Tag Archives: Hospital-At-Home

SPI Digital Health: Philips Virtual Care Management: More Than a Remote Chance of Success

As the patient care pathway moves steadily away from the hospital, Philips launched its new Virtual Care Management platform in March. The company says the platform will offer a ‘comprehensive’ approach to telehealth for patients, providers and payers, improve patient engagement and health outcomes, lower the cost of care, and make workflows more efficient. 

The Signify View 

Philips Virtual Care Management brings onto a single platform the company’s legacy remote patient monitoring (RPM) business as well as the chronic disease management capabilities of BioTel Care, the RPM arm of BioTelemetry (BioTel). Philips acquired BioTel, a powerhouse in the cardiac monitoring market, in 2021. 

The launch of Virtual Care Management in the US market is the latest move by Philips to deepen its roots in the burgeoning home care market in the country. The BioTel acquisition provided Philips with the technology to advance its own RPM and chronic care management business, where it had been a tier-2 vendor. 

BioTel Care accounted for less than 10% of BioTel’s total revenues when Philips made the acquisition, but it brings a number of strategic and competitive advantages to the table. Two years on from the acquisition, Virtual Care Management is, therefore, a powerful prospect. 

On Point 

Philips claims that the Virtual Care Management platform will reduce pressure on hospital staff and reduce the cost of care by managing chronic disease more efficiently. The platform will leverage BioTel Care technology targeting condition-specific protocols including diabetes, hypertension, heart disease, chronic kidney disease and chronic obstructive pulmonary disease (COPD), as well as gestational programmes for diabetes and hypertension.  

Generating data and actionable insights, Virtual Care Management goes beyond the ‘traditional’ capabilities of RPM solutions, says Philips. 

Many Rivers to Cross 

While that may be true, the success of RPM solutions and their vendors is typically determined by the reimbursement models that support them. In most geographies RPM does not have as clear a reimbursement structure as the US, and to date Philips’ Virtual Care Management platform has been launched exclusively in that market. 

The Virtual Care Management platform targets the clinical chronic care management programmes that have been eligible for RPM reimbursement for a number of years now. However, Philips’ ability to really disrupt the US chronic care management market is far from certain: actual reimbursement volumes remain stubbornly low, covering just a few hundred thousand lives being managed to date. No vendor has yet been able to scale successfully in this environment, and is also an extremely competitive space. Philips will have its work cut out here too with the Virtual Care Management platform. 

Home Truths 

Where the platform could fare better is in the emerging ‘hospital-to-home’ market (as opposed to the ‘hospital-at-home’ market). Hospital-to-home relates to supporting the transition of patients from acute to post-acute settings using virtual care. Specifically, Philips is not targeting the ‘hospital-at–home’ market, the segment that relates to supporting patients at home via the use of technology, that otherwise would still require support in an inpatient setting. This is currently reimbursed in the US by the Acute Hospital Care at Home (AHCaH) waiver programme.  

Philips does not refer to this in relation to the press material accompanying Virtual Care Management, but it ties in closely with the goals of reducing the costs of care (i e Value Based Care (VBC) and alleviating pressure on hospital staff. 

This, understandably, is an interesting area for Philips and the Virtual Care Management platform aligns nicely with hospital VBC contracts and other fee-for-service reimbursement codes.  

Unlike in RPM where reimbursement is a one-off payment for a service provided (for example, every time a vendor ships a device, or monitors a patient, it gets paid), hospital-to-home VBC reimbursement takes into account a range of criteria, for example rewarding a hospital for preventing patient readmission. It is a lump-sum payment for which the vendor takes a cut, and which covers the hospital’s cost of providing care and then (hopefully) leaving some profit. It is a win-win situation for both parties. 

Contrast that to hospital-at-home, which Philips is not specifically targeting. This strategy is sound: currently around 200 US hospitals are licensed to provide hospital-at-home services under the Acute Hospital Care at Home (AHCaH) waiver programme, but the actual number of people whose managed care has been billed for this is very low – just a few thousand at most. We wrote in this recent Insight that the hospital-at-home market had yet to take off, but that has not deterred provider Atrium Health and Best Buy Health, a unit of the world’s largest speciality consumer electronics retailer, taking the plunge as partners. 

But, given the need to educate patients and enable technology in their homes, hospital-at-home is more complex than hospital-to-home. Uncertainty around longer-term reimbursement has also deterred many providers from going down this route. The current AHCaH waiver programme was extended by the CMS until May 2025, but the scheme is a hangover from COVID emergency measures. Uncertainty over what happens after May 2025 continues to act as a brake on this market, and yet like RPM, it is a very competitive area dominated by start-ups. Philips will do well to steer clear from it, at least in the short-term. 

Feeling the Love 

As it rolls out Virtual Care Management, Philips might draw inspiration from the success of BioTel Heart, a leader in the mobile cardiac telemetry market and whose wearable ECG devices have been very successful. But it is a more rounded service – Philips provides not only the device but also the data monitoring services and report generation capabilities that takes pressure off hospitals and ambulatory care providers. It follows, then, that in terms of its Virtual Care Management platform, Philips will not be a pure chronic care device supplier per se. Elements of the legacy Biotel Heart service can be used in conjunction with the Virtual Care Management platform and services to provide patient pathways that allow for technology to be used to support patients remotely. This can be from diagnosis to on-going monitoring (particularly in relation to heart rhythm disorders). It will take readings remotely, physicians (and algorithms) will pore over and analyse the data, and prepare a report that is then sent to the hospital with a diagnosis. This is a tried and trusted formula in ambulatory cardiology in the US, and would translate well in chronic care management. In essence, Virtual Care Management therefore makes money from the service, not the device. 

Fighting Chance 

It is against this backdrop that vendors are now playing in the chronic care management market. It is an intensely competitive space where success is defined as much by the quality of solution as the reimbursement structures in place for each solution. These factors pose significant challenges for vendors and limit their ability to scale. 

And yet, if any vendor can make a success of this, it is Philips. The company already has an impressive, well-rounded installed base in the US hospital monitoring and remote diagnosis markets, which provides a good link into the process to then move patients out of the hospital and to the home.  

As such, Virtual Care Management gives Philips a fighting chance to drive success in the hospital-to-home market, and really push back against the crowd of start-ups vying for a piece of the action.

SPI Premium Insight: Home Truths for RPM Vendors as Atrium Health and Best Buy Team Up

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.  

Signify Premium Insight: Inbound Health Jumps into Hospital-at-Home Drive

This Insight is part of the Signify Premium Insights (SPI)-Digital Health service, which will launch on 9 January 2023. From that date, this and all SPI-Digital Health Insights will be available only by paid subscription.

Last month Allina Health, a US non-profit healthcare system, and Flare Capital Partners, a venture capitalist firm, announced the launch of a hospital-at-home-focused company. The $20M launch of Inbound Health comes as demand for hospital-level care in the home is rising steadily in the US. But what are the longer-term prospects for Inbound Health and other vendors in this crowded corner of remote care? 

The Signify View 

Inbound Health will provide at-home nursing care, plus virtual ‘visits’ and patient biometric monitoring. It will build on Allina’s Inbound Health-branded platform, which debuted in May 2022 and has since cared for more than 4,200 patients across 185 primary diagnoses in the state of Minnesota. Now, as a standalone commercial entity, Inbound Health will offer hospital-level acute and post-acute care at home on a nationwide basis. Tellingly, Allina says the service will lower the total cost of patient care, a core tenet of the US value-based care (VBC) model. 

Three Years in the Making 

Inbound Health’s launch coincides with growing demand for broader hospital-at-home care in the US. Historically, hospital-at-home has been provided on a small scale around chronic care. This then transitioned to acute care with the launch of the Acute Hospital Care at Home (AHCaH) initiative. The programme, which is still in place today, was launched in November as a response to the Covid pandemic. It enables Medicare-certified hospitals to treat patients with inpatient-level care at home. This represented the first example of payment for this level of care at home for beneficiaries with Medicare Fee-for-Service (FFS) and – in certain states – non–managed care Medicaid. While small-scale initiatives around hospital-at-home had been previously undertaken in the US, within the Medicare Advantage and managed care Medicaid markets, a lack of reimbursement prior to the pandemic had prevented any larger-scale uptake. 

The above developments have formed a cornerstone of the early, evolutionary phases of the US hospital-at-home market, and one which is an area of interest for many RPM vendors at present. 

As a result of the above, a large, yet fragmented and highly competitive ecosystem of vendors has emerged to serve the hospital-at-home market. 

Limited Lifespan 

One challenge facing these vendors is the fact that, at some point, the Public Health Emergency (PHE) legislation underpinning the (AHCaH) will end. The sword of Damocles hangs over those vendors whose business models and product strategies are built around this scheme. The PHE was recently extended until next March, but there is no guarantee it will be extended further. If and when the axe falls, some Hospital-at-Home companies will be hit hard, potentially fatally. 

A Different Tack 

The good news for Inbound Health is that it will be cushioned from any short-term shocks as and when the Department of Health and Human Services  wields the axe. We do know that Allina Health clearly has a vested interest in the Acute Hospital Care at Home Initiative being extended ad infinitum – their name appears, along with 20 or so other vendors, on lobbying letters to Congress on this matter.  

But Inbound Health will be looking at what lies beyond with justified confidence. Medicare Advantage/commercial VBC contracts are very much embracing broader hospital-at-home initiatives, and so there is strong medium- to long-term potential in this area. 

Strong Credentials  

Publicly, Inbound Health makes no reference to the Acute Hospital Care at Home waiver. Even if its product portfolio appears tailored to the program, it makes sense that the company does not publicly tie strategy, and product portfolio, to a scheme whose shelf life is coming to an end.  

Thus, although Inbound Health now enters a crowded, highly competitive acute care corner of RPM, we believe its future prospects are tied more closely to the ongoing VBC transition in the US.  

That Allina and Inbound Health are addressing demand not only for core RPM tools, but also a more future-focused VBC-type product functionality vital for hospital-level acute care at home – tools for risk stratification, care management workflows, enrolment support and clinical support – confirms a rounded RPM/PHM offering. These products will serve the companies well. 

Many RPM vendors are gearing up for this deeper move into hospital-at-home services, and in this respect Inbound Health has the ingredients to thrive: market-leading clinical, operational and technology assets developed alongside Allina Health; strong financial backing from Flare Capital Partners (whose impressive portfolio includes a host of VBC and PHM vendors) to advance its proprietary technology platform, including AI-powered analytic capabilities; and the fact it has powered one of the largest hospitals and skilled nurse facility (SNF)-at-home programmes in the US. In addition, the company has a CEO with a 20-year track record at the helm at Mount Sinai and Aetna. Inbound Health has a compelling back story, and is in good hands. 

Direction of Travel 

The overall direction of travel is towards acute hospital-at-home care, regardless of when the Acute Hospital Care at Home waiver is pulled. Uptake in that programme remains relatively limited to date. As of now, 114 health systems (including Allina) and 256 hospitals in the US are participating in the scheme, compared to 92 health systems and 203 hospitals in March 2021. Despite the risks that the programme might be shelved for good next year, participation is still growing, and large health systems such as Kaiser Permanente and Mayo Clinic have managed programmes with over 1,000 patients.  

In our 2022 RPM World Report, we noted that hospital-at-home models are likely to expand in the medium- to long-term. In June 2021 Amedisys, one of the largest home health and hospice care providers in the US, acquired Contessa Health, which provides risk-based hospital-at-home and in-home nursing services. In January 2022, Medically Home, another hospital-at-home company, announced a $110M funding round, led by Baxter, Global Medical Response and Cardinal Health. Mayo Clinic and Kaiser Permanente, who had led a previous funding round, also participated. The US Department of Veterans Affairs (VA), which runs the US’ largest integrated health system, is also a leading purchaser of RPM services in the country. Other RPM vendors leading the way in this market include Current Health, which is UK-based but heavily US-focused and who are owned by US retailer Best Buy, and Connect America, which established an RPM business in 2017 with a portfolio split quite evenly between managing chronic and acute conditions at home. 

Looking to the Future 

The prognosis for Inbound Health looks good in hospital-at-home. While a cloud clearly looms large over the Acute Hospital Care at Home scheme, the smart money is on what lies beyond that. With a future-focused VBC-type product functionality, and the backing of two healthcare heavyweights in Allina Health and Flare Capital, Inbound Health is well placed to blaze a trail in the evolving hospital-at-home market.