Healthcare 'flying blind': Medication nonadherence and how remote therapeutic monitoring can help

Medication nonadherence is a serious, preventable public health concern. When patients don't take their medications as prescribed, it can lead to poor health outcomes associated with up to 10% of hospitalizations and billions in costs annually.

As the healthcare industry shifts to value-based care, adherence can serve as a mechanism to improve outcomes and lower downstream costs. 

Yet the healthcare system is “flying blind” when it comes to medication adherence, according to Jeffrey Nadel, co-founder and CEO of Assure Health, a remote patient monitoring provider. Electronic health record software and other apps can offer some insights, like from prescription fill data, but the accuracy and relevance of that data is still being developed.

Remote therapeutic monitoring (RTM) is a relatively new advancement in healthcare, with reimbursement codes going into effect last year. Distinct from remote physiologic monitoring (RPM), it involves using medical devices to monitor a patient’s health or response to treatment using non-physiological data. The visibility it can offer can help enhance the accuracy of diagnosis and targeted interventions, thereby improving outcomes and lowering costs.

Nadel joined other healthcare experts on a panel focused on the future of virtual care management and organized by RTM platform Hero Health earlier this month.

Virtual care will grow despite challenges 

Not only are consumers becoming more sophisticated with tech, “we also want healthcare to come to us, versus the other way around,” Anand Shah, board director of Hero Health and operating advisor to Clayton Dubilier & Rice, said during the panel discussion. Between regulatory recognition of remote monitoring technologies to growing payer interest, he added, “this explosion is going to continue.” 

As care moves increasingly into the home, with it also comes the risk of medication nonadherence, noted Phyllis Yale, partner at Bain & Company and board member of several value-based organizations including Aledade and Blue Cross Blue Shield of Massachusetts.

“Getting better adherence at home is really important to payers,” Yale said. “Medicare Advantage plans have an incentive on the revenue side,” she added, because it’s part of risk adjustment. What payers want to see is an offering that is fully integrated into care—and a technology that patients are willing to use.

A major barrier to adoption is a lack of incentive in federal value-based programs, Robert Jarrin, member of the American Medical Association digital medicine payment advisory group, said in the panel. Jarrin encouraged the Centers for Medicare & Medicaid Services to include more incentives to use the technology beyond existing limited use cases.

“I think there still is this large chasm with federal programs and the use of technology and to me that’s a very unfortunate missed opportunity,” he said.

The creation of CPT codes for RTM marked the official multi-stakeholder recognition of the legitimacy of the technology, Jarrin said. Now, greater incentives are needed to use the codes and use the services. Not doing so would put at risk the collection of experimental data needed to move it forward. 

Working with, not against, providers 

“Creating further fragmentation, further siloing things, I think does no favors for patients or providers,” Nadel said. “We see ourselves as existing to augment and give superpowers to PCPs.”

Primary care providers have shrinking face-time with patients, with little to no visibility into their daily life between visits. “The bad stuff tends not to happen in those precious few minutes,” Nadel noted. “It’s all the times in between.”

Startups like Assure aim to keep low acuity cases out of a more costly brick-and-mortar setting, collaborating with care teams to remotely monitor symptoms and medication regimens. Identifying a problem early can prevent downstream illness and costs. 

Disputing the idea that more data makes people more healthy, Nadel suggested that more data, when acted on appropriately, can meaningfully improve outcomes. The key is offering actionable, near-real-time insights to providers. 

Tech-enabled human touch

When it comes to senior patients, Assure has seen a lot of adoption. Many incumbent digital health solutions are generally built for healthier, younger populations first, Nadel explained. The way they are structured might not translate for a different demographic.

Whether it is minimizing consent forms, app downloads or device setup, Nadel believes in the power of eliminating friction that could deter tech use. Seniors are also among the patients that don’t just want tech to be the star of the show, Nadel said. They crave a human element. He owes Assure’s success to its emphasis on the relationship with the care manager.

“There's something about the personal human touch that just can’t be replaced,” Shah agreed. 

Shifting to value-based care  

Fee-for-service reimbursement is an important stepping stone to generating data to prove RTM’s benefits. But the most effective way to deliver RTM is ultimately in a value-based care model, Nadel said.

Shifting to value-based thinking “enables companies like ours to put our necks on the line and to say we know we can deliver the outcomes, everything we do is oriented to that—let us prove it.” 

“We’re going to increasingly see it just embedded into overall provider capitation rates,” Yale agreed.

Policy is critical to encouraging the adoption of tech like RTM and ensuring equitable access, Shah said, whether it is through broadband access, tax credits, co-pay support or some other approach. The system needs to work collaboratively to push this technology forward in an integrated way. At the end of the day, more data is still needed.

“I think this really becomes an evidence collection and an evidence analysis problem,” Shah concluded.