about $500,000 in additional yearly revenue by implementing RPM, nearly tripling their income.

To ensure all physicians and all patients benefit, the solutions must be addressed in the technology and the platforms that enable RPM, not solely by the healthcare providers.

RPM is here to stay but if we do this wrong, the unintended consequence could be a lack of adoption, despite readiness by our government to pay for these services. If done right, everyone wins including taxpayers, doctors, and most importantly patients and future generations of patients.

Photo: Who_I_am, Getty Images

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