DHW Q&A: Bridging Gaps in Remote Care With Clear Arch Health

With Robert Flippo
MobileHelp / Clear Arch Health, CEO

In this Digital Health Wire Q&A, we sat down with MobileHelp CEO Robert Flippo to discuss the shifting remote patient monitoring landscape and how new technologies are enabling more people to age independently.

Clear Arch Health is MobileHelp’s healthcare division, which integrates RPM and personal emergency response systems (PERS) into a turnkey solution that’s easy to implement for both patients and providers.

Can you give us a quick introduction to Clear Arch Health and your overall strategy?

Our overarching goal from the very beginning has really been to improve people’s ability to age independently, starting with our consumer-facing MobileHelp personal emergency response business, and also with our Clear Arch Health remote patient monitoring platform.

To enable people to age wherever they want, which is usually in the home, you need a platform that’s both flexible and proactive. There’s the actual clinical monitoring component, where clinicians are managing patients, keeping track of vitals, checking on medications, etc. Then there’s also all the data that results from that.

A lot of people think about RPM as devices, but there’s a whole system behind those devices that’s analyzing that data to more effectively manage patients. Controlling that entire tech stack is what lets us help people age independently, and that’s the real mission here.

The longer people can remain independent, the happier they’re going to be.

How does your experience in PERS support the remote patient monitoring aspect of your business, and what sort of capabilities do you unlock by combining the two?

There’s a couple of pieces to it. First and foremost, the patients who are typically in need of PERS are also more likely to need chronic disease management using remote patient monitoring. So for the consumer, combining the two really simplifies the experience.

That’s hugely important when you think about this demographic. One of the major lessons we’ve learned from working with this population for over 15 years now is the importance of having a seamless platform that’s intuitive for someone that might be over the age of 75.

It’s easy for a lot of companies to get caught up with the shiniest tech and all of its bells and whistles, but the patients that we’re working with usually want the exact opposite.

This fundamental understanding of our customer base drives the design of everything from our hardware and installation to our customer service and manual. It’s powerful in its simplicity and fully turnkey. You plug our products in, and they work.

Can you give an overview of that hardware and the other components of the platform that you layer on top of it?

I’d say that a lot of people think of the hardware as the whole solution. It’s an important part, and it needs to be safe and reliable and all of those things, but at the end of the day it is just one component, like you said.

The flagship product for our remote patient monitoring service is a custom tablet solution that we’ve developed and manufactured for both RPM and personal emergency response. It’s purpose-built for our customers with loud speakers, sensitive microphones, and easy connectivity – but it’s also highly configurable.

Depending on the program that’s being developed, we can provide unique content for education, or a direct connection to nursing staff for video visits, but all of it is integrated with the EMR so that care teams can also have a seamless experience and access to the data.

When we deploy a program with a new client, the set-up, the training, and the ability to interact with patients directly are all just as important as the hardware. There’s at least as much service in this industry as there is technology. 

There’s recently been a major shift to RPM and home health in general. What are some of the biggest changes that you’ve seen over the last few years?

One of the biggest changes has been the willingness of CMS or Medicare to actually reimburse remote patient monitoring for chronic disease management.

Up until recently, home health agencies were tasked with taking care of patients after they were discharged from the hospital, and one of their primary incentives was to try and prevent readmissions – yet there wasn’t a specific line item that covered remote patient monitoring. RPM has now been proven to prevent readmissions, and reimbursement is following.

The other major change has been the flood of new entrants into the space, both from small startups and larger companies more at scale like we are. In my view, that’s actually created a lot of noise in the market, and it’s now more difficult than ever to separate out who the real players are and how they might be able to help.

What are the biggest trends you’re seeing in the aging in place segment that might not be getting the attention they deserve?

I don’t think that it’s so much a specific trend that people are overlooking, as much as the fact that we’re only just starting to see the beginning of what the possibilities are. At a certain point, these programs are generating so much data that the real challenge becomes getting the value out of it.

The introduction of new AI tools is giving us the ability to analyze that data in real time, which will let more people age independently by allowing us to pick up on situations that might be difficult to spot by a human looking at the raw data.

The reality is that there aren’t enough caregivers to take care of the population that’s going to be aging in place over the next 10 to 20 years, so if we don’t figure out how to use this technology to more effectively manage patients, we’re going to be in a tough spot. In my opinion, it’s not really an option that we succeed here, it’s a necessity.

Is there any advice that you would give to a provider organization or health system thinking about implementing their own remote patient monitoring strategy?

When you really dig into it, remote patient monitoring is probably more complicated than you’d originally think. The key to overcoming that is finding the right partner for your situation.

If you’ve seen one remote patient monitoring solution, you’ve seen one remote patient monitoring solution. Everybody’s situation is different, even within health systems. They’re generally solving for the same problem, but they all have unique requirements and capabilities, so finding a partner that can help navigate to the right solution and that’s flexible enough to implement it will give you a much higher probability of success.

For more on Clear Arch Health’s RPM platform, head over to their website.

CMS Reports Record Performance for MSSP

CMS just released the Medicare Shared Savings Program results for 2022, and the report managed to drum up some serious debate on the effectiveness of MSSP despite last year’s record performance. 

MSSP saved Medicare $1.8B in 2022, marking the sixth consecutive year of savings and the second-highest total since the program launched in 2012.

  • The program generates savings by working with accountable care organizations, or groups of providers who collaborate to cut down on avoidable utilization, duplicative care, and medical errors.
  • The ACOs that effectively improve care quality and reduce total spend are then able to share in that success, and 63% of participating ACOs were compensated in 2022.

Standout performers included Aledade (four of the top ten ACOs for overall savings rates) and Privia (delivered expenditures 8% lower than the median MSSP ACO), although results were mixed for other high profile participants like CVS.

  • CMS called out the fact that low-revenue ACOs comprised mostly of primary care physicians generated $294 per capita in net savings (vs. $140 per high-revenue ACO), underscoring the importance of primary care to the overall program. 

Although at first glance those numbers make 2022 one of MSSP’s best years to-date, it’s worth noting that the total cost of Medicare over that time frame was a mammoth $747B.

  • That means that MSSP, the crown jewel of CMS value-based care programs that includes 482 ACOs equipped with some of the best care delivery tools in the industry, delivered an overall savings of just 0.24%.
  • That’s not to say that $1.8B is anything to scoff at, but it highlights the sheer size of the task at hand, and CMS devoted a healthy portion of the press release to proposed MSSP updates that would include more people who receive care from NPs / PAs and encourage ACOs to care for more medically complex beneficiaries. 

The Takeaway

MSSP had a great 2022 by almost every metric, and the ACOs participating in the program are the tip of the spear for improving the country’s fractured health system. That said, it’s a long journey to lower overall costs even with $1.8B steps, and there’s still plenty of work to be done to help get there faster.

Everything That Washed Ashore at Epic UGM

Epic went with a Castaway theme for this year’s User Group Meeting, and it’s easy to see why considering Tom Hanks would need years on a deserted island to sort through all the new features and partnerships announced at the show.

Luckily for Hanks, we already rounded up all the biggest news from the event, starting with the headline grabber: 

Microsoft and Epic are going all-in on AI. Microsoft CEO Satya Nadella even attended in-person to lay out how the partnership will reshape clinical workflows with generative AI.

  • Ambient clinical note generation powered by Nuance DAX Express 
  • Added in-basket messaging features that auto-generate first-draft responses
  • Rev cycle enhancements that provide coding staff with suggestions based on EHR data
  • New Look-Alikes program that matches patients with unidentified conditions to others with similar symptoms to help inform novel treatments

Epic CEO Judy Faulkner also took the stage in a sweet island explorer / Burning Man costume to share Epic’s overhauled partnership program, which now includes four distinct categories.

  • Cornerstone Partners – tech that serves as the backbone of Epic’s own software (InterSystems, Microsoft)
  • Partners – market leaders in specific areas (Nuance for ambient voice, PressGaney for consumer surveys)
  • Member Services – established integrations providing complementary value 
  • Pals – new category that allows innovative vendors to work closely with its EHR, including Abridge for ambient voice and the just-announced addition of Talkdesk for contact center workforce management

A new app “Showroom” will be the home base for the above partners, replacing the App Orchard that Epic shut down last year. 

  • When Showroom officially launches in a few weeks, it’ll be exclusive to a much more curated cohort of Partners and Pals than the Orchard’s 800+ third-party vendors, a decision that Epic said will help users find the “signal in the noise” and facilitate deeper collaborations. 

The Takeaway

Under the bright lights of an island-themed stage, Epic’s new features look nothing short of transformative, and its newfound willingness to play nice with partners could make a huge impact on nearly all aspects of care delivery. The real question will be whether these enhancements can be deployed as envisioned so that they can live up to their potential. It’s a massive undertaking, but there are countless clinicians that would love if Epic could pull it off.  

Viome Closes $86M to Bring Gut Tests to the Masses

The link between the human microbiome and overall health has been an increasingly hot topic for both researchers and founders alike, and Viome Life Sciences just landed $86.5M of Series C funding to be the first company to bring gut tests to the masses.

Viome’s at-home testing kits analyze the microbial composition of stool and saliva samples through RNA sequencing to inform personalized lifestyle recommendations and supplements, which it provides directly to consumers.

  • Using “modern AI and bioinformatics methods,” Viome can reportedly assess the genetic expression of an individual to identify which supplements will have the greatest positive impact on their health – a claim that’s unsurprisingly drawn a bit of pushback.
  • These diagnostics can also screen for certain cancers, and Viome recently received FDA Breakthrough Device Designation “for its ability to detect early-stage cancer in the mouth and throat using saliva with 95% specificity and over 90% sensitivity.”

A major distribution deal with CVS was announced alongside the funding, making Viome’s $149 Gut Intelligence Test the first gut test to be offered at 200 CVS locations and through its website.

  • These tests are provided for “close to cost” to CVS customers, with the true value lying in the data that flows into Viome’s gene expression data pool – apparently the largest of its kind – and the downstream D2C revenue.

Although Viome has a handful of peer-reviewed studies and some heavyweight investors like Salesforce CEO Marc Benioff, some researchers remain wary of microbiome kit companies due to the lack of evidence-based guidelines for translating the data into clinical practice.

  • One of Viome’s former competitors, uBiome, was indicted for defrauding payors and misleading investors over the effectiveness of its microbiome test, a scandal that cast a lingering Theranos-shaped shadow over the category.

The Takeaway

Viome is walking an interesting line between alternative medicine startup and AI diagnostics trailblazer, but that same intersection also seems like a natural sweet spot for success with consumers. On top of that, the CVS partnership probably gives Viome more exposure than any microbiome company has ever had, and it isn’t too hard to picture that advantage snowballing into a significant chunk of market share.

Bain & Co: Getting the Most Out of Generative AI

Bain & Company is back at it again with more generative AI research, this time offering a series of ways for providers to get the most out of the tech without falling into potholes of hype.

The in-depth report gives a comprehensive overview of the current generative AI landscape, and delivers solid insight into the priorities of health system executives (N=94): 

  • Top use case priorities (next 12 months): charge capture & reconciliation (39), structuring & analysis of patient data (37), workflow optimization (36). [Chart 1]
  • Top use case priorities (2-5 years): predictive analytics & risk stratification (44), clinical decision support (41), diagnostics & treatment recommendations (37). [Chart 2]
  • Biggest barriers to implementation: resource constraints (46), lack of technical expertise (46), regulatory & legal considerations (33). [Chart 3]

Start small to go big. Although the survey itself included some valuable stats, the spotlight was stolen by Bain’s particularly pragmatic framework for guiding new implementations. 

  • Pilot low-risk applications with a narrow focus. Bain found that the systems already seeing the most success with generative AI are testing solutions in low-risk use cases where they already have the right data and can create tight guardrails (chatbot support, scheduling, rev cycle).
  • Decide to acquire, partner, or build. Bain recommends that CEOs think about different use cases based on availability of third-party tech and importance of the initiative.
  • Funnel experience into bigger initiatives. As generative AI starts to mature, organizations that gain experience and strategy alignment today will be best positioned for the more transformative use cases once they become clear.
  • Generative AI isn’t a strategy unto itself. Bain found that the trait separating top CEOs is their discipline, ensuring that every generative AI initiative reinforces their overarching goals as opposed to implementing shiny bells and whistles.

The Takeaway

It’s easy to get caught up in the generative AI hype cycle, so it was refreshing to see Bain recommend the one-foot-in-front-of-the-other approach to new implementations. Nearly every hospital boardroom is debating a massive list of potential AI investments, and although the home run use cases will be here soon, the consensus strategy for getting on base seems to be making low-risk plays with an immediate impact.

Social Needs Impact on Diabetes Management

New research published in JAMA Network Open found that health-related social needs (HRSNs) have a major impact on both quality and utilization outcomes for people with type 2 diabetes.

Using self-reported data from a national sample of 21,528 Medicare Advantage beneficiaries with T2D, researchers found that the majority (56.9%) reported at least one HRSN, and that each one significantly affected outcomes.

Here’s a look at the odds ratio impact of HRSNs on diabetes medication adherence (proportion of days covered over 80%), statin adherence (PDC over 80%), and having controlled HbA1c. Not too surprising to see that financial strain had the largest negative impact on HbA1c control.

  • Food insecurity – Diabetes (0.93), Statin (1.02), HbA1c (1.02)
  • Financial strain – Diabetes (0.91), Statin (0.91), HbA1c (0.83)
  • Loneliness – Diabetes (0.85), Statin (0.79), HbA1c (0.96)
  • Unreliable transport – Diabetes (0.80), Statin (0.80), HbA1c (0.94)
  • Housing insecurity – Diabetes (0.78), Statin (0.96), HbA1c (0.92)

Each of the five HRSNs also influenced hospital utilization, and it was interesting that food insecurity was identified as the factor with the largest impact on acute care usage. Here are the changes in utilization per 1,000 MA enrollees for avoidable hospitalizations, ED visits, inpatient encounters, and 30-day readmissions.

  • Food insecurity – Hospitalization (17.1), ED Visit (84.6), IE (30.4), Readmission (8.2)
  • Financial strain – Hospitalization (4.6), ED Visit (40), IE (6.8), Readmission (2.3)
  • Loneliness – Hospitalization (3.9), ED Visit (173), IE (-6.3), Readmission (-4.5)
  • Unreliable transport – Hospitalization (13.5), ED Visit (244.6), IE (41.8), Readmission (1)
  • Housing insecurity – Hospitalization (6.3), ED Visit (55.4), IE (16.1), Readmission (10.2)

The Takeaway

Type 2 diabetes affects more than a quarter of people above age 65 while costing the US health system over $200B each year, and this study underscores the significant role that HRSNs play in managing the disease. Much of the existing work around HRSNs relies on area-level social needs measures because patient-level data is hard to come by, but these findings suggest that collecting patient data is worth the effort to move the needle in diabetes care.

Elevance: Hospital Acquisitions Harming Patients

Elevance just published a great report leveraging data from its affiliated health plans to color in the picture that’s been loosely outlined by a few other studies: patients face higher prices and lower care quality after independent hospitals are acquired by health systems.

It’s no secret why a growing number of independent hospitals are getting scooped up each year. Elevance found that operating expenses fell by an average of 6% after an acquisition, about 60% of which can be attributed to personnel reductions.

  • The share of U.S. hospital beds that belong to health systems spiked from 58% in 2000 to 81% in 2020, and a quarter of markets no longer have any independent hospitals.
  • Hospitals inked 20 M&A moves in Q2 alone, opting for consolidation in order to secure additional resources and negotiate more favorable contracts with payors.

That isn’t exactly great news for patients. Independent hospital acquisitions resulted in 5% higher costs for patients with commercial health coverage, and increases ranged from 5% to 8% across top diagnostic categories by volume (Ex. digestive, respiratory, and circulatory). 

  • Elevance also noted that its members receiving cardiac care saw readmissions increase over 10%, and that acquired hospitals with greater staff reductions unsurprisingly experienced a greater increase. Readmissions for Medicare patients with acute non-deferrable conditions saw a more conservative increase of 2-3%.
  • The numbers were a little more vague surrounding access to care, although the study “observed the closure of maternity wards, which were concentrated in rural hospitals.”

What’s the solution? In Elevance’s view, regulators should seek assurances that patients won’t face higher costs following an acquisition, especially considering the efficiency gains for the health system. Regulators might also consider implementing quality standards during the approval process to ensure that readmissions and access aren’t harmed as a result.

The Takeaway

Elevance might have its own reasons for wanting to keep costs down at health systems, but it’s also putting out some credible evidence that suggests hospital acquisitions aren’t doing patients any favors. That said, there are plenty of very real pressures driving hospitals toward consolidation, and reports like this are important for helping policymakers chart the best path forward.

TytoCare Lands $49M to Expand to Chronic Care

TytoCare is $49M closer to making virtual primary care a reality after landing a Series D extension to help expand its portfolio of remote diagnostic solutions.

One of telehealth’s biggest hurdles has been the difficulty of conducting remote physical exams, which is exactly what TytoCare’s Home Smart Clinic sets out to address.

The Home Smart Clinic is a modular handheld device with different attachments that allow patients to conduct their own ear, throat, heart, and lung screenings.

  • These exams can either be guided by a live video chat with a physician, or performed asynchronously with the results transmitted to the care team.
  • That’s also backed by Tyto Insights smart diagnosis support, as well as the Tyto Engagement Labs suite of user-engagement and tracking services.

CEO Dedi Gilad told STAT that the funding increased TytoCare’s valuation and provided enough runway to break even over the next few years as the company sets its sights on an eventual public offering.

The round will also accelerate TytoCare’s expansion into chronic conditions that require more management than the occasional virtual visit, such as asthma and COPD.

  • TytoCare recently received FDA Clearance for its first longitudinal care module for Wheeze Detection, which analyzes sounds recorded by the stethoscope attachment for signs of respiratory issues.
  • It’s also worth mentioning that TytoCare is taking full advantage of its massive remote exam data set to train the AI models that serve as the backbone of its diagnostic support, and the Wheeze Detection module was apparently trained on the largest lung sound database of its kind.

The Takeaway

We’ve covered plenty of studies highlighting telehealth’s limitations when it comes to accurate remote diagnosis, and TytoCare is leading the charge to make virtual care viable for more conditions. The Home Smart Clinic gives TytoCare a key advantage over competitors that rely solely on video to try to replicate the experience of a doctor’s visit at home, and the modular design is a solid foundation for bolting on new functionality down the road.

Amazon Clinic Expands to All 50 States

The same eCommerce giant that brought us one-click checkout is well on its way to bringing us one-click healthcare, with Amazon Clinic now available in all 50 states.

Amazon’s blog post sticks to the company’s roots by positioning Amazon Clinic as a “virtual health care marketplace,” allowing patients to compare treatment options for 30+ common conditions like pink eye or allergies.

The clinicians delivering the actual care appear to be from four partner networks: Curai, Hello Alpha, SteadyMD, and Wheel.

  • Users can see the cost of each provider, as well as the average wait time, although notably absent is any sort of care quality metric for the desired condition.
  • They can then select either an asynchronous chat or a live video visit delivered directly through Amazon.com / the Amazon app, and medications can be conveniently fulfilled by Amazon Pharmacy. Sounds great on paper.

It’s easy to picture this playing out the same way that Amazon’s eCommerce marketplace unfolded, with telehealth costs kicking off a race to the bottom that’s great for consumers and less great for margins. 

  • Amazon Clinic’s provider partners just got a massive boost to visibility (and probably volume), and we could see more traditionally B2B telehealth vendors enrolling to get the same perks.
  • Amazon also gains a treasure trove of user data, a new gateway to Amazon Pharmacy (One Medical referrals could easily be on the way), and it doesn’t seem far-fetched to think the Amazon Basics playbook of copying/acquiring outperformers is on the roadmap.

The Takeaway

Convenience is king with all consumers, and Amazon is hard at work blurring the line between patient and consumer. This probably wasn’t news that Ro or Hims loved to see, given that they offer overlapping services without the benefit of two billion website visitors every month. Case in point, Amazon.com publicized the Clinic expansion with a homepage banner reading “healthcare for those ‘can’t wait’ days,” possibly the single most valuable ad slot for a D2C telehealth launch of all time.

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