Rae Woods (00:11):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods, you can call me Rae. Let's start today's episode out with a little bit of trivia. When do you think that the first recorded use of remote patient monitoring took place? Maybe you're thinking about your Oura Ring or your at-home pulse oximeter that you bought during COVID, but in reality, RPM has been around a lot longer than most of you may think. NASA actually first used hospital-based telemedicine in the late 1950s. So if RPM isn't exactly new, why is it so important today? Well, first of all, technology has come a very long way since 1959, and just because RPM has become more common, it doesn't mean it's used effectively. And that is a very real problem, because when remote patient monitoring is done right, it doesn't just save dollars, it saves lives. That's why in today's episode, I've invited Advisory Board's RPM expert, Lauren Woodrow to talk about why it is imperative that healthcare leaders get RPM right. Hey, Lauren, welcome to Radio Advisory.

Lauren Woodrow (01:22):
Thank you. Happy to be here.

Rae Woods (01:25):
Should I be calling this RPM or remote patient monitoring? What are our listeners going to know on the other end of their headphones?

Lauren Woodrow (01:34):
I think if we say we're going to prefer to remote patient monitoring as RPM for the remainder of the podcast, I think it saves our mouths a lot of syllables.

Rae Woods (01:43):
Yes, I'm a little bit worried that I haven't quite done my warmup exercises enough to say remote patient monitoring 65 times in the next 25 minutes. And I do know from our conversations on RPM that this is not a new concept, but it does feel, at least to me, like it's getting a lot more attention as a growing industry in healthcare, there are more use cases, there are more opportunities across businesses and services. My question for you, Lauren, is what makes this moment that we're in right now so different in RPM's actually surprisingly long history?

Lauren Woodrow (02:19):
Yeah, I think that there's a couple factors. We have an aging population, people are more used to using technology at home. I think RPM is really taking off in this post-COVID era because of people's familiarity with telehealth. We also have a lot more RPM vendors in the marketplace. The worldwide RPM market is estimated to hit 1.7 billion in 2027.

Rae Woods (02:45):
1.7 billion, that seems like a big number.

Lauren Woodrow (02:52):
Yes, it seems like a very big number, and it's actually estimated that almost a quarter of the US population will be using RPM in some form by next year, 2025.

Rae Woods (02:59):
Is that the biggest motivating factor for healthcare leaders, is it the interest coming from consumers themselves, the pandemic effect, being more comfortable with technology, or are there other reasons that are motivating healthcare leaders to invest in RPM?

Lauren Woodrow (03:13):
I would say that the patient piece is a big part of it, but I also think the physician-retention lever is also a major part. Physicians are seeing RPM vendors at these big conferences, they see a shiny new toy and they want to use it. And so they approach the boards or whoever's in charge and ask for this RPM technology. And a lot of organizations are funding it to keep their physicians happy.

Rae Woods (03:38):
Keeping them happy because it's a new technology that's frankly targeted directly at how to make their lives better, how to make patient outcomes better. I do see at probably these same conferences, a lot of vendors promoting remote patient monitoring.

Lauren Woodrow (03:54):
And I'm sure those vendors are telling everyone, "RPM can help with capacity constraints, especially with your physical footprint. It can alleviate financial constraints, and it can reduce costs associated with hospitalizations, can help the complexity of care." It seems like a silver bullet for RPM.

Rae Woods (04:11):
It does sound like a silver bullet, but that can't be true, this sounds too good to be true. I have to believe that what is possible with RPM, what we're seeing in all that marketing, is probably different from what you as a researcher are actually seeing on the ground, is remote patient monitoring actually making a meaningful difference in all of those different business opportunities you mentioned?

Lauren Woodrow (04:34):
Yes and no. I think the answer is a little complex, and it depends which organization you're looking at and how they've decided to deploy RPM. I think at some organizations, yes, they're absolutely seeing success, but others, I think have been caught in pilot purgatory and haven't been able to make progress on RPM.

Rae Woods (04:55):
Why are things so variable, what are the big headwinds facing RPM?

Lauren Woodrow (04:59):
Yeah, RPM adoption is pricey. We've heard from some organizations that RPM requires more resources and effort to implement than other digital health technologies, like I mentioned before, get stuck in pilot purgatory or pilot hell, depending on how bad your pilot situation is.

Rae Woods (05:15):
Pilot purgatory is a pretty bold statement, but I think it accurately reflects how some folks may feel here.

Lauren Woodrow (05:21):
Yes. And then the third, which I think is really contributing to that pilot purgatory, is a lot of the RPM programs' pilots are physician-led, and coming from the bottom up rather than a top-down strategic approach.

Rae Woods (05:36):
So it sounds like the challenges are really structural. It's not enough to say, "I have a problem, and I found the right vendor, the right technology, the right tool, the right partner." It really comes down to how you then operationalize and implement remote patient monitoring. So I want to dig in here for a minute, because this actually feels like something that healthcare leaders can address right now. There are other questions that rely on a third party or another stakeholder, but this is one that our listeners actually have control over. So what makes remote patient monitoring operations tricky, and what do we want to make sure our listeners do differently?

Lauren Woodrow (06:13):
I think the biggest thing is fragmentation. RPM programs are happening all over an organization, and so they're using different technologies, they have different leadership, they're addressing different problems. And so the platforms are not talking to each other, the people aren't talking to each other. So it all becomes very fragmented.

Rae Woods (06:33):
And that comes back to the very use case that you described, right?

Lauren Woodrow (06:35):
Mm-hmm.

Rae Woods (06:37):
An individual physician, maybe a practice, maybe a service line finds out about a technology, a vendor, they want to implement it, maybe they implement it as a pilot or not, but it just stays in that one location or with that small group of physicians or in one service line. And as you said, then becomes pilot purgatory, doesn't actually scale any further.

Lauren Woodrow (06:56):
Mm-hmm. So what I would tell organizations to do is to start with their governance structure. I think that the combination of clinical leadership and digital health is really important to make sure that your RPM ambition is successful, because you're able to understand the actual full needs of your RPM program, you understand what the clinical needs are, you understand what the technology and integration challenges are, and you're really able to set your program up for success if you really understand what you're actually trying to solve for.

Rae Woods (07:32):
So what I'm hearing you say is that the operations here really, really matter, and they matter over a pretty significant period of time, otherwise these pilots start and they just fizzle out. And I'll admit, we've been talking about RPM in the abstract. I think that we need to zoom in a little bit deeper and talk in more specific terms about how healthcare leaders actually use RPM in their practices and what it does for their patients and for their business. And to do that, I actually think we need to focus on a service line. So I actually want to bring in one of advisory board's experts on cardiovascular services, Kristin Strubel. Kristin, welcome to Radio Advisory.

Kristin Strubel (08:17):
Hello, hello. Excited to be here.

Rae Woods (08:20):
So to get you up to speed quickly, Kristin, we've been talking at a high level about remote patient monitoring. We've been talking about their growth, their purpose at a high level in healthcare business, but I know you have spent a ton of time talking with CV leaders who are using RPM. What makes cardiovascular such a good candidate, such a good service line for remote patient monitoring?

Kristin Strubel (08:42):
Yeah, I mean, right now about 57% of clinicians have adopted RPM and home-based cardiac rehab within the last two years. So cardiac rehab makes a really good candidate for it because they are monitoring those patient outcomes and trying to tackle those capacity problems, because demand for cardiovascular services is not slowing down anytime soon. So trying to keep those patients out of the hospital and monitoring them from their home also makes the patient happy, but improves those capacity constraints that are felt across the service line.

Rae Woods (09:18):
So it sounds like in CV, there are three parts to the business goal here. The first one is better outcomes in cardiac care. The second is better patient satisfaction, because they can be monitored in their home. And the third is it opens up capacity for physicians and the rest of the care team.

Kristin Strubel (09:35):
Correct? Yeah, I would agree with that.

Rae Woods (09:37):
Lauren told me that remote patient monitoring is really difficult in the implementation phase. And I imagine in cardiovascular, even though you've got this trifecta of the business case, that they still struggle with implementing RPM at scale. So what are you hearing from CV leaders, what are they doing that other service-line leaders should learn from?

Kristin Strubel (10:00):
So I feel like this is three-part, and there's three elements there to focus on, one of them being aligning strategic goals. So that could include solving capacity problems, perhaps it's reducing those unnecessary follow-up appointments, which also helps with that capacity, improving outcomes and adherence, especially ensuring that patients adhere to things like cardiac rehab, which have been known to improve those outcomes. So I feel like that is element number one.

Rae Woods (10:26):
Wait, wait, hold on, I want to stop you here, Kristin, because I'm a little bit surprised to hear you say that strategy, strategic goals is the first element to focus on, because I was expecting this conversation to really, really focus on operations. Lauren, are you hearing the same kind of sentiment when we look outside of cardiovascular when it comes to RPM?

Lauren Woodrow (10:47):
Yes, I absolutely agree with Kristin, that's exactly what we want leaders to take away, you need to tie RPM to some sort of strategic goal. Too often we're seeing leaders skip that step and jump straight to operating an RPM program without the groundwork to figure out what they're actually solving for.

Rae Woods (11:04):
And then you're definitely going to be stuck in pilot purgatory.

Lauren Woodrow (11:07):
Exactly.

Rae Woods (11:09):
Okay. So we need to make sure that at the strategic level we're making the right decisions and then finding the right technology. Is that where you're going to take me next?

Kristin Strubel (11:19):
Yeah. So element number two would be finding that right vendor partner, and that includes interoperability. So how does the RPM technology interact with current infrastructure, and making sure that there's a user-centered design, so that helps eliminate error. And then number three is meeting the population where they're at. I think there's this big misconception that older people are a little apprehensive to technology. They are interacting with the RPM interface, and they're interested in their data, they want to see that data. So how are health systems providing that data so that their patients can interact with it?

Rae Woods (11:55):
So don't discount patients, but make sure that you're starting with a clear goal in mind, and then finding the right partner to actually help you make progress on that goal.

(13:05):
So we've mentioned a couple of times that in order for remote patient monitoring to be successful, you have to have both things working for you. You have to have the right targeted strategy, the right problem that you're going to solve, and you have to have the right implementation. From your research in this space, is anyone actually doing this well, or are we still just seeing so much experimentation and so many pilots?

Kristin Strubel (13:31):
Yeah, let me start off by saying I think that CV is prime for RPM because we have an aging population, so we have older and sicker patients, and these patients have a lot of comorbidities, there's lots of things to monitor, heart rate, blood pressure, EKGs. So I feel like CV is prime in that sense. And there is actually one clinic out in Arizona that is doing this very well, and it's helping to reduce readmission rates so much so by 50%, which is crazy.

Rae Woods (14:02):
They're reducing readmissions by 50% by doing what, just by doing this monitoring and knowing exactly when to intervene on exactly which patients?

Kristin Strubel (14:13):
Yes. So they were using a certain suite of remote patient care software that was able to reduce 30-day readmission rate for patients, and it was compared against a patient pool that was not using the remote patient monitoring.

Rae Woods (14:27):
Just doing normal follow-ups, maybe making a phone call if they're not feeling well, showing up for their follow-up appointments, things like that?

Kristin Strubel (14:35):
Yes, and it all goes back to improving outcomes. So you want to reduce readmission. That frees up capacity, that gives doctors and physicians the ability to focus on those more complex patients. And then it also saved the clinic as much as $15,000 per patient as well, which is the epitome of doing it correctly, because you're saving the patient money, but also improving outcomes and helping patients.

Lauren Woodrow (15:00):
And I've seen that it's more than dollars. Baptist in Kentucky has continuous monitoring for heart failure patients. The national data reports that the 90-day survival rate is 18%. With Baptist's RPM program, they're able to see a 94% chance of 90-day survival for their heart failure patients.

Rae Woods (15:22):
Wow, that's huge. And so again, I come back to the trifecta of the business case here, and I want to be clear, you do need to focus on having the right business problem that you're frankly using any technology, any vendor, any partner for, but with remote patient monitoring, at least in cardiovascular, it seems like it really lines up that you're doing the right thing for actual patient lives, outcomes, survival, while also freeing up physician and care-team time, and hopefully also saving the organization some money. My question is, let's take Baptist for example, that example that you just gave Lauren, what was the difference in what they did, how were they able to get to those amazing results?

Lauren Woodrow (16:03):
Yeah, so Baptist, I think is a great example. They have the governance structure in place that combines digital health with clinical leadership. They knew exactly what problem they want to solve. They know that heart failure incidence in Kentucky in general is very high, so they knew they had the population.

Rae Woods (16:21):
Both of which are strategic points by the way. Governance structure might not sound like an integral part of strategy, but you want to know how I know that you've actually decided to make a difference on your strategy? It's where you are putting the leaders in your organizational structure. And if you're putting tech leaders at the hip with other executives in your governance structure, it's because you actually see value in how these technologies are going to solve the business problem or the community problem that you want to solve, which in this case was heart failure.

Lauren Woodrow (16:48):
Mm-hmm. Yep. And then I want to push back on something you've said a little bit earlier about RPM freeing up clinician time. That's not necessarily the case. Baptist found that it was additive, but they were able to use their entire care team and have case managers and nurses work at top of license and do everything within their scope of practice before elevating a patient to a physician, either to change the care plan, or intervene if the patient needed an intervention, but they were using the entire care team.

Rae Woods (17:21):
Wait, I think this is such an important point, Lauren, I'm so glad you brought this up. So in Kristin's example from earlier, it actually freed up actual physician time, medical-doctor time, but in your example, it didn't do that, but you're telling me that was actually okay because it meant that physicians were spending more of their time with the most complex patients, and the rest of the care team ended up needing to pick up the slack and make sure that they were working at top of license.

Lauren Woodrow (17:48):
Exactly.

Rae Woods (17:49):
So I think you're still telling me the care team was happy at the end of the day.

Lauren Woodrow (17:53):
Yes, the care team was happy at the end of the day, and I think the care team felt responsible, and that they were impacting the patient's life, and they could connect with the RPM technology in a way that was meaningful to their work.

Rae Woods (18:06):
One thing that I'm hearing loud and clear in this conversation is that rooting your decision in a business need is so important. The other thing that I've heard both of you repeat is that you need the right partner, the right vendor. Why is that so important as we try to push RPM from a couple of pilots to something that is truly scaled?

Lauren Woodrow (18:29):
Yeah, the vendor piece is huge. Not only are they providing the platform that your patients will be using, that your staff will be using, there are also so many RPM vendors out there that it can be hard to choose who exactly works best for your program. We've heard from leaders that one of the things they considered when choosing a vendor was, "Is this a startup that's going to shut down in the next couple of years?" You can't run a long-term RPM program and expect to make it out of pilot purgatory if the organization and the vendor that you're choosing is shutting down in the next couple of years. Internal readiness on the part of the vendor is just as important as your own health system organization readiness.

Rae Woods (19:16):
I'll admit, I don't often leave podcast episodes excited, hopeful, but I'm excited about what remote patient monitoring can do, particularly for CV, but I have to believe there's a lot of potential across the health system. So where should our listeners look next, what other service lines should be really earnestly thinking about RPM?

Lauren Woodrow (19:38):
Yeah, the other service lines that we are seeing a lot of movement in RPM are in other chronic care conditions. We're seeing it in oncology, we're seeing RPM for hypertension, COPD, and even emerging some in maternal health and some in behavioral health as well.

Rae Woods (19:57):
I want to end this episode with some action steps for our listeners, but I have to imagine that our listeners are probably in very different points when it comes to their own knowledge of remote patient monitoring, certainly the implementation of RPM. So Lauren and Kristin, with that in mind, I'd love for you to give me some takeaways for listeners that are in different stages of experimentation, maybe some that are a little bit further along and some that are at the beginning stages.

Kristin Strubel (20:25):
I think in terms of CV, it's all surrounding goals. So what goal are you trying to solve with remote patient monitoring? Are you trying to improve outcomes? Are you trying to address capacity constraints? Are you trying to address the workforce shortage? Is it all of them simultaneously and they're all piggybacking off each other? So I think attaching the RPM technology to a goal and a challenge that you want to solve.

Rae Woods (20:52):
If that's the starting point, Lauren, what do you want to tell folks that are maybe a little bit further along?

Lauren Woodrow (20:58):
Yeah, my advice, actually, I'm going to harken back to something that Kristin mentioned earlier in this conversation around meeting patients where they are. A big part of RPM success is focusing on the patient, watching your communication with the patient, who is actually talking to the patient? We have one example from another service line where surgery schedulers, were talking to patients about RPM, and that really reduced patients' trust and confidence in the technology, and so engagement rates were really low. So it's really important that the right person is talking to the patient, and that you have the right materials and conversation starters to have so that patients don't feel like you're trying to sell them something. They have to really understand that RPM will improve their level of care rather than just another add-on that they're paying for.

Rae Woods (21:55):
Well, Lauren, Kristin, thank you for coming on Radio Advisory.

Lauren Woodrow (21:59):
Thanks, Rae.

Kristin Strubel (22:00):
Thank you.

Rae Woods (22:06):
This is a rare case, I want you to take an idea and run with it. There's a lot of clear evidence that certain service lines, certain practices can benefit a ton from remote patient monitoring, but that only works if you're starting with the right strategic decision, the right business problem to solve. And it will only go past the pilot phase if you're thinking about the right operations. And remember, as always, we're here to help.

(22:56):
If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson, with technical support provided by Dan Tyag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins.