The momentum around digital health has been building for years. Whether it’s managing diabetes, curing insomnia or guiding patients through surgery and recovery, digital therapeutics represent exciting opportunities to improve outcomes and quality of life, and to reduce costs of care.
Despite the hype, many remain skeptical about the promise of digital health products because many products that showed impressive results in clinical trials have failed to do so in real-world settings. The problem, as highlighted in a recent New England Journal of Medicine Catalyst article, stems from a lack of durable patient engagement with real-world digital health tools. It’s one thing for patient engagement to be sustained with digital health tools in the context of a formal research study with lots of resources applied by research teams to keeping patients involved. It’s quite another in the real-world setting.
Clinical studies validate effectiveness of digital therapies
The tide, however, is beginning to turn on real-world results, validating that many digital health products on the market do make a meaningful impact on health outcomes and can, in fact, sustain patient engagement. Omada Health, for example, recently conducted a diabetes prevention study to collect real-world data and real-world evidence. The study was carried out in a similar way to how Omada interacts with real patients, providing the company with a good understanding of the real-world performance characteristics of its product.
Working with GetWell Loop, several outcomes studies were published last year demonstrating that our automated digital patient engagement platform is linked to improvements in cost and quality, and also fills an important follow-up gap that exists in post-discharge care. A multi-center real-world study conducted by Anthem, Inc. together with HealthLoop (now GetWell Loop) and published in the Journal of Arthroplasty, found that patients who underwent total joint replacement, and who were enrolled on HealthLoop, cost an average of $656 less per case, experienced a 54% relative reduction in 90-day surgical complications, and a 45% relative reduction in 90-day hospital readmissions.
University of California San Francisco researchers, led by Dr. Stephano Bini, and presented as a podium talk at the American Association of Hip and Knee Surgeons annual conference in Dallas, Texas, in November 2017, also studied the real-world impact of HealthLoop on 30-day readmission rates after total joint replacement procedures performed over a one-year period. The study found that patients enrolled on the platform had a 1.4% readmission rate compared to a 4.5% readmission rate for patients not on the platform (P=.01). HealthLoop was also very well received by patients, with a nearly 90% adoption rate, even among an older population.
In another multi-center real-world study, BTG International in conjunction with clinicians at Northwestern University, Mount Sinai Medical Center, University of Louisville and Vascular and Interventional Professionals evaluated the effectiveness of HealthLoop to educate, engage and measure health-related quality of life in 41 patients with liver cancer undergoing treatment with the company’s TheraSphere transarterial radioembolization therapy. The study, presented as a podium talk in June 2017 at the World Congress on Interventional Oncology annual meeting in Boston, Mass., demonstrated not only that patients were extremely willing to engage with the platform, providing quality-of-life survey responses at frequent intervals, but that they sustained quality of life without significant side effects through 90 days following treatment. Seventy-one percent of patients in the study completed and submitted responses to patient-reported outcomes survey questions with no work required by the providers to collect these surveys.
Real-world evidence for other digital therapeutics companies is beginning to roll in as well. These clinical validation studies, combined with increasing reimbursement for patient engagement and remote monitoring, are positioning digital therapeutics to reach critical mass in the coming year.
Patient engagement reimbursement gains momentum
On the reimbursement front, the Centers for Medicare and Medicaid Services (CMS) recently announced it will reimburse physicians for using remote monitoring technologies to provide ongoing assessments outside of the office visit beginning this year, using the CPT code 99091. This allows providers to be reimbursed for time spent collecting and analyzing health data that is generated by the patient, transmitted to them and digitally stored.
In addition, on Jan. 1, CMS added a patient engagement measure to the Improvement Activity Category under the Merit-Based Incentive Payment System (MIPS). I was particularly happy with this development because I led the authorship and submission process with colleagues at two other digital health companies that resulted in this measure being adopted. We’re thrilled that CMS increasingly sees the value of activating patients in their care and keeping physicians and patients in contact through appropriate sharing of patient-generated health data.
CMS unveils BPCI Advanced
As if CMS had not been busy enough, earlier this month, CMS announced the next generation of Bundled Payments for Care Improvement, BPCI Advanced. The new payment model includes 29 inpatient bundles anchored by 105 MS-DRGs and three new outpatient bundles identified by 30 HCPCS codes. Bundles include hip and knee replacement, coronary artery bypass grafts, acute myocardial infarction, percutaneous coronary intervention, cardiac defibrillator implantation and back and neck procedures (except spinal fusion).
As with the original BPCI model, payment for BPCI Advanced is tied to performance on quality measures. BPCI Advanced aims to incentivize more efficient spending and better care coordination between providers, which ultimately reduces costs. Engaging patients in their care will continue to be a key ingredient to drive patient satisfaction and reduce costs and unnecessary utilization under BPCI Advanced.
Since the program is voluntary, it won’t face some of the early opposition that the mandatory programs like Comprehensive Care for Joint Replacement (CJR) and Episode Payment Models (EPMs) did. In fact, there is great interest in BPCI Advanced for a couple of reasons. First, it qualifies as an Advanced Alternate Payment Model (APM) under MACRA. Second, providers that participated in BPCI generated substantial savings, especially in the total joint replacement episode of care. With GetWell Loop, our partners can attest to the savings and quality improvements under BPCI and see BPCI Advanced as another way to differentiate from their competitors.
The time is right to engage your patients outside of the four walls of the clinical setting
These reimbursement and bundled payment advances are important steps for CMS in recognizing the value of patient engagement and remote monitoring technologies across medical episodes, which will continue to play bigger roles in healthcare delivery as the population ages. We have also seen ongoing investments and commitment to value-based models from private payers, driving the transition from fee-for-service to value-based care. Outcomes are the new incomes, and organizations making commitments to that mantra will be the ones that flourish in the coming year.
Although 2016 and 2017 were years when the most forward-thinking and early-adopting organizations entered into the true use of digital therapeutic technologies at scale, 2018 will be the year when many more mainstream organizations make the similar commitment; a commitment that will be increasingly necessary to remain competitive in a value-based era, and an era in which patient and consumer expectations about the services they receive for their healthcare will continue to climb. 2018 will be the year of mainstream adoption of digital health tools that engage patients in their care and deliver better outcomes at lower costs.
The real-world evidence is here, and will continue to demonstrate that digital therapeutics, when designed in a user-centric way that is compatible with the needs and workflows of its users, and that solve real world problems — work. The financial incentives are in place, the studies have shown that these tools can work and evidence points to real-world sustained adoption by patients and providers alike. The time has never been better to get on board.