Many Americans discovered the convenience and quality of virtual care for the first time during the pandemic. Now that the long-promised future of virtual healthcare has made its debut to so many, consumers expect it to remain and improve. So what does this market acceleration combined with the shift in consumer expectations mean for remote patient monitoring and digital health more broadly?
Dr. Steven Shook, director of telehealth at Cleveland Clinic, Dr. Kenneth Snow, medical director, chronic care team at CVS Health and Dr. Nick Patel, chief digital officer at Prisma Health joined Validic CEO Drew Schiller to share their thoughts on the rapidly-changing digital health landscape and trends they see for the year to come.
The following is a portion of the free Validic webinar: 2022 Trends in Remote Patient Monitoring and Digital Health. The transcript has been edited for length and clarity. See the full discussion in the above video on Validic’s YouTube channel.
Drew Schiller: 2022 will be the year of what in virtual care?
Dr. Kenneth Snow: I think 2022 will be the year of normalization in virtual care, I think it’s going to become part of the normalized practice of care that’s provided.
Dr. Nick Patel: I would say that the trend of the year would be optimization and consolidation in health care. I think we’re going to see a lot of optimization of all those point-of-care solutions this year.
Dr. Steven Shook: It’s going to be a year for building digital adoption in virtual care. We saw a huge surge in interest early in the pandemic, and as we re-opened for in-person care we saw that begin to level off — much higher than pre-pandemic levels, but we haven’t seen it maintained at the level we expected. So we’re looking to tap into the interest that we saw from our patients.
Drew: As we’ve said this is the year of normalization for digital health, what is the biggest sort of shift in thinking or lesson learned for payers and providers in the last year?
Dr. Snow: Well, I think there’s been a continuation of this consumerization of health care where we recognize that if we really want to be providing care in the most optimal way, we need to meet people where they are, and make health care as convenient as possible for them, that we need to make it accessible for them. And certainly, the adoption of virtual care or the expansion of virtual care came about, not because of the reason we all would have liked. But as we were thrown into this, this clearly demonstrated the ability to reach people where they are in a more convenient fashion. And I think that this has really become part of how certainly payers and many providers are viewing this, that there’s a real opportunity here to be able to develop that rapport with our patients and make accessing the health care system easier.
Dr. Patel: Yeah, I 100% agree with that. There’s a major shift to the retail consumer experience. And one of the other driving forces has been seeing how much you can really accomplish at home and be effective and give quality care. That proactive, in-between-office-care and monitoring of patients really helps you with quality and getting people to stay healthy and stay out of the hospital.
Dr. Shook: On the payer side, I’d mentioned that a lot of the payers were very concerned about utilization by opening the floodgates, if you will, to virtual care. Their concern was that there would be overconsumption of health care. And the payers that we’ve been chatting with, haven’t seen that increase in utilization. It’s going to be a huge change in the way that our payers look at what can be done. And I’d say that what’s really cool is that we really changed what we believed we could do virtually. It’s amazing what you can accomplish when you’re forced to try.
Drew: Nick, what do you think is next for hospital at home and how do you think that will fit into the broader strategy for care outside of clinical settings?
Dr. Patel: You know, when we started doing hospital home, we actually started at pre-pandemic, because we found that we wanted to help decompress the hospitals. Number two, we saw a trend of devices and wearables and partnerships that are occurring across the industry that allowed you to do this at home. We found that admitting patients by having the right people look at the inclusion criteria and making sure that it’s safe to do in the home environment and giving those patients appropriate equipment right out of the box. They don’t need broadband, they don’t need to have Wi-Fi, it’s all ready to go out of the box.
But the important part of that is what happens post-acute. So you get discharged from an acute side, but then you’re actually monitored for another 30 days plus by a home recovery nurse and escalated to hospitalists when needed. And what we found, after doing over 1,000 of these now, we had zero readmissions and their satisfaction score was over 95%.
And then we’re expanding that to post-acute where we’re actually going into skilled nursing facilities and doing that as well. What we’re finding is that it’s much better than the old way of admit and discharge. Monitoring post-acute allows people to make sure they have a safety net. We’re seeing this emerge across the industry because it really helps patient satisfaction, decompresses the hospital system, reduces readmissions and reduces cost of care.
Dr. Snow: I think one of the things to also keep in mind is that going into a hospital is not necessarily a benign event. We know there are nosocomial infections and adverse events. We know patients get confused during the middle of the night and there’s risk for falls. And all of that can be minimized by keeping people at home, in an environment where they feel more comfortable, where they know the surroundings and can avoid some of those adverse effects associated with hospitalization while still providing the level of care that they need.
Drew: How are providers adopting that hospital at home? Nick, I know you and I have had conversations in the past around workforce shortages and burnout. I’m just curious if you can sort of relate to how folks are adopting this in your system?
Dr. Patel: So far, the hospitalists enjoy it. You know, one of the biggest things we talk about is physician burnout, but really, it’s just provider burnout, nurses, everybody-involved-in-the-care-team burnout. And what we’re finding is that being able to spend 50% of your clinical FTE at home, taking care of patients is a good work-life balance. And they like it because it’s a more efficient way of seeing patients than having them waiting in the waiting room.
So I think that we’re going to continue to see this so long as we don’t penalize people for working from home and we enable them. The key to that is linkage to brick and mortar. There has to be a way to escalate people to a brick and mortar location or labs and ancillary services when those things are needed and it needs to be seamless.
Drew: Steve, how has your organization’s view around these sorts of virtual remote patient monitoring strategies in health care changed since before the pandemic to today?
Dr. Shook: At the Cleveland Clinic, we’ve had more of a science fair approach to remote patient monitoring solutions. It’s been one really cool little thing over here and another really cool thing over there, but no really centralized strategic approach to bringing this all together in a way that helped us perform better on value-based purchasing contracts, for example.
And I think that we’ve learned a lot from that and we’re very, very excited about doing things in a more scalable way. We’ve realized that we need to really put together some shared resources around doing remote patient monitoring with a centralized administrative function. So I think one of the key things we determined out of necessity during the pandemic was that to really unlock the potential of remote patient monitoring, we need to bring it all together in one place with a central strategy.
Drew: In what ways do you see the roles of health plans and health systems sort of shifting in 2022 and beyond?
Dr. Patel: First of all, we’ve got to get fee-for-service out of here. I think that’s just not something that’s sustainable. And I think a lot of this move, while people say we’re doing it for our patients, it’s also about trying to bend the cost curve to reduce admissions.
But I think the key here is understanding how we’re going to bring more value to the patient and get them quality care. To me, it’s all about what that shared risk model looks like. So you have to make a decision as a health system, are we doing this because of our bottom dollar? That does have to be part of it to be solvent as a health system. Then, if we’re taking on so much risk, we need to make sure that patients stay healthy and they stay in the ambulatory space or they stay home. And in order to do that, I have to be able to provide care when and where they live and how they live.
Drew: Steve, I know, you know, Cleveland Clinic is very much in the fee-for-service world. I’m just curious, how are you thinking about that right now? It is a bit of a challenge, right?
Dr. Shook: What I learned for us was that at least in our ACOs and in our patients at risk, we were already doing a really good job managing those patients for the most part without RPM. And there wasn’t as much bang for our buck there. I mean, in those patients, it’s all about utilization, it’s all about hospital admissions, readmissions, ED visits. So it really changes the focus for us at any rate.
So the work that we want to do in diabetes, for now, does need to be fee-for-service. I saw a question from the audience: Well, do you really care about the fee-for-service stuff right now and our organization? We do, at least for now. We do understand the long-term play, absolutely, is going to be delivering value. There’s no doubt about it. It’s just that in the meantime, we need to be able to get paid for the work that we’re doing. I mean we have got to have the ROI. You know, where you can’t lose money and go out of business before you realize the whole vision of value-based care.
Drew: Coming off CES we’re seeing a proliferation of continuous health sensors — things like stickers, sensors that can get 60-hertz data, continuous glucose monitors, as well as some other more passive data elements. Do you think that is something that will help drive consumer adoption?
Dr. Patel: In order to build adherence, digital health devices need to melt away into your environment. It needs to just be part of what you do. You put your shirt on that takes your blood pressure and heart rate with sensors built into appropriate areas, or you’re brushing your teeth and you’re standing on this mat that tells you your weight, it needs to be just part of what you do.
Dr. Snow: I think there also has to be a focus on what a consumer of health care wants out of this. So I agree that it has to be everything that Nick just said about being present and easy, but also we have to address what’s the ultimate goal of why patients will want to wear this stuff. And the answer for everyone may not be, “Oh, because you’ll be healthier.” So we have to start thinking about other reasons why people will do this. How does it make their life easier? How does it make their life better? What kind of value does it add for them as a consumer of health care? We can’t only focus on what’s the long-term outcome and expect that to be a motivator for everyone.
This conversation was an edited selection from the fourth webinar in Validic’s Best Practices series. Watch the full series on our YouTube channel to hear more best practices and insights from industry leaders or connect with us at firstname.lastname@example.org.
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