RPM (Remote Patient Monitoring) Challenges

Yesterday, we took a broad view of RPM (remote patient monitoring) including some of the pressures it faces and the reasons many healthcare organizations are embracing RPM.  Today we want to look at some of the challenges that RPM still faces going forward and what it will take to overcome those challenges.

As we partially described yesterday, reimbursement for RPM services is still a challenge, but one that’s improving.  Todd Bellemare, SVP, Strategic Solutions at Definitive Healthcare, dove into their extensive data set and gave us a view into what’s happening in this regard:

Claims data from Definitive Healthcare, a healthcare commercial intelligence company, found that remote patient monitoring (RPM) setup increased nearly 61% last year compared to 2020. Additionally our data shows that last year, 619,000 patients had an RPM-related procedure claim, and that the top RPM patient diagnoses in 2021 were for hypertension, hyperlipidemia, type 2 diabetes, hypothyroidism, and heart disease.

Reimbursement has traditionally been a barrier, but it’s become easier to reimburse for RPM. There are now five codes specific for RPM services, with CMS introducing the fifth one in 2020 right before the pandemic hit. The easier it is for providers to get reimbursed for these services, the more likely they are to provide it to their patients. As a result, RPM has seen massive patient adoption, as it enables patients to take their healthcare into their own hands and allows the medical community to meet patients where they are.

Watching this data will be interesting, but the fact that 619,000 patients were involved in RPM is a real sign that RPM is gaining traction and I predict will rapidly expand from here.

Sarah Carroll, Senior Director, Center for Care Transformation at AVIA, is seeing this growth in their network.  She describes this growth along with the challenges and best practices they’ve learned, “We see growth in remote monitoring (RM) driven by increasing demand from consumers, providers and payers, who are all seeing real benefits. In the AVIA Network of 50+ systems, we see a lot of pilots run into challenges as they scale. Typical issues include optimizing reimbursement, administrative complexities, changing workflows, and setting unrealistic goals. Our best practices for breaking through include building consensus on primary use cases, identifying priority solution features, building a realistic business case, and dedicated support teams.”

I’ve seen many of the challenges described above before.  The most common being trying to bite off more than you can chew.  This is particularly true with RPM since it has such a vast number of use cases that it could be applied to in healthcare.  Getting buy-in for specific use cases that makes sense for your healthcare organization is essential to the success of RPM.  Otherwise, you’ll do a lot and accomplish nothing.

While organizational buy-in can be a challenge, patient engagement can be as well.  What’s needed for this?  Mohammad Jouni, CTO at Wellframe, answers this question “The consumerization of healthcare over the past few years is driving the adoption of remote patient monitoring (RPM) since RPM is centered on the individual patient and their specific care needs. The challenge that health plans and providers must navigate is offering the level of personalized, engaging digital care that people are now accustomed to. Health plans, since they reach a large percentage of the population, have a unique opportunity to drive RPM adoption and improve health outcomes for their members. Giving patients a central place to manage all aspects of their care – data from medical devices, medication, appointments, direct support, etc – increases their engagement with their provider or health plan, which gives a fuller picture of their health and leads to improved outcomes. Since RPM is centered around the patient, it empowers them to take charge of using accurate, trusted information to make decisions about their health.”

Whether you’re a health plan or a provider organization, personalization really is key.  In fact, it’s the promise of RPM.  Plus, it is what patients want and expect from these new programs.  The worst RPM programs I’ve seen collect all this data about a patient and then send generic responses to patients.  Is it any wonder that patients don’t trust healthcare when patients provide all this data and then don’t see that data being used to improve their care?  Personalization is going to be key to every successful RPM program.

Another major challenge with RPM programs revolves around trust.  Do patients trust your healthcare organization with their extremely personal health data?  Two important areas that build or destroy trust are around privacy and security.  Maayan Cohen, CEO at Hello Heart, describes the privacy challenge well:

“Who can see my data? is the #1 question we hear from members when they are considering enrolling in the program, and honestly, I understand it. I wouldn’t want clinicians I don’t know or no longer choose to see accessing data that I track in the privacy of my own home. Other people looking at your data is intrusive and can also be judgmental. The only way to solve this and get to mass adoption is to allow members to choose who sees their every data point. Solutions seeking to empower patients should provide a way for members to choose which clinicians have access to their data, ensuring that no one can access their data without consent.”

Obviously, the problem of privacy is much easier said than done.  Empowering patients to share the data where they want works with an engaged patient.  How do we do it with a patient that’s not engaged and just wants you to share the data for them?  It’s a complex challenge, but one we need to master for patients to entrust us with their RPM data.

Security is another component of patients’ trust.  RPM creates a number of new security issues.  The attack surface that has to be protected and secured dramatically increases as you ship devices to patients and start sharing that data.  Krishna Kurapati, Founder and CEO at QliqSOFT. describes the challenge:

“Last year, more than 40 million patient records were compromised by cyber incidents. The vulnerability of patient data stored on medical devices (IoT) is one of the biggest challenges faced in remote patient monitoring (RPM). Not all devices are created equal, which means not all devices are secure. If a device is compromised, it is hard to identify the culprit responsible. Some devices connected to the internet are easy targets, lacking proper security protection. What’s more, cyberattacks can be launched remotely through these devices. Healthcare organizations must take extra precaution implementing security protocols and plans to protect those medical devices associated with patient care from being hacked.”

No doubt RPM presents incredibly difficult privacy and security challenges.  However, all of these challenges can be addressed.  Security is always a fine balance between usability, value, and risk.  The same is true with RPM and we’re going to need to continue to find the right balance as we roll out RPM to more and more patients.

Another challenge for RPM is sharing the data with the organizations that can do something with it.  That’s right.  Interoperability is a challenge in RPM too.  Travis Palmquist, SVP and GM, Senior Care at PointClickCare, has seen this first hand in the senior living space and describes the need for robust interoperability in this way: “Senior living has already changed from a care setting-specific model to a patient-centered model, where services can happen anywhere. This includes home care with an emphasis on remote patient monitoring. Robust interoperability will be necessary moving forward. Patients need to remember that tech is responding to new needs in healthcare delivery. Remote patient monitoring should be viewed as a tool to ensure the safety and health of vulnerable populations – not intrude on patients’ privacy.”

What’s incredible about RPM is how it can be applied to every part of healthcare.  We see RPM happening in hospitals, medical practices, insurance companies, pharma, senior living, behavioral health and more.  The challenge is that the need is there and the technology is available, but there’s not parity across categories.

Will Shortt, Co-founder and COO at Ksana Health, described how this is holding back RPM in behavioral health, “For behavioral health remote patient monitoring, parity is the essential issue. Remote patient monitoring is reimbursable for physical health conditions such as diabetes with the use of glucose monitors – but not for mental health – yet. With evidence-based measurement, remote patient monitoring should be reimbursable as well. This will allow healthcare providers to implement assessment and intervention more effectively, affordably and at far greater scale. Evidence is another critical issue.”

As you can see, RPM is maturing, but it still faces many important challenges we have to navigate.  There’s a repeated comment about making sure we have the evidence that prove its effectiveness.  I think this may be the biggest challenge RPM faces.  The evidence is mounting, but there’s certainly plenty of proof work that needs to be done since RPM is such a big topic.

Every CIO and CMO I know is watching this space and trying to figure out the right timing and approach.  You don’t want to be too early and be the guinea pig whose staff and patients suffer.  However, you also don’t want to be too late where you have a massive uphill battle to build it into the culture of your organization.

Where are you at in your RPM efforts?  What other challenges do you see?

Be sure to check out all of our remote patient monitoring coverage and take a look through our ever expanding list of remote patient monitoring companies to see who might be able to help your organization.