A “Wired for Health” study recently reported by The Scripps Translational Science Institute in San Diego poses a significant challenge for those working to realize the potential of digital health technologies.
The Scripps team has been investigating the relationship between wireless health-monitoring technologies, healthcare costs, and outcomes in patients with chronic disease. After equipping one cohort of patients with an iPhone and a connected tracking device, researchers analyzed claims and medical data to track care utilization and outcomes, ultimately finding no significant economic or clinical benefit for the patients being monitored versus a control group.
The study did have limitations. As Eric Topol, study author and Scripps Translational Science Institute director, noted in an interview with MobiHealthNews, a short follow-up period and small sample size may have affected the results. Putting study design aside, though, other data tell a quite different story about both the clinical and economic benefits of digital health technology. Prescribed medical devices with built-in monitoring capabilities have shown a much more positive impact on outcomes, and have grown the medical community’s understanding of how patients use prescribed therapies, and how remote monitoring can support the best possible care.
ResMed’s deepest experience in digital health stems from our work in sleep-disordered breathing, including sleep apnea, a disorder that affects more than 100 million people worldwide. Left untreated, sleep disordered breathing is linked to a number of other serious conditions, including drug-resistant hypertension, type 2 diabetes, and obesity. Recognizing that patient compliance with prescribed sleep apnea therapy is linked to lower medical costs and fewer readmissions, we developed a cloud-based method of diagnosing, treating, and monitoring sleep-disordered breathing that now encompasses more than 1.3 million connected devices that send usage data to appropriate members of the patient’s care team every morning. Ensuring that patients stay on therapy is important. In a study of sleep apnea patients in 2007-2008, an untreated patient group averaged 32 percent more hospital readmissions than the treated group, while sleep apnea patients on positive airway pressure (PAP) therapy (standard treatment) had 31 percent lower medical costs than those not on therapy.
In sleep-disordered breathing specifically, home medical equipment providers (HMEs) often serve as coaches, keeping patients on therapy and are under strict reimbursement regulations by the Centers for Medicare and Medicaid Services (CMS). These reimbursement mandates make the sleep-disordered breathing environment quite different from other disease settings, and mean that digital patient management and monitoring technologies must be evaluated not only on their ability to improve outcomes, but also to improve business efficiencies.
In our efforts to address outcomes and efficiencies at the same time, we’ve seen that digital health is most effective when integrated with existing therapy protocols, rather than as an add-on item. A few years back, we made a conscious decision to equip the majority of our devices with built-in cellular connectivity so that therapy and device performance data can flow reliably and securely. The devices send data to the cloud just one hour after therapy concludes. Because connectivity is seamlessly built into the prescribed therapy, the devices require little human interaction to do their job. To ensure HME customers can take advantage of this data, we’ve armed them with secure, cloud based patient management solutions to monitor therapy usage, remotely troubleshoot devices, manage patient populations by exception, and integrate data directly into their existing patient management and business systems.
Our data show this holistic approach can be remarkably effective.
A randomized study recently published in Sleep and Breathing Journal found a 59 percent reduction in labor associated with coaching patients when using ResMed’s U-Sleep patient management platform, which automates coaching messages instead of traditional postcards or phone calls. The technology had an impact on helping patients stick to therapy as well, with an observed difference of +10 percentage points in Medicare-defined adherence for the U-Sleep group (83 vs. 73 percent).6 Other ResMed partners have seen increases in compliance to therapy as high as 27 percent and have been able to increase the amount of new patient set-ups by up to 83 percent with the same staff when using U-Sleep.
The debated economic and clinical benefit of digital health and remote monitoring has been realized in sleep apnea treatment. Digital health technology built in to existing devices and systems can help patients benefit from more personalized care and consistent therapy use, while HME partners can benefit from increased efficiencies and more compliant patients. The benefits extend to all parties, as payers benefit from lower readmissions and reduced healthcare utilization, and physicians get fuller pictures of their patients’ care. We strongly believe comparable gains can be seen with a similar strategy in other disease areas.
The benefit of digital health is clear, and it has only just begun.