The acceleration of remote health care could be one of the most sustained innovations to emerge from the COVID-19 pandemic. As people avoided traditional health care settings over the last two years, adoption of telehealth and remote services soared. A potential 250 billion dollar industry is on the verge of becoming a reality if prescribers, policy makers and ultimately patients, want it.
The surge of virtual medical visits in the early pandemic is well documented, with the share of Medicare telehealth visits in 2020 increasing from approximately 840,000 in 2019 to 52.7 million, a 63-fold increase. New models of care evolved to pair virtual visits with a range of services including routine consultations to HIV and STI testing and abortions. For those at higher risk of severe COVID-19, a convenience for many continues as a lifeline to essential health services.
Arguably, the longer-term digital transformation in health care is not in virtual visits, which essentially facilitates a patient–doctor conversation. It is in the full roll out of remote patient monitoring through personal devices.
Consumer wearable devices—smart watches, fitness trackers and phones—are now enabling the continual capture of physiological data including heart rate, blood pressure, Vo2 max levels, blood glucose levels and even fall risk. These insights can be integrated with medical information through electronic health records and shared with the patient and their doctor remotely. This data presents new opportunities to personalize care, increase patient engagement with their health and ultimately lower health care costs.
An Evolving Device Landscape
Evolution in remote patient monitoring is being driven by new functionality in the consumable wearables sector and traditional medical devices. Continuous blood glucose monitoring and insulin delivery has provided a measured improvement in patient outcomes. By digitalizing self-monitoring, these devices have lowered the risk of complications and healthcare utilization.
The addition of health data capture to consumer wearables can further drive this trend. Continually capturing physiological data is helping individuals prevent and act on changes in health status. In 2022, the FDA approved Fitbit’s new atrial fibrillation detection function. By tracking heart rates and identifying irregularity, a wearable is rapidly advising users to seek medical attention and minimize risk of a heart attack.
Overcoming HCP Skepticism
Provider skepticism on the quality and ability of consumable wearables to integrate data may inhibit the broader prescribing of remote monitoring. A survey of 588 health care professionals found that almost 70% of HCPs were ‘not ready’ for the mass consumer-initiated screening for atrial fibrillation.
The evidence continues to evolve. A study of ambulatory COVID-19 patients showed that remote patient monitoring could reduce deaths. Yet, a study of heath failure patients found that there was no significant differences in hospital readmission using remote monitoring and incentives for taking their diuretic medication. As tracking tools evolve and our body of evidence grows at scale, consumer wearables can eventually provide a critical mass of evidence to justify changing care management approaches.
Digital health companies can accelerate this evidence generation by forming partnerships with academic health systems and payer groups in both clinical and real-world studies. New health care partnerships between payers and health systems can also lower the uptake costs of these new models, expand access to underserved population and demonstrate the long term value of these devices to patients, doctors and health systems.
Removing Policy Barriers
As my colleague Emily Scherberth wrote in August 2021, the surge in telehealth adoption was enabled by the Centers for Medicare and Medicaid Services (CMS) who relaxed its regulations for telehealth services and added telehealth visits as a covered benefit. These temporary measures will need embedding into comprehensive regulation if the benefits of telehealth are to be fully leveraged within the system following the acute phases of the pandemic.
At the beginning of 2022, the CMS has taken steps in this direction with five new reimbursement codes covering set up, monitoring and review of remote patient data. Further reform of existing payment rules is required to fully embed payment parity between remote and in-person services. Equitable reimbursement incentives will be required to lower any disincentives to adoption remote patient monitoring among providers.
Incentivizing Consumer Uptake
Continued consumer adoption will be critical in expanding the use of wearables and issuing rewards to individuals for tracking their health data over time could be the key. Building incentive mechanisms for individuals may be as simple as offering desirable devices like Apple watches for free. Two out of three Americans reported willing to use digital wearable devices to track health as part of health insurance wellness programs. To reach scale combining health promotion and financial incentives may prove the best payer model to create a win-win approach to us devices and promote healthy behaviors.
But consumers are uniquely wary about sharing their sensitive health data, and with good reason. As my colleague Brian Keeter wrote in March 2022, there were more than 700 cyberattacks that involved 500 and more patient or customer records were compromised in 2021. All health care stakeholders need to collaborate to generate confidence that the free flow of health data from a device across the health care system can be done securely. As digital health and device companies look to differentiate their products, a commitment to health data privacy and security could be a smart strategy to enhance corporate reputation and encourage uptake.
We are only just beginning to leverage the full power of data to improve health. Innovations in the functionality of medical devices and consumer wearables, and the experience of the early pandemic, create a unique catalyst to scale how we capture and use data to inform health care. It will take a concerted effort by companies, policy makers, health systems and consumers to unlock its full promise and remove barriers to create healthier lives at lower health care costs.