Tag Archives: Remote Patient Monitoring

SPI Digital Health: Validic’s Trapollo Acquisition a Question of Logistics

About two weeks ago, remote patient monitoring (RPM) vendor Validic acquired the assets of fellow RPM vendor Trapollo from Cox Business, a subsidiary of telecoms and automotive retail company Cox Enterprises. 

The deal, the value of which is undisclosed, brings together what Validic claims is the world’s largest health Internet of Things (IoT) platform with Trapollo’s high acuity-focused platform and impressive logistics background.  

The acquisition is the next logical step in a relationship between the two vendors that goes back to 2019, when they embarked on a strategic collaboration offering hardware and software services supporting RPM. 

Validic says purchasing Trapollo’s assets will ‘round out’ its core capabilities. 

The Signify View 

Established in 2010, Validic’s origins are in consumer wearables tech. In 2015 it modified its platform for healthcare providers and payers, and nearly six million people are now connected to the Validic platform in the US. The vendor also supports what it claims is the largest RPM programme in the country for managed care consortium Kaiser Permanente, with more than 300,000 patients enrolled since it was established in 2010. Validic says that, overall, its platform includes more than 530 supported devices, and is available as a standard integration in Epic’s Connection Hub, Oracle Cerner’s Millennium and other EHRs. 

Trapollo, meanwhile, began life in the same year as Validic as a pure logistics solutions provider to large health payers as they started to roll out virtual care solutions. The company’s position in this respect was significantly strengthened in 2015 when it was bought by Cox Business. Trapollo subsequently moved into RPM, chronic care management and hospital-at-home. 

Up the Value Chain 

To date, Validic’s business has largely been in either so-called ‘bring your own everything (BYOE)’ or ‘bring your own device (BYOD) RPM programmes. BYOE programmes can integrate with more than 530 devices that can be supplied by either the healthcare provider or patient. These are aimed at large-scale RPM programmes for chronic condition patients with low to moderate risk of near-term hospital admission. This accounts for the majority of lives managed on Validic’s platform, and offers the greatest scope for scaling.  

Under the BYOD model, Validic supplies from a smaller selection of devices, using the patient’s smartphone as a hub. Again, this is offered to low-to-moderate risk patients suffering from one or more chronic conditions.  

However, the company has been much less successful in selling higher value, higher acuity solutions. This is where higher revenues can be achieved as healthcare providers pay a premium per patient for support via the platform. In buying Trapollo’s assets, Validic is now well positioned to make inroads in this area too. 

Limited Elbow Room 

Despite the implied benefits of the acquisition – and notwithstanding the fact that the lower end of the RPM market is still extremely fragmented with few vendors yet able to scale across borders – medium-sized players like Validic find themselves in a space with limited elbow room.

Consolidation is happening, and the Trapollo acquisition follows fellow ‘medium-sized’ RPM vendor Clear Arch Health’s acquisition last year of Resideo Technologies, and Best Buy’s acquisition of Current Health in 2021.  

Philips, which at one point looked like it was distancing itself from the RPM market, entered a strategic collaboration with BioIntelliSense in 2020 to support the remote monitoring of at-risk patients from the hospital-into-home. In the same year it acquired BioTelemetry which, as well as servicing the ambulatory diagnostic cardiology market, was also growing its RPM business via BioTel Care (further details on Philips RPM strategy in this insight). And high acuity telehealth vendors like Teladoc, Amwell, AMD and GlobalMed are said to be eyeing partnerships with RPM vendors to round out their portfolios beyond high acuity inpatient care and into the home. 

When Acquisition Alone is Not Enough 

As such, acquisition alone will not be enough for medium-sized vendors to grow. Scale is central to success going forward and, in a crowded US market, for many that will mean scaling internationally. With non-US markets also highly fragmented with a fiercely competitive ‘race to the bottom’ still taking place, overseas success is neither immediate, nor a given.  

Validic is fortunate in that it has other potential routes to scale in the US. Its existing contract with Kaiser Permanente is one such pathway. Kaiser and regional care provider Geisinger Health System last month launched Risant Health, whose mission is to sell value-based care (VBC) solutions to large community health systems. Its launch is being billed as accelerating VBC adoption in diverse, multi-payer, multi-provider and community-based health system environments. These health systems – Risant’s customers – are a rich potential source of business for Validic, which also has sizeable contracts with Mayo Clinic, ChristianaCare and Prisma Health.   

Home Truths 

Another promising route forward for Validic is the US ‘hospital-at-home’ market, a notoriously complex space compared to low acuity chronic care management with a number of barriers to entry (ongoing concerns over the status of reimbursement structures beyond 2025 being one).

Validic’s hand in this market is again strengthened with the acquisition of Trapollo, whose existing hospital-at-home programmes focus on non-critical patients and are mainly within integrated delivery networks (IDNs) that increasingly use VBC rather than fee-for-service models. But, again, this is a competitive arena, where the likes of provider Atrium Health (which recently teamed up with Best Buy Health to develop a new ‘hospital-at-home’ service in the US), Health Recovery Solutions, CareSimple, Connect America, AMC, Contessa Health and Amedisys are all battling for share. 

Raising Questions 

The Trapollo acquisition raises questions beyond how vendors can scale and evolve in the current market. One question is Validic’s apparent strategic about-turn. Signify Research spoke to the vendor last year as part of research for our RPM World 2022 report, and at that time they were still pushing the ‘low touch platform’ message. At the time they claimed they were neither looking to be a full patient engagement solution, nor a full digital front door, nor trying to duplicate EHR functionality by providing video consultations, patient education or clinical documentation (as many RPM vendors now do). The Trapollo acquisition appears to contradict this. 

It is also worth mentioning here what Trapollo stands to lose in its acquisition by Validic: not least access to growth funding from Cox and a footprint across all 50 US states, including in remote areas where RPM really comes into its own. Cox Business also has an established customer base of more than 260 hospitals. It is not clear at this stage whether Trapollo will retain any relationship with Cox, or whether it will lose all leverage over those much-coveted supply chain networks. 

Regardless, Validic still sees Trapollo’s logistics expertise as a USP post-acquisition. In the media release announcing the deal, Validic stressed how device logistics would support the full range of personalised care programmes, from BYO-tech, low-touch programmes to high-risk, high-touch and fully kit-based RPM. 

Completing the Missing Link 

Overall, therefore, Validic’s decision to buy Trapollo’s assets makes business sense. Trapollo’s expertise in high acuity completes the missing link in Validic’s offering, while both companies’ alignment with the growing VBC movement in the US is smart.   

And while it is unclear to what extent Trapollo will lose its competitive advantages around logistics as its eight-year ownership by Cox ends, Validic still sees this as a key differentiator, and pivotal to scaling, going forward.   

SPI Digital Health: Can New £150M NHS Framework be RPM’s Golden Ticket in England?

At the end of March, NHS Shared Business Services (NHS SBS) announced a new £150M framework to develop new remote patient monitoring (RPM) initiatives across England’s health system. 

The Technology Enabled Care Services 2 framework is arranged into six lots covering Remote Clinical Monitoring (allocated £36M in funding), Alarm Receiving Centre Platforms (£14M), Digital Alarm Solutions and Peripherals (£36M), Intelligent Activity Monitoring (£24M), Patient Controlled Personalised Healthcare Records ($14M) and One Stop Shop / Combined Solutions (£26M). 

Overall, the Framework aims to free up hospital beds, reduce appointment backlogs, accelerate patient hospital discharge, and alleviate pressure on social care. An estimated 14,000 hospital beds are occupied by a patient who is clinically fit to leave, but has no appropriate care setting to be discharged to, and so creating new ‘virtual wards’ should go some way to relieving this costly bottleneck. 

The Signify View 

One of the most potentially impactful lots in Technology Enabled Care Services 2 is the £36M being allocated to Remote Clinical Monitoring solutions to expand England’s virtual ward capacity. These virtual wards had their origins during COVID, when transitioning patients out of hospital was a matter of crisis management rather than cost consideration. Even as the pandemic eased, hospital bed capacity in England remains under intense pressure, and staff shortages make care delivery more difficult than ever. 

The Framework gives England’s 42 Integrated Care Systems (ICSs) the ability to rapidly procure RPM technologies from shortlisted vendors to build virtual ward capacities and support health and care professionals in delivering clinical care. The NHS intends for these virtual wards to care for people with chronic conditions such as diabetes, stroke and heart failure, as well as providing post-operative surveillance.  

ICSs therefore have a central role to play in linking up health and care functions beyond the hospital. Whether they can deliver on the UK government’s goals to have 50,000 virtual beds in place in England by March 2024 (from 10,000 at present), is another matter, however. 

Centralised Approach 

NHS SBS is responsible for providing the funding and shortlisting vendors to carry out contracts in each of the six lots within Technology Enabled Care Services 2. It is then up to the individual provider organisation (e g the ICS) to select the vendor and manage the contract budget.  

In terms of the Remote Clinical Monitoring lot, £36M won’t go far given that it must be spread across 42 ICSs in England. The fact that it is a one-off funding stream is also less than ideal, because it prevents RPM adoption from really scaling and delivering longer-term benefits. A consistent funding supply would nurture RPM technology adoption by giving providers the ability to develop long-term plans based on ‘guaranteed’ budgets. 

Reimbursement Riddle 

As Signify Research regularly reports in its Insights, the lack of reimbursement or ongoing funding structures in most countries, including England, also restricts progress in ‘hospital-at-home’ programmes, and RPM adoption, in a big way.  

Even in the US, which is more advanced than in any other country in this respect, only around 200 hospitals have to date taken advantage of reimbursement for ‘hospital-at-home’ care (‘hospital-at-home’ being the US equivalent, to all intents and purposes, of England’s virtual wards), and only a small number of patients have actually been managed at home. Ongoing uncertainty over the renewal of specific ‘hospital-at-home’ reimbursement codes beyond May 2025 continues to play on the minds of providers in the US, and this is seriously dampening the RPM market potential. 

A lack of clear long-term funding structures in England (and the UK), parts of Scandinavia and elsewhere means that the appetite to build virtual ward capacity and ‘hospital-at-home’ programmes depends almost entirely on more unpredictable, one-off funding streams. This  funding, like Technology Enabled Care Services 2, is not tied to the number of patients being monitored at home (as would be the case in a reimbursement model). Instead, it is good for putting in place the service and workflow, but there is then no specific mechanism for providers to fund schemes on a long-term basis. It is no wonder that providers are reluctant to invest in RPM solutions. 

Big Picture View 

Despite the above, it is a positive that ICSs are responsible for how the £36M is spent on Remote Clinical Monitoring in England. The siloed nature of the healthcare system in England (as in many other countries) has traditionally meant different organisations in the system providing, for example, acute care and care at home, operate under siloed, individual budgets. It is not uncommon for a community healthcare organisation to invest in RPM technology but derive little real benefit from it because it’s the acute providers that benefit the most from them in terms of keeping patients out of hospital or being able to move patients out of acute settings quickly. For these community providers, RPM is largely just a cost burden. 

So again, this stunts RPM adoption. While it will still be the hospitals, individual primary care networks, GP practices and social care systems who do the ‘legwork’ to expand virtual ward capacities, ICSs have the unique oversight of every different care setting. It is the ICS that can co-ordinate the various players in the system, and hopefully dismantle the silos that prevent RPM adoption from reaching its true potential.  

In such a scenario, the shortlisted vendors competing for a slice of the £36M pie – Aseptika, Baywater, BT, Doccla, Docobo, Huma, Immedicare, InHealthCare, Prescribing Services, Solcom, Specialist Computer Centres, Spirit Healthcare and Vcare – will view this as one of many opportunities in this space going forward.  

Of these vendors, Doccla, Docobo, Huma, InHealthCare and Vcare have already had success implementing virtual wards for the NHS on initiatives such as the COVID-led £65M NHS Spark Dynamic Purchasing System and COVID Oximetry at Home projects in 2020, and the NHS National Innovation Collaborative. They will be in pole position to benefit from the latest funding initiative. 

Internationally, structures are also being put in place in France, Saudi Arabia, parts of the Nordics and Australia where big health systems (the equivalents of the ICSs) will also be in a better position to break down barriers and provide that big picture view on patient care management. 

A Case of Myopia?  

The Technology Enabled Care Services 2 framework nudges virtual care in England another step along the road. However, while undoubtedly helpful, the £36M one-off funding to expand virtual ward capacity in England is a short-term solution, when what is really needed is a long-term vision. Providers need a long-term spending commitment around which they can plan, deliver the number of virtual wards required in the future and enable RPM adoption to scale in the country. 

While the desire for change is clear as hospitals and their staff creak under unrelenting pressure, joined up thinking and long-term strategy are essential to have a lasting impact. 

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: ATA2023: Signify Research’s Top Five Show Predictions

The annual American Telemed Annual Conference (ATA2023) convenes once again in San Antonio on 4 March. A lot has happened in and around telehealth since the 2022 edition of the show: billions of dollars-worth of acquisitions and a concerted move by big retail and big tech into primary care (opening new opportunities for telehealth vendors). And, having been at the sharp end of the 2020-2022 emergency COVID response, a chance at last for the industry to reflect on the challenges and opportunities that lie ahead. 

Products and profitability are key talking points in an industry adapting to the transition to value-based care (VBC) in the US and reimbursement codes introduced during COVID. This will form just some of the discourse among delegates in San Antonio, and here we present what we believe will be five of the main themes at ATA2023. 

Virtual Care Positioned as Key Tool in Providers’ VBC Strategies 

Population health management (PHM) requires a provider’s most critical and costly patient cohorts to be identified, and strategies implemented to manage these cohorts in the most (cost) effective way possible. The ‘last mile’ of PHM is patient outreach, engagement, activation and management, the heart of value-based care (VBC). At ATA2023, telehealth vendors will market their solutions as key tools in effective VBC strategy.  

The graphic below illustrates the various building blocks of a PHM system. The system takes patient and other data from different sources and the resulting data lake provides a clinician with a summary view of the patient. Different tools leverage the data lake to stratify populations, identify high risk populations, provide clinical decision support and care management tools to help identify patients’ most critical needs, and implement processes to manage patients.  

Complete Integrated Care/PHM Solution

The ‘last mile’ of PHM – where the VBC programme kicks in – is patient activation, co-ordination, consultation and management, and links provider and patient.  

Telehealth and population health are increasingly interlinked. Evidence of this is in the large acquisitions that retail companies have undertaken over the last year, that all had virtual care – video consultations and remote patient monitoring (RPM) technology – as core elements of broader PHM strategy for chronic care patient populations. 

In response, RPM vendors are starting to offer tools to identify cohorts, and telehealth platform vendors are looking to team up with PHM vendors with virtual care modules. We expect tight relationships to develop, not only between pure telehealth and PHM vendors, but also EHR vendors – all of which want virtual care, telehealth and RPM functionality in their toolsets to support PHM programmes.  

More Enhanced Support for Providers Looking to Scale RPM Use 

Reimbursement models for fee-for-service (FFS) RPM implementations in the US have resulted in rapid RPM uptake over the last two years. However, uptake has still fallen short of expectations. A focus at ATA2023 will be how vendors and service providers can collaborate to accelerate uptake, and how telehealth’s role in VBC can take the conversation beyond FFS reimbursement.  

Before COVID, no clear reimbursement structure existed in the US for providers using RPM to receive payments from commercial and government insurers. This changed during COVID when the CMS launched specific reimbursement codes around Medicare FFS and some Medicaid patient populations (see chart below). These primary care-focused reimbursement structures covered RPM technology provision, installation and monitoring itself, resulting in more chronic condition lives managed by RPM. Simultaneously, the ‘hospital-at-home’ reimbursement structure incentivising providers to manage some patients at home, that previously would have been looked after in hospital, has been another driver in RPM adoption. 

However, concerns about the long-term future of the ‘hospital at home’ reimbursement model, as well as wider supply chain logistics problems, has stymied RPM uptake. 

US RPM CPT Code Claims (Numbers of Claims by Code) 

A big focus now for RPM vendors will be to reverse this and truly scale RPM. At ATA2023, we expect to see greater emphasis on providers and tech vendors collaborating on scaling strategies, focusing not only on RPM technology itself but also unlocking supply chain bottlenecks and hospital-at-home workflows, as well as making RPM technology easier to implement and easier for patients to use. 

While reimbursement structures will continue to stimulate RPM technology uptake (and notwithstanding concerns around the future of hospital-at-home reimbursement), the broader move towards VBC in the US will also be a catalyst. Consequently, healthcare providers at ATA2023 will look at ways to prevent escalation of patient diseases, avoid hospital re-admission, and explore ways for RPM to handle certain procedures.  

Specialise, or be Left Behind  

Platforms and services must increasingly be tuned to the needs of specific conditions/use cases (e g behavioural health, chronic care, stroke assessment, etc.) Vendors’ solutions will double down on supporting individual specialties.   

The COVID crisis required providers to implement video consultation platforms as quickly and often as cheaply as possible. Just getting a solution in place was often prioritised over specialty suitability. Now, however, it is not enough for a provider to offer a generic virtual care solution. Demand is growing for tools and clinical decision support solutions tailored to specific use cases. 

Big vendors (for example, AmWell) have been acquiring to strengthen specialist expertise (for example, in behavioural health). At ATA2023 vendors will position themselves as having a broad array of services and IT to support more diverse patient virtual care requirements.  

Clear Pitch to Retail and Big Tech  

US primary care is being transformed as retail, pharmacy and big tech enter the playing field. For most of these new players, telehealth is a key tool in managing primary care populations. IT vendors at ATA2023 will be increasingly focused on this area.   

The likes of Walgreens, CVS and Amazon will all become mainstream primary care providers in the US this year (as we predict in this Insight). Billions of dollars are being invested by big retail and big tech firms to fuel their ambitions, and telehealth IT vendors are increasingly in their sights to supplement their expertise, capacity and portfolios. This was illustrated in CVS’ purchase of Signify Health last year for $8B, and Walgreen’s-backed VillageMD buying Summit Health for $9B.  

While this is not necessarily a greenfield opportunity for telehealth vendors, it is a potentially rich seam of business, and leading players such as AmWell and Teladoc will be exploring how they can take advantage of the new retail primary care trend. 

Some companies that retailers have acquired have developed their own technology. This is a challenge for off-the-shelf vendors to convince retail companies that they should be focusing their resources more on healthcare provision, rather than technology.  

Increase in AI and Automation Tools for Telehealth Use 

For telehealth consultation providers such as AmWell and Teladoc, reducing costs is key to future profitability. For traditional bricks and mortar providers, meanwhile, tools to support triage, signposting and operational efficiency will be in demand. AI-based tools that ultimately prevent a live consultation unless really needed, while still giving patients critical advice, are the end goal. Many vendors will push their credentials on this front at ATA2023.  

AmWell and Teladoc both experienced a major surge in virtual consultations during COVID, but this came without any commensurate profit rewards. Indeed, loss margins widened for some as physician payroll costs skyrocketed with more consultations and employer/insurer payments/reimbursements failed to adequately cover costs. 

In the medium-term, telehealth service providers must find a way to convert scale and market share into profit. One strategy is to reduce the need for a lower-acuity case to have a tele–consultation, without any deterioration in quality of care provided.  

AI-based healthcare advice, chatbots and algorithms will be key to this going forward, and telehealth’s main protagonists are already gearing for this: Google’s $100M investment in AmWell’s IPO in August 2020 a case in point as it seeks to leverage its AI expertise. Although the effects of AI have yet to significantly impact providers’ bottom lines, it will ignite lively discussion at ATA2023. 

Addressing the Challenges 

ATA2023 convenes at a time of global macroeconomic challenges, price inflation and even shortages of healthcare personnel, which are all putting unprecedented pressure on healthcare budgets and the ability to deliver quality care. More than ever, innovation holds the key to driving costs down streamlining healthcare processes. Vendors attending ATA2023 will want to convince providers that their telehealth solutions will help address their myriad issues today and in the medium-term, offer solutions for specialist use cases, and support the broader transition towards true value-based care (VBC).