A new paper published in the Journal of Cardiac Failure shows that patients on Cadence’s remote physiologic monitoring program had better outcomes than patients eligible for the program who did not enroll, and, the program demonstrated a 52% cost savings per month for Medicare beneficiaries using RPM for heart failure with reduced ejection fraction.
Heart failure is the leading cause of hospitalization in people older than 65, the new study says. Some of the biggest costs to payers are emergency department visits, hospital stays and nursing facility stays for rehabilitation after a hospital stay.
“Unfortunately, we're doing a poor job managing patients with heart failure… heart failure has become a more complicated disease process over the last few years given [our] increasing understanding,” David Feldman, cardiology fellow at Massachusetts General Hospital and clinical adviser to Cadence, told Fierce Healthcare in an exclusive interview about the study.
Cadence is a national remote physiologic monitoring service provider that serves 22,000 patients across nine health systems and 21 states. Among Cadence's patients, 3,500 are being treated for heart failure.
The landscape for heart failure has even gotten worse in recent years, Feldman said, pointing to another study published by the senior author on Cadence’s paper Marat Fudim, associate professor in the Duke Department of Medicine.
Fudim’s study found that since 2012, heart failure fatalities have risen in the U.S. due in part to increased diabetes and hypertension. “The gains made from 1999 to 2012 have been entirely undone by reversals from 2012 to 2021, meaning that contemporary heart failure mortality rates are higher than in 1999,” Fudim said in a Duke Medical School blog post.
Cadence’s remote monitoring outcomes could move the needle on this trend.
Over 350 patients were involved in Cadence’s study. For all participants, Cadence’s remote monitoring program boosted treatment uptake for heart failure for each of the four medications that comprise the best practice guideline-directed medical therapy (GDMT) standard of heart failure care.
Feldman told Fierce that one of the major issues in heart failure treatment is the staggeringly low amount of participation in the four major effective treatment options; he said current research puts participation in the full GDMT regimen at around 3% of all heart failure patients. Feldman listed a variety of reasons for low participation in the full GDMT. One issue for patients is the cost of the medications. Another, he said, is because doctors can feel uncertain about starting a patient on medication when they’re only seeing a patient every few months.
“What can we do? Cardiologists are not available to see these patients more often. So how do we extend our care? I think that's really where I'm a firm believer … in comprehensive remote patient monitoring,” Feldman said.
With the remote monitoring program, though, that requires near daily interactions with a health team. Cadence showed a major leap in treatment uptake, which all but guarantees better outcomes for patients. The study found that patients on all four medical therapies increased from 7% to 23%.
Not only did patient outcomes improve, but the study authors found that using Cadence also saved costs for the 70 patients in the study enrolled in a partner accountable care organization (ACO). Using a differences-in-differences analysis, Cadence’s study shows that remote monitoring saved payers 52% on cost per month per patient.
“Of the $1,076.64 per patient per month reduction in spending, the majority was attributed to reduction in hospital and post hospital discharge spending,” the study says. The cost savings includes the cost of the technology.
The study uses claims analyses from three years prior to enrollment and a year beyond enrollment, which straddles the period of the COVID-19 public health emergency. The study compares patient costs before and after enrollment in the remote monitoring program.
Cadence also found that the population which chose to enroll in the remote monitoring program were sicker at baseline than patients who didn’t enroll. For a sicker patient population, the cost savings are particularly notable.
“We know that to keep somebody in an RPM program, costs are somewhere along the lines of $500 a year to $600 a year… But, you know, in a heart failure patient for instance, if you're generating $1,000 per patient per month reduction [in spending], I don't have to do the math for you,” Feldman said.
Cadence is continuing to recruit data on outcomes and cost of care from its programs.
While only about 20% of study participants were involved in the ACO and could demonstrate cost savings, Feldman said that all patients showed improved outcomes, which is a good indicator that payers will save money by using RPM for heart failure.
Comprehensive RPM programs could even be a more effective option than GDMT clinics, which specialize in medication therapy and adherence for heart failure patients.
“There are what's called GDMT clinics at many of the big academic medical centers who are pitching themselves as kind of the solution here,” Feldman said. “It's impossible to get patients into those programs. And so I think we realized we need to be realistic about what the scalable options are here and I think what we’ve been able to show with this data is that … the comprehensive RPM program is … one solution to really help fill that gap.”