Name:
Rheuban: Telemedicine Ch. 11: Remote Patient Monitoring and Care Coordination
Description:
Rheuban: Telemedicine Ch. 11: Remote Patient Monitoring and Care Coordination
Thumbnail URL:
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Duration:
T00H06M55S
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Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DR. ALI: So, I think one of the big opportunities we have right now in digital therapeutics, actually prescribing apps to patients, is to now capture data and look at compliance, how do we work on behavioral changes, just, for example, simply by doing push notifications. In fact, my mom, for example, you know, I had initially just set up an alarm system for her to take her medications. Now I found a digital therapeutic app to do push notifications where she can notify her loved ones that, "Yes, in fact, I've taken my medications." What a simple digital therapeutic, right?
DR. ALI: And that's a very basic 101 concept, which is compliance. And then we started looking at behavioral changes. So, behavioral changes, I think, is one of the biggest areas in telemedicine that we can push. So, I think one other bucket that I may have not mentioned is also, maybe in the chronic condition, but it is wellness. And the wellness space is chock-full. As cardiologists-- I think McGuinness, from the NIH, had done a study in 1990, 2000, and 2010 and showed that the cause of death in America-- MIs, stroke, cancer, and other-- motor vehicle accidents, COPD, pulmonary diseases, many of those are driven by behavioral changes.
DR. ALI: That's the effect. The cause is actually lack of exercise, not smoking, having good dietary habits and then, actually using the preventative services as played out by the United States Health Task Force. And so, those are the causes. The effects are heart attack, strokes, COPD, right? So, these are behavioral changes in chronic conditions that we can change. So, I think we have an opportunity in the space of telemedicine and wellness, to actually help those individuals focus on the cause of disease.
DR. ALI: And we know that a vast percentage, more than 50% of these diseases, are modifiable. And now, finally, and I will shift the subject into actually how do we get paid for this? Because I think that's a big driver. I think technology is great, but for adoption we have to show metrics of success not just through these behavioral changes and data analytics, but to get adoption: the physicians have to get paid, the system has to-- the patients have to be provided for.
DR. ALI: So, what's your thoughts on-- I think it's is a big elephant in the room in telemedicine by the way, right?
DR. RHEUBAN: Sure, sure, sure. You've covered the entire spectrum, I want to harken back first to what you've talked about, post-acute care, and compliance, and behavior change. Not necessarily though-- The prevention piece is critical as well, but starting with that piece, we-- Traditionally, patients were discharged from the hospital and they'd get their return appointment, and they might come and they might not come.
DR. RHEUBAN: But integrating remote monitoring tools into that can affect compliance and can affect behavior change. So, in our experience in remote patient monitoring post-hospitalization, patients absolutely love it. I mean, I was amazed at the incredible, incredible positive feedback that we have gotten. And we've demonstrated a reduction in hospital readmission, as much as 70% in some conditions, on average about 40%.
DR. RHEUBAN: But patients, they really need to know somebody is watching and somebody cares. And if there are outliers in physiologic data, somebody is calling in. That impacts the patient. The patient then can say, "Oh, I had too much salt yesterday, that's why I gained three pounds." And somebody noticed it, as opposed to waiting until they get more and more edema and heart failure, and then come back in extremis.
DR. RHEUBAN: So, that's one really important piece-- behavior change and compliance is huge. We are looking at things like Apple watches to tell patients the same thing, to get prompts, push notifications, to say, "Take your medicine." Totally appropriate. Prevention is really important. We haven't really fully incentivized prevention, although employers are moving in that space as well. And there are incentives that can be provided, not only to the providers, but to the patients themselves in terms of adhering to some of the recommendations in the wellness space, and smoking cessation, and all the things that can add to the morbidity and mortality.
DR. ALI: Yeah, I think one of the examples that is prevalent today is actually the Diabetes Prevention Program. We just gave grand rounds at University of Texas, actually yesterday, on this topic. So, I think that encompasses, actually, everything we've spoken about because in the Centers for Disease Control they did a trial where they looked at pre-diabetics. Now, pre-diabetes defined as a glucose of a 100 to 125, and A1C that would be not your traditional, above 6.5% is diabetes, but between 5.7 and 6.4. And now, we've finally found out that a diabetic, if you quantify-- if a pre-diabetic became a diabetic, it costs the health care system about $7,000 per patient.
DR. ALI: But if we were able to prevent those diseases, then, now we are in a different era and we can actually reduce. So, the Diabetes Prevention Program showed, through a trial that was done approximately seven years ago, that we could reduce the incidence of pre-diabetics becoming diabetics by up to 58% just by lifestyle choices, and that metformin actually did not do as well, it was actually non-inferior to lifestyle choices, so that it meant that if we prescribe lifestyle choices over a medication, we actually reduce the incidence of pre-diabetics going to diabetics.
DR. ALI: That's huge. So, there is the opening for behavioral change and compliance. And now, the CMS has given money to reimburse the physicians and the patients to get on board to really look at their pre-diabetes. And I think the space for telemedicine is there. And, actually, there is a company known as Solera, that is looking at this pre-diabetic space in DPP and using digital therapeutics, and even in their own data more patients would rather use a digital platform than go in person.
DR. ALI: And that was across the spectrum.
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