A new era of population health: Overcoming technology gaps in value-based care

There are specific and strategic technology gaps that are inhibiting the acceleration of value-based care, including:

1. Remote patient monitoring (RPM) is limited to the highest 1% of risk
2. Point solutions are siloed and prevent a more complete view of patient and member health
3. RPM and point solutions have not been focused on discovering undiagnosed conditions
4. Payers and providers are lacking innovative tools that foster collaboration

Traditional Remote Patient Monitoring doesn’t scale broadly

Despite costs for an RPM intervention often exceeding $150/month per active patient enrolled, RPM aligns well with value-based care (VBC) initiatives for reducing costs through averted emergency department visits and hospitalizations while simultaneously improving clinical outcomes. 

For example, a common use case with RPM is reducing risk for 30-day readmissions among discharged congestive heart failure (CHF) patients, a condition with a national 30-day readmission average of 21% and charges per hospitalization averaging $50,000.  

That said, effective remote patient monitoring solutions have been constrained to the highest 1% of risk within a population. This is due principally to the high cost and complex logistical processes required for deploying monitoring devices to the patient’s home and returning them to be reprocessed and shipped to a new patient.  

Too few patients and health plan members outside of that 1% of highest risk ever receive the proactive attention, assessment, and interventions they would benefit from with an RPM solution. These missed opportunities result in fewer proactive interventions, higher costs of care, more long-term high-risk profiles, and sub-optimal outcomes. 

Point Solutions aren’t designed for whole-person health

Beyond high cost and complex operational processes, today’s RPM solutions are also typically designed for single conditions, i.e. “point” solutions that are absent of focus to whole-person views and the frequent polychronic nature of chronic disease. 

The prevalence of multiple chronic conditions increases with age, with nearly 3 of 4 adults over the age of 65 having two or more chronic conditions. Sixty-six percent of total health care spending is related to the approximately 27% of Americans with multi-morbidity. 

Take CHF, for example. Hypertension, chronic kidney disease (CKD), and diabetes mellitus are all co-occurring conditions with CHF at rates of 90%, 49%, and 33%, respectively. Not only do we need to assure all conditions are being addressed and managed proactively through a holistic lens, but we also should be seeking to prevent polychronic disease in the first place by discovering its early origin. One appropriate example is recognizing that hypertension contributes to 39% of heart failure cases in men and 59% in women. Another relevant example is CKD with diabetes and hypertension together accounting for approximately two-thirds of chronic kidney disease cases. 

Too many siloed point solutions exist today with little mechanism for making sense of the disparate data for providing care teams with a composite picture and understanding for each health signal’s impact on the others. This approach has limited benefit for patients and the clinical teams who deliver care.  

Alternatively, a singular platform focused on whole-person care that analyzes disparate data and immediately provides healthcare insights that largely resolves the problems created by siloed point solutions. This composite picture capability offers incremental value of clarity and perspective for many stakeholders, including physicians, care teams, and payers.

The costs of conditions hiding in plain sight

For the U.S. healthcare ecosystem to fully embrace value-based care, we must be better at identifying chronic disease more proactively. Imagine if we could sniff out pre-diabetes and hypertension early and effectively treat them to prohibit their advancement to Type 2 diabetes and CHF. 

Consider mild cognitive impairment (MCI): Statistics show that 92% of MCI cases are not diagnosed early, which inhibits the opportunity for reversing (or minimally stalling) advancing cognitive conditions.  

Finally, how staggering is it that 90% of individuals today with CKD are not yet diagnosed nor aware of their condition? With 38% of all age 65+ seniors in the U.S. suffering from CKD, how many of those individuals dealing with dialysis and organ transplant prospects could have been avoided with an earlier discovery of their kidney disease? Likewise, what percent of the $129 billion in Medicare spending annually for CKD could have been saved?

The need for Population Health Monitoring

If traditional RPM is cost-prohibitive to scale throughout rising and high-risk populations, is not suited for helping to discover early disease, and lacks a whole-person view for holistic management, clearly a new tool that can intelligently and broadly impact population health outcomes is needed. A smartphone-enabled and device-free population health monitoring platform capable of driving clinical efficiencies would cross the chasm to facilitate broad scalability, simplistic use, low cost and flexibility for accommodating multiple conditions simultaneously.

Payer-Provider collaboration requires shared insights

Another impediment to more rapid progress with value-based care is the lack of true payer-provider collaboration. Even though both stakeholder organizations have the same goals of better outcomes, lower costs, and more value, they lack a shared line of sight into real-time opportunities for improving health at the individual and/or population level. Therefore, this is as much a business problem as it is a technology problem.

Aside from claims (which are limited and lagging), there isn’t yet a widely adopted mechanism for payers and providers to share data and information on a patient’s/member’s health status, risks, and needed interventions.

Properly architected multi-tenant software with adjustable transparency to allow a payer and provider with real-time visibility of their patients’ and members’ healthcare situations could help to align both parties within the context of value-based care, including financial incentives offered by payers for value-based care — deemed by governance — as next-best actions. 

Step into a new era with Percipio

Percipio Health is privileged to answer this call for action and bring the right people, talent, and technology platform to the healthcare table to remove these current value-based care boulders and accelerate progress that benefit all ecosystem stakeholders, beginning of course with leaving fewer patients and/or members behind. 

If you are ready to see how Percipio Health can help your organization increase its capacity and ability to manage populations of growing size and risk, please reach out to request more information and a demo.