Remote Patient Monitoring for Disease Management: 10 Observations About the State-of-the-Market
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Transcript of Remote Patient Monitoring for Disease Management: 10 Observations About the State-of-the-Market
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Remote Patient Monitoring for Disease Management: 10 Observations About
the State-of-the-MarketPresented at
NMHCC Disease Management Congress Chicago, Illinois September
2002
Better Health Technologies, LLCVince Kuraitis JD, MBA Harry Leider MD, MBA
www.bhtinfo.com (208) 395-1197
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Top 10 ObservationsRemote Patient Monitoring (RPM)
1) The market is extremely fragmented. RPM comes in many sizes, shapes, flavors.
2) The value proposition of RPM is compelling!3) Show Me the Evidence! The strength and specificity of the RPM value
proposition is unproven.4) Customers are adopting RPM applications.5) Cost savings (NOT quality improvement) is driving current RPM
adoption.6) Valuation of RPM companies is unclear (market cap/sales)7) RPM has multiple drivers AND multiple barriers.8) Weak links in the RPM value chain9) The immediate RPM market is being driven by niche applications (as
opposed to integrated, enterprise-wide adoption).10) Watch for RPM’s synergy with other promising health care
information technology killer applications.
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The Big Picture: Health Care in 2002Relative Cost & Quality
OptimalQuality
RelativeCost &Quality
OptimalCost
?
Source: Northeast Consulting Resouces
xYouAre Here
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Shifting DM Metrics:Creating Value for Patients and Shareholders
OptimalQuality
RelativeCost &Quality
OptimalCost
?
Source: Northeast Consulting Resouces;Better Health Technologies, LLC
xYouAre Here
ROI
Outcomes
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High Variation in Chronic Care
Source: Rand Health, Taking the Pulse of Health Care in America, 1999http://www.rand.org/publications/RB/RB4524/
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Ch. 4 – Taking the First Steps
“common chronic conditions should serve as a starting point for the restructuring of health care delivery”*
*IOM Report, Crossing The Quality Chasm, 3/01
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Restructure Health Care Around Priority Conditions
• AHRQ should identify 15-25 priority conditions (mostly chronic conditions) Cancer
Diabetes Emphysema High cholesterol HIV/AIDS Hypertension Ischemic heart disease Stroke
• Purchasers, health care organizations, and professional groups should develop strategies and implement action plans to substantially improve quality for priority conditions over the next 5 years
Arthritis Asthma Gall bladder disease Stomach ulcers Back problems Alzheimer's disease and other dementiasDepression and anxiety disorders
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Strategic ContextPersonalized Medicine
• Remote patient monitoring (RPM)• Contact center (mail, email, call center, in-
person…..)• Appropriate treatment settings (home,
ambulatory……)• Customer Relationship Management (CRM)
software• Customized pharmaceuticals• Genomic profiling and therapies
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1) The market is extremely fragmented. RPM comes in many sizes, shapes, flavors.
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RPM CompaniesA&D MedicalADTActive CorporationAdvanced BodymetricsApplied Digital SolutionsAeroTel Medical SystemsAgilentAlereAMD TelemedicineAmerican Medical AlertAmerican TeleCareAvidcareBiotrokikBodyMediaCambridge HeartCameron HealthCardioComCardioNetCyber-CareCyberNetData CriticalDigital AngelDMCareElite CareGeneral Electric
HealthCare VisionHealtheTechHealthFrontierHealthHero NetworkHeart AlertHomMedIGEN InternationaliMetrikusInterComponentWareIntelliServicesInterCureiSenseKivaloLife NavigatorLifeLine SystemsLifeConnectLifeLinkLifemastersLifestreamM-BiotechMedipatternMedisana USAMedisignalMedtronicMicronics
NexanPanasonicPersonal Electronic DevicesPolarQRS DiagnosticRemote Medical CorporationRoadside Telematics CorpSensatexSensitronSiemensSpacelabs MedicalSportBrainStayhealthyTelemed.comTelemedicine GroupTelemedicine Solutions in HealthcareTherasenseTransMedExTransMedExVISICUVitalComVivoMetricsWelch AllynWellness Monitoring, Inc.World Wide Video
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MEDICAL MONITORING
MEDICALDEVICES
TELEMED
DISEASE/CONDITION
MGMTFITNESS/
WELLNESS
SENSORS
SMARTHOUSES
ETC.
REMOTEREMOTEPATIENTPATIENT
MONITORINGMONITORING
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TelemedicineTelemedicine
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Fitness/WellnessFitness/Wellness
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Smart HousesSmart Houses
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2) The value proposition of RPM is compelling!
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3) Show Me the Evidence! The strength and specificity of the RPM value proposition is unproven.
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The Evidence
• Conclusions-to-date– RPM and clinical improvement: positive, inconclusive– RPM and cost effectiveness: almost non-existent evidence
• AHRQ Evidence Report*: “The evidence for the efficacy of telemedicine technology is less clear. The
problem is not that studies have strong evidence against efficacy, but rather that their methodologies preclude definitive statements. Many of them have small sample sizes that preclude statistical power, and the settings of others may not be equivalent to clinical settings. Still others focus on patient populations that might be less likely than others to benefit from improved health services, such as people who have complex chronic diseases.”
• Other studies with similar conclusions*Source: http://www.ahrq.gov/clinic/telemedsum.htm
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5) Cost savings (NOT quality improvement) is driving current RPM adoption.
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3 Definitions of Chronic Disease Market Size
(Drawn to scale)
$500 MDMSCs
$700 B Chronic Care Patients$20 –$100 BOpportunity*
* Projections by BCG and First Union
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“Inside the Box”
DMSCs (Business Model)• Prevent unnecessary
hospitalizations and ER visits• Save $$ short term for payor• Quality w/o ROI only “sells” for a
few diseases• 4 to 6 top diseases• Done “to” the patient• Care coordinator = 3rd party• Local/regional focus• Outsource vs. build
DM (Care Delivery Model)• Optimize patient health status & clinical
outcomes• Save $$ long term for payor or patient• Health care consumerism/ patient
empowerment• 100+ conditions/diseases• Done “by” the patient• Care coordinator = patient or doctor
• Not geographically bound• Assembly from components viable
“Outside the Box”
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4 Different Chronic Disease Customer Segments Emerging
MCOsEmployers
Patients/CaregiversProviders
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Varying Value Propositions for Chronic Care
Who cares most about ________?MCOs Employers Patients/
CaregiversProviders
Short-termMedical Costs
Health/Quality of Life Clinical Quality Peace of Mind/Monitoring Productivity Convenience/Time Savings New Revenue Source
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Varying Value Propositions for Chronic Care
Who cares most about ________?MCOs Employers Patients/
CaregiversProviders
Short-termMedical Costs
Health/Quality of Life Clinical Quality Peace of Mind/Monitoring Productivity Convenience/Time Savings New Revenue Source
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Varying Value Propositions for Chronic Care
Who cares most about ________?MCOs Employers Patients/
CaregiversProviders
Short-termMedical Costs
Health/Quality of Life Clinical Quality Peace of Mind/Monitoring Productivity Convenience/Time Savings New Revenue Source
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6) Valuation of RPM companies is unclear (market cap/sales)
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Valuation of Health Care Sectors Differs Dramatically
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7) RPM has multiple drivers ANDmultiple barriers.
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Trends Fueling RPM
1. Health care consumerism2. Medical error reduction/quality improvement initiatives3. Connectivity infrastructure: transaction processing lays the
foundation for e-care4. DM “assembly” model gaining prevalence (vs. making or buying)5. IT – data warehousing, data mining6. Clinical work flow automation software 7. ASPs: particularly suited for health care8. HIPAA = standardized data9. eHR: employers connecting with employees10. Physicians accept the Internet, particularly for clinical applications11. HMOsRUs.com: Defined contribution/eHealth Insurance12. Medicare reform
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Barriers to RPM
• Reimbursement• HIPAA: Privacy/confidentiality issues• Physician resistance• Technology maturity
– Infrastructure– Bandwidth– Standards– Friendly user interfaces
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8) Weak links in the RPM value chain:
ReimbursementMobility (wireless)Point-of-care access
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9) The immediate RPM market is being driven by niche applications (as opposed to integrated, enterprise-wide adoption).
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Mobile Computing Apps
• Charge capture and coding• Prescription writing• Clinical documentation• Lab order entry/results reporting• Decision support• Alert messaging and communications
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10) Watch for RPM’s synergy with other promising health care information technology killer applications.
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Scanning the Horizon – Possible Killer Apps
• Medical information sites for physicians • Wireless reference, ordering and coding systems • EMR (Electronic Medical Records) • Voice recognition • Physician patient email • Telehealth in the patient's home • Expert systems for decision-support
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• RPM – early, promising• Value propositions
– Initially cost savings– Multiple others
• Need for industry collaboration– Evidence of RPM effectiveness– Improving reimbursement– Rapid development of synergistic, complementary apps
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Better Health Technologies
• Strategy, business models, partnerships• Disease/care management and e-health • Consulting/Business Development
• E-Care Management News– Complimentary e-newsletter– 3,000+ subscribers in 27 countries worldwide– www.bhtinfo.com/pastissues.htm
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Recent BHT Clients• Pre-IPO Companies
– Life Navigator (remote monitoring connectivity and health intermediary services)– DiabetesManager.com (Internet diabetes DM)– CogniMed (highest cost/risk patient management software)– Caresoft (consumer focused DM)– Benchmark Oncology (oncology DM)– SOS Wireless (cellular phone technology)– Click4Care (Internet DM)
• Established organizations– Medtronic -- Neurological DM (medical devices/chronic disease solutions) -- Cardiac Rhythm Patient Management– Disease Management Association of America (trade association)– PCS Health Systems (PBM)– Varian Medical Systems (oncology equipment & systems)– VRI (behavioral health care management services)– Washoe Health System (integrated delivery system)– S2 Systems (medical transaction processing software)– CorpHealth (MBHO)– Physician IPA– Centocor (biopharma)