Improving Respiratory Care with Remote Patient Monitoring (RPM)

300 million people suffer from chronic asthma and COPD globally. This number is expected to be 400 million by 2025.

While many respiratory medications have proven to be clinically effective and capable of managing these diseases, real-world results are less than optimal, with 50% of adult asthma patients uncontrolled.

Connected devices paired with remote patient monitoring tools to track, engage, and connect are disrupting respiratory care to increase medication utilization, reduce costs, and save lives. In this webinar,  guest presenter, Dr. Melissa Manice of Cohero Health, joins Matt Weisensee, VP of Healthcare Sales at CRF Health, to discuss the current state of respiratory care and the future of connected health through remote patient monitoring. 



Thank you for joining today’s webinar. Today’s webinar is Improving Respiratory Care With Remote Patient Monitoring.

We’re really excited today to have two presenters on the call. The first presenter is Matt Weisensee. Matt is the VP of Health Care Sales at CRF Health, responsible for the continued development and growth of the global organization, including all top line sales and revenue objectives. Prior to going to CRF Health, Matt held senior leadership positions within the security, consulting, biotech, and investigative industries. And there’s a couple of business names you may recognize that are on the screen. So we’re welcoming Matt today.

Joining Matt is Melissa Manice. We’re really excited to have Melissa on the call today, coming to us from Cohero Health. And she’s today’s special guest speaker. Dr. Manice has a PhD in Clinical and Health Research from Mount Sinai, specializing in pulmonary medicine and biostatistics. She grew Cohero Health out of her career in academic clinical medicine, and she has a Master’s in Public Health and has years of clinical research and managerial [audio break 01:08] Melissa was also named a Top 40 Healthcare Transformer in 2014 and among the PharmaVOICE 100. So we’re really excited to welcome both of our speakers today.

And with that we’ll get to the agenda. So today’s webinar agenda is to understand the current respiratory health landscape. Then we’ll learn about the challenges of managing respiratory health. And then we’ll discover how remote patient monitoring supports better respiratory care. And finally we’ll wrap up with some recommendations for getting started.

So with that I’d like to pass the presentation over to you, Matt, to get started on the current respiratory health care landscape.


Well thank you, Jackie. And thank you everyone for joining us this morning, and around the world. I am really excited and honoured to be co-presenting with Melissa Manice. She is a thought leader, visionary, and an innovator in the field of respiratory care. So thank you for joining us today.

Let’s get started and talk about the current landscape of respiratory care. Now, first of all let’s define it for some of the people that might not be fully aware. It’s a sudden condition in which breathing is difficult and the oxygen levels in the blood promptly drop lower than normal. There’s many different types of respiratory disease, and most of them you are aware of—asthma, cystic fibrosis, acute and chronic sinusitis, as well as sleep apnea, emphysema, even respiratory infections. But most prevalently, the biggest cost factor to healthcare today is COPD, chronic obstructive pulmonary disease. And we’re going to go into some of the remedies, the ways to measure and manage these conditions.

So let’s talk about the numbers. It’s a huge epidemic. And I don’t know if you’re all aware, that it’s expected to become the leading cause of death worldwide by 2030. That’s very alarming news. So what can we do about it? Well 400 million patients worldwide today have chronic respiratory disease. That’s an enormous percentage of the global population. And out of that, 300 million patients worldwide suffer from asthma and COPD alone, a huge portion of it. So in the US, how much does it cost? Direct spend on asthma and COPD is $80 billion a year. Two-thirds of asthma costs are due to poor control of the disease, a monumental amount. And as a result, $40 billion of revenue to pharma is lost annually due to poor patient medication adherence. They’re not taking their meds, they’re not improving their health, and they’re not changing their behaviour. Half of all direct asthma medical costs are avoidable. And that’s the good news, this is the opportunity. It’s directly attributed to the non-adherence of controller medications.

So with that, I want to introduce Melissa Manice. She’s going to talk about the challenges. Thank you for joining us.



Thank you so much Matt for having me. And thank you all for attending.

So if we dive right into three of the most critical hurdles in management of respiratory disease, at the very top poor compliance to daily controller medications. We know that 80% or greater daily compliance is what it perceived to be therapeutically optimal to achieve outcomes and drive down avoidable cost. And currently we know that medication compliance is hovering around 35-40%. Combined with that is really on the patient’s side but also on the care provider’s side, is insufficient data to support clinical decision making. So if we look at compliance data as well as connecting that to how a patient is responding to therapy by lung function, both of those metrics—and we’ll dive a little deeper into this—are currently self reported at the point of care. So we’ll talk about what we’re doing to automate that and digitize that care delivery experience.

And so when we look at a lack of product innovation, this comes down to the drug delivery system itself, and a lack of innovation around those respiratory drug delivery systems, but also the types of biometric data that are required for a clinician and a care team to respond proactively, to drive down those avoidable acute events. And so we’ll talk about what we are doing at CRF Health and Cohero Health to really optimize this.

So going a bit deeper into compliance and the challenges around it, again going into 80% or great compliance being therapeutically optimal, oftentimes patients end up relying upon their rescue medication, which can lead to broncho-dilator resistance and so forth. So if we can drive and sustain behaviour change around their daily therapies, this has been shown extensively in the literature to drive better outcomes and drive down these high avoidable costs in the form of emergency room visits and in-patient stays.

So then if we look at the data to support treatment decisions, if we look at refractive asthma for example, we’re really at the point of care as a clinician trying to triangulate whether a patient is taking their therapy correctly, but then also connect that to how they’re responding to their medication. So these two critical components again in connecting proper techniques but also proper daily compliance, and then connecting that to the pharmacoefficacy, so whether the patient is responding to that particular therapy. And so currently, a lot of this is really quite subjective, so relying on patient self reports, but also quite manual in nature, outdated technologies that are not digitized and integrated into the clinical workflow.


So we’ll just give the current landscape in standard of care. So we look at—at left—their daily medication, rescue medication being that Ventolyn inhaler—top right. What we’ve found in several of our programs on the Cohero Health side, is that oftentimes in terms of basic patient education, patients don’t understand the difference between these two medications and can switch them. So we’ve done quite a lot to educate the patient in our application and on the physical form factor as well. And then going into their action plan, so it’s mandated that a patient should be given an asthma action plan and use this longitudinally. And we know that this is incredibly cumbersome, often very poorly adopted because it’s cumbersome and manual in nature. And there is a lot that we can do to make this incredibly automated and integrated for the patient and the provider that cares for them.


So shifting back over, Matt’s going to give a great overview to remote patient monitoring and how it fits within the telehealth ecosystem.



Great, thanks a lot, Melissa. That was very informative.


We’re going to go into the basics of remote patient monitoring. First we’re going to define it. So what is remote monitoring? It’s a part of telehealth. And telehealth is in many modalities. It could be video teleconferencing or virtual visits. It could be a store-and-forward method to transmit images, radiology, etc. from one place to another. And it also is a form of mobile health. Many of the consumer apps you see today, devices like Fitbits and garments, are all part of an overall mobile health environment. The ecosystem and the most prevalent portion of telehealth is remote monitoring, because it is in a nutshell the collection, transmission, analysis of biometric data from one location to another. And the data is used to support decisions and drive clinical outcomes. So as the Center for Clinical Health Policy defines it, use of technologies to collect medical and other forms of health data on individuals in one location and electronically transmit that information securely to healthcare providers in a different location for assessment and recommendation. In reality it’s a tool in order to create more access to care, to have real-time data to drive clinical outcomes.

There are many applications for remote monitoring. Of course the most prevalent is the treatment and management of chronic care, including pulmonary patients—COPD, asthma—as we mentioned and outlined in this presentation. In addition to that, of course for congestive heart failure, diabetics, as well as for post-traumatic events, monitoring cardiac events for diagnosis of disease and managing basic wellness and health programs. There’s also a very good application for reducing readmissions into the hospital. There’s a huge application today for behavioural health. And I’m going to go into a couple of the real detailed portions of the solution now.

How does it work? Well, biometric sensors, either wired, wireless, connected through Bluetooth, GSM, Wifi, or even wired, connect to the cloud. This health cloud then shares data using APIs back into EMRs and different types of laboratories, health apps, hospital systems, revenue cycle management programs. It then synchronizes back to a patient portal. It could be in the form of a patient, caregiver, family member, an analyst, or a physician, who can visualize this data and then make those decisions accordingly. This data then—and this is a glimpse of the future of this application—can be shared with predictive modelling databases, used for artificial intelligence, machine learning. It can also be shared with social media sites to help change behaviour, which improves adherence, and then can also synch back into the cloud with practice data, outcomes data, genomics data, insurance claims data, and of course continuously being fed by real-time patient data. And we call this solution CareMax at CRF Health.

So with that, I want to talk about supporting better respiratory care, and I want to turn it over to Melissa. 


All right thanks again, Matt. So Matt obviously went into how the CRF Health ecosystem is really serving to optimize remote patient monitoring and overall clinical care. And so I’ll go into some of the front-end devices that we’re utilizing, and that Cohero Health has built to really provide incredibly robust input into that ecosystem.

So if we look at respiratory care then versus now, we know that metered dose inhalers have not really evolved in form or function since their early days. Additionally, devices like peak flow meters and handheld spirometers have also really seen a lack of innovation. And so what we have really done at Cohero Health is spend a lot of time really trying to understand patient behaviour, being incredibly iterative in product development, both on the application side as well as on the device side.


And so I’ll start by going into how we’re transforming care through our universal inhaler sensors. So these track patient adherence by understanding time and date stamps around dosage, doses taken, but really driving behaviour change by reminding the patient, tracking them, engaging them when they have missed a dose and so forth, so allowing that application to educate and drive and also sustain behaviour change. And we’ll see some of our results data on that front.

But then connecting patient utilization of therapy to lung function, lung function being an incredible indicator of whether a therapy is working and whether a patient is at risk. It’s really why the action plan is grounded in this red-yellow-green zone around peak flow. Well we know that peak flow is a good indicator, but FEV1 and FVC being the types of metrics that are really used for diagnosis, and that are also used at the point of care to really try and connect the dots on whether a patient is at risk, and how they are doing across the life span. And so the two devices that Cohero Health has built on the spirometry side, one that you see at left is a clinical grade mobile spirometer and the use case here is at the point of care. So in a telemedicine use case that can be used in a telemedicine program. School-based health centers, for example, and other point-of-care use cases and then connecting that pulmonary function data back to a specialist or a care team, and so really allowing for incredible visibility and optimized efficiency in care delivery and providing robust specialty care in a remote fashion, and that provides the full set pulmonary function parameters, so it is clinical grade and is not just peak flow FEV1 and FVC.

On the other hand—at right—this is a wireless handheld spirometer that is primarily used in the home. Both of these devices are FDA cleared, and this captures eight of the core pulmonary function metrics, so it’s not just peak flow but allows for tracking of FEV1/FVC, for example, and also peak flow. And both of these are integrated into the BreatheSmart application that Cohero has built.

And then really, when we think about real-time access to this data, it’s not just that engaging and educational patient-facing application, but how do we connect this clinically actual data in real time to care teams and other stakeholders. And so what we are proud of with our partnership with CRF Health is the ability to allow for population health management and integration into the CRF Health ecosystem. And the use case there is not just for clinical care, but also empowering incredibly rigorous clinical trials and clinical programs. And so we really feel that the key here is to be interoperable in systems like CRF Health, but also connecting that into workflows such as Epic and other EMRs, and so that’s something that we currently offer and really allows for that real-time data to be used in clinical decision making.

And so, when we look at connected devices, what it allows for, it allows really for—we see it and what we’re proud of with the BreatheSmart platform that we’ve built at Cohero— is the ability to track, engage, and connect respiratory patients with their care team. So we’ve got into the ability to track lung function and adherence through our core proprietary devices, but where it becomes incredibly robust in predictive analytics and really responding at an individual patient level, is the ability to overlay other sources of third-party data such as environmental aspects as well as symptoms and trigger tracking. So just at a high level, it’s not just the biometric data but all of these other sources of data that become incredibly predictive on an individual patient level and allow for more robust population health management.


And so when we look at just a very brief snapshot of the evidence base on why remote patient monitoring matters and efficacy, I’ll highlight one of the programs that we’ve done at Mount Sinai in New York City. We’ve deployed in several high-volume pulmonary clinics and what we were doing in a longitudinal fashion but also as a randomized control trial, is trying to understand what percentage uptick in medication compliance we saw, patients coming into the program were around 35-40% compliant, and we were able to sustain them over a one-year term at about 78% adherence and really tried to understand qualitative and quantitative aspects to patient usability and allow that to be utilized to iterate the platform. But then, ultimately, something that really matters is trying to connect that to reduction in emergency department utilization and all of these other critical endpoints. And so what we saw is a significant reduction in those using the Cohero Health platform from patients coming in with a mean of about four ED visits a year. And again we really—this was anyone with a diagnosis, we did not try and prioritize based on disease severity or high ED utilization. We were trying to show that remote patient monitoring tools are just as effective and have high utility in the most at-risk patients as well as those that are perceived to be sort of moderate.

And so in summary I’ll pass it back to Matt in closing, and thank you all again so much for your time and listening.


Great. Thanks a lot, Melissa. And thanks everyone for continuing with this presentation. It’s a real pleasure to be able to look at new innovative approaches to help manage and control these types of chronic illnesses.

In summary today, I want to talk about some of the changes in the industry. As you’re probably aware—you’ve seen it in your own homes—over two billion people today use smartphones. By the year 2020, they expect six billion users with smartphones. In the US alone, we’re approaching 20 million people with a Fitbit. And ten years ago, the cost of a pulse oximeter was over $1000. Now you can get one built onto your Samsung smartphone or included at a few dollars a month in a remote patient monitoring kit. So it’s a real shift in the paradigm in the way that healthcare is delivered, because now with this integrated approach, a patient, a family member, a caregiver, their clinician, a payer, a provider, an employer, health manager can all see the same data in real time and help change behaviour, not only of the individual and how they self manage their care, but the behaviour of the organization and how they treat and care for their patients and populations. So in this new opportunity to improve care with RPM, there’s a dramatic increase in patient compliance and adherence, that’s one of the key things. Reducing acute exacerbations and in patient stays saves patients thousands of dollars in care costs and empowers pulmonary patients and the stakeholders that support them to engage in their care.

And with that, we’re going to talk about recommendations, next steps, and kind of open up the floor and talk about some great success stories. And I want to finish off with just talking about what I recommend.

First of all, especially because a lot of you are without an RPM program today in your organizations, is assessing your current care coordination, telemedicine, and population health strategy. Ask yourself first, do you even have a strategy. And then seek executive sponsorships in your organizations, and align that strategy with the mission of your company. Establish an overall goal. Is it about population health? Is it about reducing readmissions, or optimization of reimbursement plans? With the changes in Medicare and MACRA laws and alternative payment methods, the landscape is changing rapidly, and you have to be aware of those new conditions. So there’s a room in some cases to increase revenue. Sometimes it’s saving time, saving money, improving care, increasing satisfaction, and of course driving more adherence which ultimately ends in positive health outcomes and financial health outcomes for your organization. So engage your patients and providers, create a roadmap, and engage.


Thanks everyone. And Melissa, do you want to talk a little bit about considerations with assessing technology and some of your success stories?


Sure. So at the end of the day when we think about factors to consider when assessing technology partners, we find that often top of mind is a question around cost of how can we fit this into a business model, and we have found that there’s really sort of evolving support for remote patient monitoring both at the system level, so in large health system programs, and through sort of new at-risk providers. But ultimately, one of the biggest questions is, when assessing partners, really looking at both ease of use, usability, but also the evidence base, and so that’s something that we’re quite proud of at Cohero that we’ve really focused on clinical efficacy, and then ultimately seeking partners like CRF Health that allow for very robust implementation but high scalability. And it also means that ultimately if you are a partner that is trying to manage several chronic diseases, care management companies like CRF Health that currently not just work in the respiratory ecosystem but other chronic disease states, really allow for incredible scalability and ultimately interoperability into clinical workloads, it’s something that they are quite well versed in and have incredible traction around.


Great. Thanks a lot Melissa, that was a great summary.


We will move on now to the Q&A. So Matt, I’ll pass it over to you to answer some of these questions that are being filtered in.

[Q&A 27:30]


Great. Thanks a lot Jackie. And thank you everyone for joining us. I have several questions now. First one: How do I get started with remote monitoring of respiratory care? That’s a good question. It’s very simple. I always suggest that you analyze your claims data, you look at your patient population, you stratify the most needy, the highest cost factors. And then you target those. You can first look at the total cost per patient per month and the total healthcare spend per year and then compare that to the intervention of remote monitoring and the cost associated with it. So assessing your current claims data is what I would suggest.

There’s a question on cost here. Melissa, I’d like to let you take that one.


Sure. So we really can work collaboratively with partners around cost. What we can say at a very high level in a non-confidential forum like today is that we traditionally offer it on a per-patient per-month basis. Ultimately, in terms of—this sort of gets back to how you get started and thinking about cost—what we often find with partners is that if we think about a Phase I and then a larger deployment with partners, I think Matt can point to this a bit, but often you’re looking at the 20% of patients that are driving almost 90% of costs. And so partners will again look at the sort of high avoidable attributed costs in that patient population, start there, and then scale accordingly. And so we can say that we have something that has worked for our wide variety of customers that range from pharmacy benefits managers to health systems to ACOs to pharma partners, etc. And for them we traditionally charge on a per-patient per-month basis. I can’t go into specific pricing on today’s call, but happy to have a follow-up conversation around that.


Yes, thank you, Melissa. And anyone who wants follow-up, we’ll also offer a live demo of the platform. So just reach out to us if you are interested in that.


I have a question regarding data security, how do we protect it when we collect and transfer it? Well our platforms are HIPAA compliant, they're based in high-trust web servers. We use a global platform. We encrypt all data, de-identify it and then transfer it across the web and then re-associate it with double authentication password protection. So very secure. In today’s world, I know that’s a very good question.

Another one: How much does it cost to be the provider? We’ll address that individually to you. We have all of your questions, and we’ll send out anything that we can’t answer today on the call and also schedule some one-on-one time with you.

A question for Melissa on Mount Sinai’s study, is that available?


Sure. So in looking at the Mount Sinai cohort we had when we had asthma versus COPD, if that’s the question, we’re actually currently doing several COPD programs and really trying to connect those to clinical endpoints. But that Mount Sinai study was in patients with asthma. So I think Christine Duffy’s question was around publication of that data. Stay tuned there, that’s forthcoming. So we published some early data on those studies and now we’re closing out the final phase of a much larger expanded trial. So stay tuned for that this summer.


Great, thanks. Another question: Is the live demo free? Yes it is, of course. We’re glad to do that for you. It takes about 30 minutes, so just reach out to me if you’d like that.

A question regarding: Other than the ED, have you been able to identify other areas within the health system with preventable asthma utilization? That’s a good one for you, Melissa.


Sure. Yeah, so others within the health system with preventable asthma utilization other than the ED. So in terms of preventable costs related to asthma utilization, traditionally we look at in-patient stays as well as emergency department utilization. So that’s a parameter that’s quite easy to sort of calculate attributed costs for those hospitalizations. One thing that we’re trying to really get at, again, to build the economic model is other areas of care efficiency that have been observed in deployment of the Cohero platform. So one very obvious one that I pointed to is a program for example that we did, a very large program in several sites with the Children’s Health Fund where we deployed in school-based health centers and community clinics. And then that allowed for several thousand patients to be managed by a single specialist. So you know, it’s how do you attribute a dollar value to improved economics to that care delivery model. Hard to do but we’re really trying to look at how remote patient monitoring and telemedicine is really supporting improved care efficiency. So more informed clinical visits, but also the ability to allow for clinic visits to be more sporadic in nature but also to utilize specialists in a better fashion in these kind of resource-poor settings.

And one piece just real quickly that we went into scalability, that I didn’t mention in the webinar and I’d be remiss. If we think about scalability ultimately of these kind of platforms, having a platform like CRF Health that’s very easy to implement and deploy is really important. But the actual physical hardware really needs to also be quite scalable. And so that’s something that Cohero Health has worked really hard at actually—and it’s a key differentiator for us—that our device that we called a HeroTracker is universal fit to every different shape and size and circumference of metered dose inhaler. And so it means that when you're doing a program where patients are on a variety of medications, not having devices that are unique to every form factor is quite critical. So it’s those kinds of elements that allow for us to have an incredibly user-friendly platform but it will allow for our partners to get up and running and also retain patients even though they might switch medications and so forth. So these kinds of attention to detail around usability is really critical, and scalability being something that I would say is a mutual sort of mission statement of Cohero Health and CRF Health.



Okay, well said, Melissa. That’s a great segue to the next question too. What has the patient’s experience been? Well I can answer the first part of that. I can tell you, just from the recent data I read and my own personal experience of deploying these kits for many years worldwide that the patient loves the ability to manage their own care, to have devices in their own home. They can eliminate the long drive time, waiting room visits, the fact that they have privacy in their own home to administer their tests. There’s a lot of advantages to it. But the data that I just read yesterday said that 80% of all patients say they welcome and want remote monitoring. That’s a US poll as of yesterday. And I also read some really great data on Medicare. They're estimating now that 13% of the average population in America attributes to 87% of the cost. So it’s increasing, the problem’s getting worse. So if there’s ever a time to have this type of technology, it is now.

And then we have another question for Melissa: What percentage of the Mount Sinai cohort had asthma versus COPD?


So that one was 100% asthma patients, or patients with an asthma diagnosis. The eligibility criteria was that they had to be on a daily therapy but it was not limited to any particular daily inhaled corticosteroids. So again, we have a universal-fit metered dose inhaler form factor as well as a Diskus, so patients were just moderate to severe with an asthma diagnosis.


Great. There’s a few other questions that we’ll answer individually, but for now I think that’s a great summary and wrap-up. So thank you everyone for joining us.


Great. Thank you so much, Matt and Melissa, I really appreciate you guys answering all those questions. As Matt said, if we did not have time to get to your question today we will we follow up with you separately. So we’ll make sure that all of those questions get sent to the presenters.

I’d like to really thank our guest speaker Melissa, Dr. Manice, for joining us today. Thank you so much for all your insight on the call. And we look forward to seeing you on a future webinar, everyone. So thank you so much for your time today. And we wish everybody the best of luck. And great rest of your day.


Thank you everyone.


Thank you so much, thank you everyone.

[END AT 38:37]

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