The COVID-19 pandemic has pushed digital health solutions and telehealth to center stage during the pandemic. While this is one positive, it has left me wondering… is this newfound appreciation for remote patient solutions sustainable? And what can we, those who are creating solutions, do to make sure they stay mainstream when we return to whatever is considered “normal” post-pandemic? As we head further into 2021, I have made a few observations and predictions for how I think this newfound appreciation for telehealth will pan out as we head into a post-COVID world.
Help us fail faster.
Telehealth is certainly nothing new, in fact, the “new” aspect of telehealth is its emergence into the mainstream consciousness. Previously, many insurance providers and practitioners simply did not cover, offer or allow the deployment of such solutions. Given the stacked deck against this technology, the processes for getting such technology approved have never landed on the side of swiftly vetting and rolling out to market these solutions.
But as those in the pharmaceutical space have often advocated for, “help us fail faster,” meaning we understand the gravity of a regulatory body approving such devices, and certainly recognize the importance of thoroughly vetting a medication or device responsible for managing someone’s care, but give us the ability to get through the gauntlet faster and in a way that is not needlessly capital-intensive. COVID-19 and the subsequent EUA process have certainly helped shine a light on what a more efficient, innovation-minded approach to approval might look like for entities like the FDA. It’s one of the silver linings of the pandemic I hope carries through 2021 and beyond.
A hammer looking for a nail.
I firmly believe good ideas can come from anywhere, especially when it comes to healthcare, but all too often in healthcare we find there are hammers looking for nails, particularly in the case of the telehealth and the remote patient monitoring space. At the beginning of the pandemic, we saw a flurry of activity – folks trying to toss their hat into the ring to bring “new” solutions to market, when many digital health solutions have already been operating in this space and honing their technology for quite some time.
These incumbents are the organizations with stronger partnerships and, most importantly, were created with a specific population in mind. Remote monitoring for remote monitoring’s sake and an avenue to deliver care outside of the clinical setting isn’t enough. There are specific challenges these patient populations face which must be accounted for. The clinicians who utilize these tools and their workflow must be accounted for as well. This is often the complaint of many clinicians. “It’s great you built this technology, but it doesn’t fit into my day to day and I certainly don’t know how to bill for it.” The most successful solutions in this space put the patient and their specific problems and needs at the center of their product development.
Rethinking payment models.
The reimbursement pathway has always been one of the biggest obstacles in this space. As the market for telehealth continues to evolve so must the way we think about payment models in the space. Candidly, many VCs are wed to the tried and true payment models that have always been in place for medical devices. As we begin to rethink other aspects of this faction of healthcare, I’d argue it would also be beneficial to also consider new revenue models as well.
The recurring revenue model has arrived at medical devices’ proverbial doorstep. We have seen DexCom enabling not only sensors but also services on top of the devices they provide, and there is likely to be a similar convergence in the diagnostics world. This is particularly relevant when it comes to chronic conditions, their ongoing management, and keeping at-risk populations out of the clinical setting as long as the pandemic continues. Even beyond when we can say goodbye to relentless hand washing and masks as a daily accessory, it is important for us to consider how we can better understand chronic conditions between visits.
Financial sponsors open to a device and software company pursuing a recurring revenue model will be essential in bringing forward better solutions for those who need care and monitoring on an ongoing basis. At present, most of these solutions are seemingly limited to conditions like diabetes, but considering how costly chronic kidney conditions are, we have a unique opportunity to curb one of the most expensive and preventable causes of adverse health events.
While the reimbursement pathway still has challenges and obstacles that we must overcome, I believe there is also reason for optimism. First of all, the recently finalized Stark and Anti-Kickback rules from HHS specifically created a new patient engagement and support safe harbor that creates new opportunities for Alio to partner with providers and other healthcare entities in something known as a “value-based arrangement.” Secondly, nearly 40% (which is over 24 million) of current Medicare Beneficiaries are currently using Medicare Advantage plans (and some project that nearly 50% of beneficiaries could be using Medicare Advantage plans by 2050), and many of these plans are continuing to expand the use and coverage of remote patient monitoring devices as a way to improve care. And, lastly, a recent hearing on telehealth has demonstrated that the federal government sees clear benefits for RPM technology.
The past year has certainly provided a number of lessons and opportunities with broad-reaching implications for years to come. Our hope at Alio is that 2021 will be notably different than 2020 but help us sustain some of the insights we have gained from this past year, particularly those which have pushed us to rethink how we diagnose, monitor and deliver care.
Cheers to 2021!
