The Peterson Health Technology Institute, an independent evaluator of digital health technologies, released a report on hypertension solutions Monday that put a crater in the remote monitoring industry.
The report lauds remote monitoring solutions that include medication management while it raises question about other digital approaches to hypertension management. Both groups of companies claim they have strong evidence to show that their solutions have a meaningful impact on patient outcomes and cost savings for providers and payers.
The findings seem to be a repeat of the group’s digital diabetes report published in March, which drew ire from the digital health industry.
The PHTI hypertension report is the third in a series of reports the group is doing on the efficacy of digital health technologies.
The Peterson Center on Healthcare launched the PHTI, with a commitment of $50 million, to assess the clinical benefits and economic impact of digital health solutions along with the offerings' effects on health equity, privacy and security.
The organization says it aims to provide independent, evidence-based assessments of emerging products, something that is currently lacking in the market.
In the latest report, PHTI reviewed the clinical evidence and cost of remote monitoring hypertension solutions provided by major players including Teladoc (Livongo), Hello Heart, Story Health and Omada. Some of these companies were also evaluated, and eviscerated, in PHTI’s diabetes report.
The report classified the solutions into three categories: blood pressure monitoring, medication management and behavior change. Each solution included an element of remote data collection from a connected blood pressure device, but what the companies did with those data had a major impact on patient outcomes, according to PHTI's analysis.
PHTI found that remote monitoring solutions with medication management are the most effective in treating hypertension, while solutions that encourage behavior change have little to no evidence of improving outcomes and are a net drain on organizations that use them.
“Not all digital hypertension management approaches are equally effective,” Caroline Pearson, PHTI’s executive director, wrote in the report. “Solutions that ensure that data from patients is used by care teams to manage medications have superior outcomes. Solutions that primarily target patients’ behavior change—including reminding patients to take their medications and encouraging them to improve their diet and exercise—do not deliver incremental health improvements compared to usual care."
The so-called medication management solutions fared the best in PHTI’s report. The companies, which included Cadence, Story Health and Ochsner Digital Medicine, dedicate a separate team of providers, beyond the ordering provider, to manage the dosage of a patient’s hypertension medication based on their daily blood pressure readings.
PHTI found that the medication management solutions achieved better systolic blood pressure than the traditional standard of care, and they delivered the results faster, in a matter of months.
Though the medication management solutions lost health systems money in the first three years of deployment, they achieved cost savings over a 10-year period because patients had less cardiovascular events, according to the analysis. PHTI’s confidence interval was high.
“The PHTI report vindicates Story Health product differentiation,” Tom Stanis, CEO and co-founder of Story Health, said in a statement. “Medication management is the key strategy that has strong evidence-based results, indicating meaningful improvements in hypertension management. Pairing this with home-based blood pressure monitoring brings even more value, as the report notes. However, the thing that makes us unique is that we do all of this together with providers, serving as an extension of their team and data sharing directly into the EHR.”
In a statement, Theodore Feldman, M.D., Cadence's chief medical officer, said, "The report concludes that Cadence and other medication management hypertension solutions drive clinically meaningful reductions in blood pressure compared with usual care. The report highlights the vital role of technology in transforming hypertension care, emphasizing Cadence’s clinical efficacy and long-term cost savings."
Blood pressure monitoring solutions, which transmit BP readings directly to the ordering provider for trend analysis, came in second place, according to PHTI’s findings. The solutions marginally lowered systolic blood pressure (SBP) compared with the standard of care; however, they cost health systems more than they saved given the current reimbursement for remote monitoring, the report said.
The report said these companies, which include AMC Health, Health Recovery Solutions and VitalSight, could bend the cost curve if providers consistently act on BP data. PHTI’s confidence interval was high.
The remote physiologic monitoring billing codes do not require medication management but rather the transmission of data from the patient to the provider, the provider's analysis of the data and the device setup and patient education.
The behavior change companies—Teladoc, Omada, DarioHealth, Hello Heart and Lark—had little to no effect on SBP compared to usual care, PHTI said. The analysis found that the solutions may close equity and access gaps in traditional care but concluded that the tools were a cost sink. PHTI’s confidence interval was low.
PHTI said the evidence does not support broad adoption of the behavior change approach.
But the behavior change group presented evidence to Fierce Healthcare that their solutions were significantly better than PHTI recorded in its latest report. For example, Hello Heart shared data that showed it decreased SBP between 16 and 21 points. PHTI reported that the behavior change group only had a 1-point improvement on SBP, on average.
Hello Heart said that PHTI failed to include this evidence in its data analysis because the study did not have a comparator arm, which it said was impracticable to include and is not the industry standard.
"Unfortunately, PHTI took a shortcut of only considering studies that compare SBP reduction to usual care from a limited set of our competitors, and therefore estimated only a 1 mm Hg improvement over usual care without considering our actual published outcomes," said Edo Paz, M.D., senior vice president of medical affairs at Hello Heart.
PHTI said the report lists each company's generated evidence.
"These include some poorly designed studies without comparators, high selection bias (e.g., only patients who opted in), and selective analysis (e.g., only patients who completed the program and discarding those who didn’t) that yielded very large effect sizes," Pearson said in a statement. "These studies were reviewed by our clinical advisors and external health evaluation partners."
Tejaswi Kompala, MD, head of cardiometabolic clinical strategy at Teladoc Health said that the report did not take into consideration Teladoc's comprehensive approach to hypertension management, which is treated alongside obesity, diabetes and depression.
“Our members and clients trust us to deliver clinically meaningful outcomes, and we do," Kompala said. "As noted in the report, we put our full program fees at risk and offer performance guarantees based on target outcomes. Unfortunately, PHTI's methodology excluded data on the compounding benefits of our multi-condition programs. Hypertension often coexists with other conditions, such as obesity, diabetes and depression, and our programs were built to address this interconnection and improve overall cardiometabolic health. Our data demonstrate improvement in weight and mental health, in addition to blood pressure.”
Carolyn Bradner Jasik, chief medical officer at Omada Health said it provides care in line with the American Medical Association's Return on Health framework.
“Omada Health has published outcomes using an evidence-based approach in line with best practices endorsed by the AHA and AMA," Jasik said. "We believe that the latest PHTI assessment inadequately groups companies with very different offerings, narrowly focuses on select clinical metrics (i.e. blood pressure), and presents virtual care providers as point solutions, which is inconsistent with buyer and member needs. We believe the AMA’s Return on Health framework provides a more holistic and relevant approach, and we encourage the digital health industry to join us in adopting it.”