Business Solutions

A Measured Approach

Leveraging patient data could unlock new referrals, revenue and business models for HME providers.

• By David Kopf
• Aug 01, 2015

It is undeniable: U.S. healthcare is fixing a nationwide focus on outcomes-oriented patient outcomes. Case in point: Medicare’s increasing emphasis on Accountable care organizations (ACOs), which are groups of healthcare providers that provide end-to-end healthcare solutions that focus on optimizing patient outcomes for the lowest price.

While ACOs don’t necessarily have much to do with the HME industry at the moment, they indicate where healthcare is going: If Medicare continues to set the pace for the rest of healthcare, it is likely that health professionals across the patient care spectrum will look for partners who can help them ensure the best outcomes for the best price. Insurance companies will move to match Medicare’s approach, and referral partners will follow (if they aren’t already doing so with Medicare).

This focus on demonstrating outcomes provides HME businesses with a key opportunity: if they can create services that help better manage the care patients receive, then they will position themselves as a key player in the healthcare process.

And how do they accomplish this? By managing and monitoring patients, and that practice generates a considerable amount of patient data that HME providers can then use to help referral partners generate improved incomes.

We’ve already witnessed this in the sleep corner of the HME market for several years now. Using a variety of communications methods and remote monitoring innovations, those providers serve as information conduits to the physicians and other sleep professionals involved in patients’ care.

What if providers could expand this and apply it to other patient segments, such as respiratory? This could well be where the market is headed.

Square One: The Sleep Market

Let’s begin by looking at the where patient data is being leveraged the most: The sleep arena has given us a good starting point for understanding how patient data is being used to great benefit.

“Patient data is so important in sleep therapy,” says Rob Levings, vice president of Healthcare Informatics, for sleep therapy equipment company ResMed. “For patients with obstructive sleep apnea (OSA), monitoring and treatment compliance is key. Measuring adherence is relatively straightforward and the treatment devices themselves (e.g. CPAP) serve as a monitoring platform. Many modern devices feature wireless communications out of the box to enable data-on-demand. This is not the case for many chronic conditions that can be much more difficult to measure and track.”

More than that, reimbursement is often tied to outcomes efficacy, Levings adds, which compounds the need for monitoring.

“Compliance mandates for reimbursement have also driven the need for patient monitoring,” he explains. “This has created a clear economic rationale and is a key driver in the need for patient data.”

“Compliance and efficacy data has become an integral component of successfully managing patients to become adherent on CPAP therapy,” adds Matt Hitchings, product manager for sleep therapy equipment maker Fisher and Paykel Healthcare. “It allows providers to know which patients are tracking okay and require less attention, so that staff can spend their limited time on the patients who require extra coaching to address their issues and help them achieve compliance.”

And data allows that coaching to get incredibly personalized, according to Mark D’Angelo, Sleep Business Leader for sleep and respiratory equipment company Philips.

“Connected health technology affords HMEs and RTs new ways to encourage patients to take a more active role in their care, which in turn could lead to more efficient new patient setup and fewer follow up needs from patients who may have initial questions about their therapy,” he says. “Virtual coaches that are accessible via desktop and mobile devices provide patients with basic information about their disorder, tips on mask fit and cleaning, and insight into their apnea hypopnea index (AHI). RTs have more educational tools to offer patients, which provide guidance on how to use products.”

The Value of Patient Data

And from its starting point in the sleep market, the value of collecting and using patient data is spreading. The worth of patient data in the current DME/HME market is becoming a hot commodity.

“Patient data is becoming more and more valuable in the homecare industry,” says Kimberly Commito, director of product management for the Home care solutions division of healthcare software company Mediware. “From assessing a patient’s responsiveness to a particular therapy, services or even device to defining new fee schedules for proper payment for services, therapies and devices that are effective.”

And that is a key point: a patient’s therapeutic data is not isolated. Providers can relate it to a variety of data points within their business.

“Software applications gather financial, clinical and demographic data that can useful to providers in assessing whether they should continue to provide a specific type of service, to payors that can address whether they are paying competitively for a specific type of service, therapy or even piece of equipment,” Commito explains. “Even manufacturers are asking for patient data in ensuring that they are developing cost effective solutions for different disease states and patient needs in general.”

Moreover, patient data can help drive efficient deployment of resources, Philips’ D’Angelo points out.

“Risk-scoring algorithms enable HMEs to identify potential, noncompliant patients for interventional management, and then direct RTs and patient support staff to focus on the patients that need the most assistance,” he explains. “This reduces high-touch follow up with those who have adjusted well to therapy, and ensures RTs are focusing on the patients struggling with compliance. A recent retrospective review of Philips Respironics EncoreAnywhere data showed that such insight has the potential to help HME providers reduce follow up by an average of 60 percent, thus ensuring that the patients who need follow up visits to be compliant get the time and attention they need to be successful with their OSA therapy.”

And let’s not forget that can directly drive revenue. A good example of this is how sleep providers are using patient data to ensure their re-supply efforts are not only ensuring patients have optimal equipment, but are optimizing revenues at the same time.

“In addition, patient data can enable sleep providers to automate the outreach and resupply process, from tracking patients who may be eligible for new supplies to helping patients order supplies via phone, text, or email,” D’Angelo says. “An automated resupply program creates more efficient operations and encourages adherence to therapy for patients. For RTs, an effective resupply program enables them to devote their time to activities that help to increase compliance, such as in-person check-ins, instead of dedicating their time to securing equipment for patients.”

Data as a Differentiator

When providers act as data go-betweens for patients and physicians, they find themselves in the proverbial sweet spot. Now, their ability to provide fast, detailed and accurate patient data to their referral partners establishes them as key player in an outcomes-oriented care continuum.

And that expertise providers can offer can help solve new problems. Fisher and Paykel’s Hitchings cites the effect home sleep testing has had on sleep care as a good example of how providers can use patient data to help referral partners and their patients. There can actually be less patient education occurring in the HST model, where patients who are very likely to be suffering from OSA are quickly given a HST and then put on PAP therapy right away. The response is almost too quick.

“The small number medical professionals the patient comes in contact with in the journey to get their PAP device has resulted in a void in the education of the patient,” he explains. “The traditional pathway of a sleep study patient meant many touch points along the way where patient education and support occurred. … It is clear to see today that in the payer sensitive markets, the process has almost been streamlined to a fault.

“The reduced number steps in the HST pathway compared to the traditional sleep study pathway have removed touch points where a patient gained education, assurance and support along their journey,” he continues, “which may have provided the best chance of successful adherence to therapy”

But when sleep therapy equipment providers indicate that they understand this dearth of up-front education and clear data, and can fill that hole by sharing insights based on solid data, their partners will greatly appreciate that clarity.

“The opportunity to PAP providers is to show their referral sources that they understand this growing void and are addressing it, which in turn improves patient outcomes,” he explains.

Nuanced Marketing Messages

Of course, the key is to let referral sources and other key care partners know that the provider can deliver the data that will improved outcomes, and that means marketing.

“At the heart of telemedicine and the capturing of patient data is the desire to create a care plan that enables the best possible outcome for the healthcare consumer,” D’Angelo says. “Providers can market themselves to referral partners as able players in this new environment by building an entire patient care program and implementing the collection and use of patient data as part of this program. They can then position themselves in a way that helps the referring physicians become more efficient with patient care and assure the physician is getting all of the clinical data they need. Patient data can also help the HME show how their patient outcomes potentially compare to other HMEs in the area.”

However, if providers aim to differentiate their businesses through patient data, they must tread carefully when it comes to marketing messaging. Obviously, providers should never release patient names, or other personally identifiable information to the public.

“Providers should educate themselves on HIPAA laws and limitations as to how much of the data they can share, or how that data should be handled once outside the application, which should have security associated with the access to that patient sensitive information,” Commito offers.

Once a provider has a solid understanding of privacy and other regulatory requirements when it comes to marketing, they are some varied approaches in how they should let their numbers do the talking.

“When it comes to using patient data for marketing purposes, there are typically two schools of thought,” Commito says. “One is to identify patient demographics and clinical information that could lend to outreach on other products you might provide to market to them directly. By looking at patient profiles, you might be able to establish additional services they might require for example.

“Additionally, looking at patient information from a trending perspective could be useful in marketing specific services and products a provider offers,” she adds. “Using statistics to indicate the number of patients cared for within a specific disease state or using a specific product, for example, can show a providers expertise in that area of patient service.”

And that reputation for expertise will grow as a provider continues to leverage patient data.

This article originally appeared in the August 2015 issue of HME Business.