Episode #3: Obvious Truths Our Healthcare Policy Still Doesn’t Support: Home Care and RPM
These truths may be obvious to you as a healthcare innovator, but regulators, payors, and sometimes even consumers still lag behind for some very outdated and sometimes odd reasons.
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In this episode you’ll discover:
Why people prefer care at home, and what COVID-19, Amazon, and the Moving Health Home Coalition are doing to make that more of a reality
How remote patient monitoring (RPM) improves health outcomes—even though we make it hard for providers and patients to use it
What features innovators and investors should look for in healthcare solutions to build on these obvious truths
Keep scrolling for a transcript of this episode.
Learn more from Carrie and Rebecca:
Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)
Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn
“Care at home should have been a no-brainer before the pandemic. It is absolutely a no-brainer after the pandemic.”
Learn More Here
Find out more about Moving Health Home, an alliance whose members are “working towards a future where care comes to patients.”
Forrester Research predicted that “every company will become a healthcare company in 2021”—and Amazon is leading the way.
We broke it down hours after it was released: RPM Reimbursement in the 2021 MPFS: The Good, the Bad, and the Ugly
Read the transcript:
Rebecca Gwilt (00:00):
For innovators and investors out there, you should be looking for solutions that enable not just virtual care via telemedicine, but other ways to make delivery of care by clinicians available in patient homes.
Announcer (00:12):
You're listening to Decoding Healthcare Innovation with Carrie Nixon and Rebecca Gwilt, a podcast for novel and destructive healthcare business leaders seeking to transform how we receive and experience healthcare.
Rebecca Gwilt (00:26):
So what I love about innovators is their very unique ability to reject the status quo and to mold the world around them into their own image of how things should be. Carrie and I try to do this all the time in the practice of law, it's one of our core values and we work with a lot of innovators that are doing this as well. When these innovators invent something, we not just in the context of healthcare, but in anything that we experience when they invent something, we often smack ourselves in the foreheads and we say, why didn't I think of that?
(01:00):
How many millions of times did we lug around suitcases until somebody finally popped on some wheels? These are the kinds of innovations that we love to see in the marketplace where people just accepted how things were and the innovators came around and said, no, this can be better. This can be better. So today I want to focus specifically on healthcare. Of course, that's what we do and get it to some obvious solutions. And Carrie, in my view that I think it's time that we embrace, and when I say I'm not talking about the innovators, we talk with them every day. They're already on board. By I mean the policy makers and the payers and even consumers, some of whom just still haven't embraced the future of healthcare as we see it. So I've got a whole list of these in my head. I will be talking about more of them in future segments, but today we're going to talk about two of these and I'm really excited.
Carrie Nixon (01:56):
So Rebecca, I love this topic. There are many, many obvious solutions out there in healthcare. I know patients could themselves name some obvious solutions. You're right, the innovators are squarely on board there. There's resistance though, because there's a regulatory infrastructure that doesn't necessarily support innovation, and sometimes large entities like big commercial health plans or hospitals and health systems just aren't flexible and nimble enough to be able to embrace them as quickly as we would like. So yeah, I'm eager to talk about these obvious solutions.
Rebecca Gwilt (02:39):
Okay, great. So the first thing I want to talk about, and we've seen some news about this recently, at least through the spring and that is people prefer to get their care at home. They want to get their packages at home, they want to get their food delivery at home. They also want to get their healthcare at home. They don't want to go in an office and sit in line. They don't want to go into a hospital if they don't need to. They want it now and they want it without having to pack all the kids in the car. We're seeing massive mergers and acquisitions happen in the health care market, even some IPOs this year. A lot of the action has been, however, in sort of on the private side we're seeing a lot of new partnerships after years of payers including the government underfunding and undervaluing home care and I think consumers are done with that.
(03:35):
Amazon Care is a good example of a mix of virtual, of a model that offers a mix of virtual and in-person care, it's been rolled out in a very limited way to their employees. I think in Washington, it might be expanding to the East coast soon but they are experimenting with not just having doctors beamed into patients homes, but actually having a clinician arrive at a home and take care of folks there. And they wouldn't be doing this if they didn't think that there were dividends. They didn't think that this would reduce costs and improve the lives of their employees. Amazon has teamed up with a consortium of other healthcare organizations that are interested in moving care home. In fact, the coalition is called Moving Health Home. It includes Signify Health and Ascension and a couple of others. They're going to be advocating with the goal of changing policies to expand at-home care.
(04:35):
I think any of us, if we really thought about how we would rather receive our healthcare, we would all say, yeah, we'd like to be in our house where we're most comfortable. And it's not just when we're really, really ill and we're home bound. In any case, if your child is sick, you want to hold them and put 'em in a their jammies and you want the doctor to come by and see how they are, not pile 'em in the car and put 'em in a waiting room. And the same as for parents and loved ones at home is where we're comfortable and at home that we would rather receive our care and we're really seeing a lot of movement toward making that happen.
Carrie Nixon (05:13):
So care at home should have been a no-brainer before the pandemic. It is absolutely a no-brainer after the pandemic because we have proven that it can happen and it needs to happen. We talked last week about healthcare as a national security issue and I do firmly believe that's the case. So now we've seen that care delivery at home is of value and can happen. I'm thinking that this at home care, these at home care models though also address the concerns that a lot of physicians have raised about virtual care and telehealth. They want to be sure that virtual care services are not a replacement for face-to-face visits, like in-person visits. And this model really reflects that, right? I think it envisions really incorporating a hybrid of in-person care, telehealth and virtual services, and then as needed in office visits or acute episode, acute care settings where that's needed. I'm really excited to see the Moving Health Home Coalition. I do think that we're seeing some payers and we're seeing Medicare in particular talk a little bit more about care at home. Medicare has put out the hospital at home program and that's getting some interesting traction but a hundred percent, this is something that seems really obvious that we need to be working pretty hard to get out there.
Rebecca Gwilt (06:56):
Yeah, I mean the technology is there, the payment needs to, needs to catch up. So I would say for innovators and investors out there, you should be looking for solutions that enable not just virtual care via telemedicine, but other ways to make delivery of care by clinicians available in patient homes. So innovations to optimize time spent seeing patients as opposed to time in transit. That's a real issue. Mobile phlebotomy and lab services, for instance, there are some things that can't be done through a screen and they'll need to be actually delivered in the home. Remote monitoring, which we'll talk about in a second. Devices that will help with medication management and actually remotely dispense medications to folks. Virtual patient care solutions for things that are traditionally restricted to in-person. So we represent a number of physical therapy companies. You wouldn't think you'd be able to do PT virtually, but you can.
(07:52):
And as Carrie mentioned, even acute care acute care, home tools and technologies and for the companies and coalitions that are already in this space and driving this forward, we're going to need to continue to put pressure on policy makers to expand among other things, services covered in a home-based setting and to really rethink to rethink how we pay for this that in a way that's commensurate again with the value that it's providing. So I would hope that that folks would be moving toward a less fee for service option and more of a value-based option as far as that goes. So I'm going to turn it over to Carrie for number two because she's the expert on the benefits of the kind of real-time monitoring that we're starting to see proliferate in the market.
Carrie Nixon (08:41):
Yeah, thanks Rebecca. So this is a very obvious healthcare solution that some people would say policy is now supporting, but many people would say policy has a way to go in supporting and that's remote patient monitoring. So we absolutely have the ability to provide ongoing consistent monitoring of individuals who need monitoring. If they have hypertension, we can write readily monitor their blood pressure on a regular basis, and we can identify problems as before. We can identify abnormalities that are signaling that a problem might occur and address them before it actually occurs. We can monitor implantable heart devices as well as sort of external heart monitoring devices for continuous look at those patients who may have congestive heart failure failure or some other condition. We do have reimbursement opportunities now for remote patient monitoring. The margin, the way that the reimbursement is set up is such that the margins for those who are providing remote patient monitoring services are really pretty slender.
(10:02):
So that's sort of thing number one. We want to make sure that the incentive is appropriate and enough to actually encourage physicians and other camp kinds of providers to implement remote patient monitoring programs for their patients. The second issue really is that some of the requirements around reimbursement currently are making it too onerous for patients and physicians to really successfully implement. So for example, right now there's a requirement that 16 days worth of data from a connected peripheral device must be transmitted by a patient during a 30 day period in order for reimbursement for that device to occur. That's kind of silly, right? I mean, it may be, and it absolutely is the case that that amount of monitoring is not really necessary to adequately be able to review patient data and identify trends and intervene in problems. So personally, I'd really like to see our policy makers acknowledge that and put more flexibility in the hands of the medical providers to decide how much monitoring per month or how many data transmissions per month are really appropriate for a given patient. We've got Rebecca, the Medicare physician fee scheduled proposed rule that will be coming out for 2022 will be coming out in July at some point. I would really encourage people to submit comments to that proposed rule as they apply to remote patient monitoring and other virtual care services. I would also suggest that they even contact their local legislators. It is absolutely the case that sometimes legislators can definitely encourage some of the regulators in the direction that they take healthcare policy. So that's another one that I'm hoping will make some progress on.
Rebecca Gwilt (12:13):
Yeah, and I think the resistance to really embracing paying for value for remote monitoring is so steeped in this idea of fee for service. So it's hard to innovate outside of it. They're thinking, well, the more monitoring, the more money. And that's true. It's on a fee for service basis. But the theory behind this is that if you're catching things in a low acuity environment, people don't end up in the hospital or they don't end up sicker or they don't, it takes a shorter amount of time for them to get better because they're adhering to their treatment protocol or they're making sure that they catch things early, and that ultimately is meant to reduce costs. And oh, by the way, this healthier people are happier people, and we want better outcomes. So the point here being people have tiptoed into the water here in RPM, and not because the government sort of said, let's open the floodgates, but because people who knew this obvious truth that we're talking about today pushed and pushed and pushed and continue to do so, and that's why we have what the news is calling a 30 billion industry explosion overnight.
(13:31):
Well, this is years of folks talking about the real value here. So now I'm hoping that all the folks in this industry will be collecting lots of data and be proving this out so that this isn't just sort of a bunch of pundits talking about the value of this, but rather something that really gets embraced on a broad scale. So like I said, there's a ton of these that I'd love to talk about. We're going to wrap up for today. I'd love to hear your thoughts about what else belongs on this list. Tell us on social, we're on all the platforms and we're listening, and thank you so much for being with us today.
Carrie Nixon (14:10):
Thanks everyone.