Last week, US healthcare provider Atrium Health (owned by Advocate Health) and Best Buy Health, a unit of the world’s largest specialty consumer electronics retailer, revealed they were joining forces to develop a new hospital-at-home service in the US. Atrium and Best Buy say the partnership will help address ‘complex’ hospital-at-home programme requirements, especially in relation to patient education and enabling technology in the home.
The Signify View
The tie-up is a significant step for a US hospital-at-home market that has flattered to deceive since emerging during Covid. Together, Atrium and Best Buy will inject forward momentum to a market primed for growth, dismantling some barriers to RPM adoption, especially around logistics and technology.
The partnership announcement also coincides with news that the US CMS is extending reimbursement for hospital-at-home providers for two more years until May 2025. These schemes were originally introduced as Covid emergency legislation to reward providers for keeping people out of hospital to free up hospital capacity for Covid patients. There has been considerable uncertainty over whether these schemes would be renewed. The extension is, therefore, welcome news for Atrium, Best Buy and the RPM vendor community at large, and will deliver a shot-in-the-arm for the hospital-at-home market.
Formidable Foundations
Best Buy says the partnership will enable providers to deliver ‘high quality’ at-home care. Beneath this rather bland statement of intent are formidable foundations: Atrium’s established hospital-at-home programme; Current Health’s single-solution platform (that Best Buy bought in November 2021) including RPM, telehealth and patient engagement functions; and Best Buy’s reach with more than 1,000 branches and a growing ‘army’ of highly trained technical support personnel, known as the ‘Geek Squad’, who will provide a point of contact with patients.
RPM vendors have been waiting for the moment when hospital-at-home becomes much more than a passing pandemic fad and establishes itself as a fixture of telehealth. Uncertainty over whether CMS would renew the Acute Hospital Care at Home Waiver caused many providers to hold off investing in hospital-at-home programmes, despite the clear efficiency opportunities the programmes presented.
As a result, the hospital-at-home market has been in a state of limbo. Around 275 hospitals across 115 health systems in the US are eligible to run hospital-at-home ‘wards’, but by our estimates, only around 60 do. Hospital-at-home care has been reimbursed for only a few thousand patients, and Current Health, the leading hospital-at-home RPM vendor in the US, has sold its platform to approximately only a dozen providers to date.
Removing some of the psychological obstacles around reimbursement will give hospitals confidence to invest in hospital-at-home platforms, at least for the next two years, and bodes well for Current Health and other RPM vendors.
The Atrium-Best Buy partnership also promises to help dismantle two other hurdles which have held RPM adoption back: logistical complications around providing hospital-level care in people’s homes, and training patients (many of whom may be elderly) to implement and use the devices.
Tearing Down Walls
We predicted recently (see here) that providers would need support to roll out their RPM programmes, and Best Buy/Current Health provides an excellent example of how this can happen. Current Health will leverage Best Buy’s broad US branch network, which will get technology into homes across the country. This will be complemented by Best Buy’s ‘Geek Squad’, an army of up to 20,000 technical support ‘foot soldiers’, currently being trained to implement and support Current Health’s portfolio, who will visit homes to help patients set up and use the RPM devices.
Many RPM vendors have also started to move away from using WiFi-based RPM solutions, that typically require connecting patient peripherals to a hub, to implementing cellular technology directly into the patient peripheral. This removes one more technical challenge when supporting RPM programmes such as hospital-at-home. Current Health has not yet moved to this technology, but CareSimple is a vendor that has. At this month’s ATA show in San Antonio, it was promoting devices that rely on 4G and 5G networks, rather than WiFi ‘hubs’, to collect patient data. More vendors will follow suit as they look to offer more mobile, and user-friendly, technology for patients. This is something that Current Health should also examine in its drive to remove technical challenges relating to RPM.
VBC Comfort Blanket
While the above developments are a cause for celebration for Current Health and the wider RPM vendor community in the short- to medium-term, the longer-term picture also looks bright. Vendors we spoke to at ATA confirm that value-based care (VBC) will really start to galvanise the market and help it grow. They say that, while fee-for-service reimbursement codes will remain important, many hospitals will leverage RPM technology within the broader scope of VBC.
Signify Research recently predicted before ATA (see here) that it will be vital for RPM to align with VBC in general (hospital-at-home as well as chronic care) going forward, and many vendors at the show echoed this point. Indeed, Current Health must avoid putting all its eggs in the hospital-at-home basket, where volumes remain relatively low compared to chronic condition management. This is a very crowded, competitive space including Health Recovery Solutions (HRS), CareSimple, Connect America, AMC, Contessa Health and Amedisys. But Current Health, owing to the ecosystem that Best Buys provides, is well positioned to maintain its market-leading status as hospital-at-home scales. With a solid (and growing) footprint of health system customers in hospital-at-home, it can also develop its chronic condition management customer base.
Higher-acuity telehealth vendors like Teladoc, Amwell, AMD, GlobalMed and Solaborate are also said to be looking at RPM vendor partnerships to round out their portfolios beyond high acuity inpatient care and into the home. As and when they are forged, these partnerships will spearhead further RPM adoption.
Potential Pitfalls
In light of the above, the prospects for RPM driving hospital-at-home are very good. The only real challenge comes in monitoring and analysing all the data being generated by RPM devices in patients’ homes. While in the long-term this might be a job for AI, for now it must still be done by humans – and hospitals are very short-staffed and will be unable, or unwilling, to introduce new workflows now. Again, this is where Current Health has a competitive advantage, as it offers not only the technology platform but also people to monitor and analyse the data.
With this, Best Buy’s November 2021 decision to bring Current Health into its stable looks set to pay off handsomely. To an extent, it was a decision forced on Best Buy: its electronics business had largely reached saturation point and the business needed to diversify. Like big retail pharmacies such as CVS and Walmart now offering primary care across the US, Best Buy is turning its supply chain expertise and geographical reach to its advantage in a whole new business sector. Having boots already on the ground in the form of the Geek Squad being trained in a new discipline, gives Current Health a unique competitive advantage that other RPM vendors would find challenging to replicate. In addition, the dedicated GreatCall medical alert platform for elderly patients complements its portfolio.
Home Sweet Home
Having overpromised and under delivered for more than a year, hospital-at-home is showing signs of scaling. Doubts over the longevity of reimbursement schemes can take a back seat for now as new frontiers open up at last for RPM vendors.
The highly fragmented vendor landscape will consolidate, one of the many chapters still to be written about RPM’s journey. But the Atrium-Best Buy partnership feels like a milestone on this journey, and Best Buy’s strategy in RPM could well be a blueprint for other retailers/pharmacies that have already made the move into care provision.