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Remote patient monitoring's reimbursement problem

Claire Rychlewski
May 23, 2023
Roundtable of panelists at Axios' Expert Voices lunch

Expert Voices roundtable. Photo: Axios

The major stumbling blocks for remote patient monitoring are obstacles health care has seen for decades: health system buy-in and reimbursement.

Why it matters: Care is moving beyond the four walls of the hospital and digital health players are ready to deliver it — but the speed of that evolution is TBD.

What they're saying: "The country rolled out CPT codes in 2019 and yet RPM is still anemic in its growth. Why is that?" said ACME Capital partner Aike Ho.

Context: Ho and others were speaking at an Expert Voices discussion before the Axios BFD event in San Francisco on Wednesday.

  • "I think what it's devolved to, unfortunately, is a way to get at new codes for revenue purposes that have little to do with the things that (help patients) get better," said Venture Valkyrie CEO Lisa Suennen.
  • Mass adoption of RPM would be better enabled if "we had a value-based health system at all, really, that would allow for risk management in the way that managing risk and resources matter," she continued.

Between the lines: Remote patient monitoring can take on myriad definitions, but not all panelists agreed on what it encompasses.

  • Direct-to-consumer plays have oft-dominated the space via wearables and other devices, though Suennen said for her, RPM is not wellness-related.

Zoom in: "I think there's an interesting distinction because of the way our health care system is structured in the U.S.," said Amy McDonough, general manager at Google's Fitbit Health Solutions.

  • Fitbit Health's global business, for example, is much quicker to adopt reimbursed, provider-led RPM, versus consumer-led tracking, she added.
  • However, Fitbit's reimbursed RPM initiatives still leverage wellness data from wearables to inform clinical guidelines — which has led to better patient outcomes, according to McDonough.

Be smart: The potential for longitudinal patient data is where consumer-focused and provider-led RPM merge, some panelists said.

  • "I care that I walk 10,000 steps a day," McDonough said. "My physicians — all of them — do not care, but they might care if my trend is changing and health care systems are not set up to take on longitudinal data."
  • Hybrid care models using RPM tools to monitor patients between visits generate crucial longitudinal data, said Connie Chen, COO of behavioral health tech company Lyra Health.
  • Learning more about a patient's trajectory can "create a world where we could accurately identify the first symptoms and onset of disease and intervene before it happens," said Evidation CEO Christine Lemke.

Yes, but: "One of the challenges here is we're still living in the world of predictive analytics," said Suennen.

  • "Prediction is nice. But action is better and we need to move towards prescriptive analytics: 'Here's what we learned. Here's what you should do about it.'"
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