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HEALTHCARE TECH AT A CROSSROADS: THE RISE OF REMOTE AND VALUE-BASED CARE
Healthcare is rapidly coming to a crossroads. In the U.S., healthcare costs amounted to 17.7% of GDP.1 Unfortunately, despite this high spending, Americans experience worse health outcomes than their peers around the world. According to new provisional data from the CDC’s National Center for Health Statistics (NCHS), life expectancy at birth in the U.S. declined nearly a year from 2020 to 2021—from 77 years to 76.1. This was the biggest two-year decline since 1921 to 1923.2
While cost pressures are particularly dramatic in the U.S., the rising cost of healthcare is a vital concern affecting populations across the globe. Although a huge number of factors are at play, Analog Devices, Inc. (ADI) sees a tremendous opportunity in one area—the value technology brings to the management of chronic diseases and conditions.
BREAKING NEWS: ADI is proud to announce our first ever, FDA-cleared product, the Sensinel™ CPM System. This is the next generation of heart failure management for remote use by patients in home settings before they get acutely ill. Read more information on the system here.
MANAGING CHRONIC DISEASE
Tens of millions of Americans suffer from chronic conditions like diabetes, heart disease, and asthma. With 6 in 10 having a chronic condition and 4 in 10 having two chronic conditions, many people’s lives are affected by these debilitating and often deadly disorders. In addition to the human cost, chronic diseases pose an undue financial burden on the healthcare system, with the top 35 conditions driving more than 70% of all hospital costs.4
AMERICANS SPEND NEARLY $1 BILLION DAILY IN MEDICAL COSTS DUE TO HEART DISEASE AND STROKES5
Rapidly rising healthcare costs are causing a shift in not just the economics or modalities of care, but more importantly, the incentives to adopt technology-driven solutions. However, despite efforts to introduce new solutions to the market, previous attempts have failed due to lack of acceptance from physicians, patient noncompliance, lack of fit into a patient-care workflow, and scalability issues.
THE GOOD NEWS ABOUT VALUE-BASED CARE
A combination of government and market incentives drives changes to address both the human and economic toll exacted by chronic disease. An example is the concept of value-based care, wherein providers, including hospitals and physicians, are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. In this scenario, providers are incentivized/paid based on the patient’s health outcomes.
Two examples of value-based programs are:
- Medicare Advantage Plans (MAP) administered by major insurance companies
- Medicare Shared Savings Plan (MSSP) administered in Accountable Care Organizations (ACOs)
In the U.S. today, there are over 65 million patients enrolled in Medicare, with over 31 million enrolled in Medicare Advantage (MA).6 The MA population is expected to grow to over 37 million members by 2026.7 The data in the chart shows this shift has been rapid.
The importance of this change in healthcare administration cannot be overstated. Under value-based care agreements, providers enter into written contractual agreements with payors in which the payment terms for healthcare are tied to clinical circumstances, patient outcomes, and/or measures. These value-based agreements drive quality incentives within the provider organizations to minimize costly acute care.
THE KEY DISRUPTOR: AN ADVANTAGE TO BOTH PAYOR AND PROVIDER
The key disruption in these models is that any reduction in care expenses for the patient is advantageous to the payor and the provider (they get to keep the savings) whereas, in the traditional fee-for-service (FFS) model, additional services are incentivized, which adds to the model’s disfunction.
Easier access to care at home offers an unprecedented opportunity to leverage advances in healthcare technology in the fight against chronic diseases. In response to COVID-19, the Center for Medicare & Medicaid Services (CMS) has added payment codes for at-home treatment and monitoring, making it easier for patients to get advanced monitoring and screening outside the hospital site.8 Biosensors, wearable monitors, and algorithms have the potential to fundamentally improve how care is delivered to patients in alternate settings.
A key element to success for value-based organizations is improved treatment for patients with chronic diseases, who currently drive $1.1 trillion in costs.9 Improving daily functioning and reducing the burden of care for these patients is critical. One method to do this is by shifting care outside of a physician’s office or hospital through at-home monitoring.
EARLY DETECTION: THE #1 OPPORTUNITY
The goal for many patients with chronic disease is management, ensuring a comfortable and healthy daily life. Wearable precision sensing at home will allow patients to conduct daily measurements and capture subtle changes in their physiology without having to wait for medical checkups in a clinic or with a physician. Armed with a robust set of patient-specific data, algorithms can further identify these subtle physiological changes that serve as early warnings when a patient’s condition deteriorates. Early detection can create opportunities for preventative treatment while reducing the amount of acute and/or emergency care required—not to mention the value in preserving the quality of life by avoiding an acute event.
CRITICAL HURDLES IN DIGITAL CARE MANAGEMENT
The notion of better patient care through at-home, continuous management of chronic diseases is not new. But, based on ADI’s internal expert assessment, the top three problems that plague its successful implementation even today, despite obvious economic advantages, are:
Information Overload
When a large number of patients are instrumented for home monitoring, the new devices generate voluminous amounts of heterogenous data that require monitoring and acting on critical alerts. Doctors and nurses are already operating at capacity during working hours. This is a resourcing challenge that must be met.
Clinical Acceptance
Without an identifiable medical explanation, medical practitioners might be reluctant to accept solutions rooted in sound, interpretable clinical methods that show good final outcomes. They might also be more amenable to methods that are understandable to them from their training protocols. Furthermore, it takes significant work to convince physicians, to adopt a new technology on top of their existing systems.
Scalability and Ecosystem partnership
Spot solutions that work for a single patient and cannot be scaled across a larger community are economically unviable. The customers (both providers and payors) are looking for not just a medical device, but also a scalable population health solution that fits into their existing care-pathway without massive changes in information flow.
IDENTIFYING THE PROBLEM IS NOT ENOUGH
Each day, physicians face decisions that create significant demands on both their time and attention. New technology options supplying actionable data to medical practitioners need to be accurate, reliable, and trusted. Critical development decisions must incorporate intelligent algorithms that precisely filter the right physiological data, accompanied by clinical relevance. These decisions must be issued promptly to address deteriorating patient conditions. Intelligent patient management will not only aid clinician performance but also keep chronic care efficient and effective. Delivering solutions in this new continuum will require assurances that the right data are captured and follows the disease management standard of care to deliver information that clinicians understand and trust enough to use in their decision-making process.
The new era in healthcare requires integrations and partnerships. No one organization can deliver against the market’s needs. Industry professionals must partner with organizations across the ecosystem and create value up the entire value chain. With new incentive structures emerging through Accountable Care Organizations and Medicare Advantage Plans, market conditions have never been so ripe for opportunity, collaboration, and growth.
ADI has taken the challenge of advancing healthcare technology to heart; in its commitment to developing healthcare solutions, in the ways we collaborate with manufacturers, physicians and payors, and how we work to improve the lives and well-being of patients across the globe. ADI is enacting advanced technology that provides trusted measurements that deliver insight to the physician that they can act on.
1 U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes
2 American Economic Association; NCHS: U.S. Life Expectancy Fell from 78.8 Yrs 2019 to 76.1 Yrs 2021 (8.31.22), State Variation 2020 (8.24.22)
3 Centers for Disease Control and Prevention: “Chronic Diseases in America” infographic
4 BusinessInsider.com: “Most Expensive Health Conditions in the US”
5 CDC Foundation: ”Heart Disease and Stroke Cost America Nearly $1 Billion a Day in Medical Costs, Lost Productivity”
6 Center for Medicare Advocacy: “Medicare enrollment numbers”
7 Axios: “Medicare has become more of a private marketplace—and it’s costly”
8 MS.gov: “Coding and Billing Information”
9 Milkeninstitute.org: “The costs of chronic disease in the U.S.”
