PharmaVOICE Blog Post

Better understanding where and how we live will vastly improve remote patient monitoring approaches

Posted By: Dan Limbach
June 20, 2018

by Carlos Rodarte, Founder & Managing Director, Volar Health, LLC

This is part two of a three-part series that discusses how enhanced access to in-depth health data is impacting our understanding of personhood, the environment around us, and the pharma model.

Our Environment, Decoded

Depending on who you are speaking with, the word “environment” may be viewed from different lenses – some may see this as the naturalist, as the physical environment/exposome, as a built environment, or even the context of our everyday lives that include social and behavioral determinants of health. Let’s also not forget the tech-focused person that will view the environment through the lens of the connected world of Internet-of-Things devices.

Such perspectives will influence the way we find solutions to patient’s needs. For example, when we think about improving patient outcomes, our minds tend to naturally focus on treatments which have been prescribed, clinically-focused outcomes, drug adherence rates, and a host of other medical factors. This is both expected and part of the problem. In reality, where we live – and how we live – will often play a more influential role on our health than we typically ascribe to it. This notion is by no means new – it forms the foundational pillar to many disciplines including sociology, public health, and urban studies, to name a few.

Innovation in healthcare and pharma should not begin with a technology in mind but rather with a specific question and a particular mindset.

“How might we begin to understand, address, and modify the various environmental factors, broadly defined, that influence health and disease in order to improve the wellbeing of individuals?”

A relatively recent report titled Zip Codes Alone Don’t Deliver, which was further highlighted in a Health Populi blog, discusses the role that socio-behavioral determinants of health (SBDoH) play across populations. This is a step up from purely acknowledging “social” determinants of health, but this still does not emphasize critical physical/built environmental components.

Responsive Living & Next-Generation Measurement

In Part I of this series, we discussed a new notion of personhood based having a more comprehensive view of a person’s behavior. Devices that are worn on our bodies or that we carry around with us emit lots of information that is indicative of our health status. While social and behavioral factors certainly modulate health and disease, so does the amount of light we are exposed to, the air we breathe, or the temperature we experience, to name a few (see below).

[Source: Volar Health, LLC]

Altering the weather patterns and ambient conditions of our cities to generally improve health is a huge and separate type of effort; our homes, on the other hand, are much more under our control.

According to some estimates, we spend upwards of 90% of our time indoors and researchers are taking note of how building health is intimately linked to human health. Simultaneously, large tech companies like Apple are fully diving into the smart home movement with the goal of improving comfort, convenience, and livability.

Let’s take a closer look at the Apple Home Ecosystem.

[Source: https://www.apple.com/ios/home/]

On first blush, the Apple Home ecosystem aims to make individuals more comfortable and relaxed, while also providing “peace of mind” with security features. The intent is not to explicitly impact health, though parts of the ecosystem clearly hit on social, behavioral, and physical factors that do impact health and disease. The home environment is on the front lines of health and disease management.

Where Does Remote Patient Monitoring (RPM) Fit In?

Health systems and payors have been implementing remote monitoring programs for many years. The inpatient setting is costly and the promise of RPM approaches are attractive. They enable patients to stay in their homes and maintain their social ties, while being monitored with clinical-grade technology as needed. In addition, providers can now be reimbursed for providing such services in certain cases.

This latter part is a game changer because it means that RPM solutions can now expand beyond serving solely high-risk patients who have high-cost care. While there are examples or RPM solutions being implemented for management of a wide gamut of diseases, it also has  the ability to address our aging population and enhance aging-in-place.

While stakeholders involved in care delivery shift the care to the outpatient setting and to people’s homes specifically, these same stakeholders are scrutinizing the costs of all the components of a patient’s care, including drug prices.

This is where pharma enters the picture. Remote patient monitoring unites stakeholders around the patient, the home, and forms of real-world evidence.

Pharma is engaged in various initiatives to get a better sense of their treatment’s real-world effectiveness in a greater context that involves RPM, smart homes, and the types of communities that people live in. There are some areas that represent “low-hanging fruit” such as respiratory diseases, allergies, and others where environmental parameters trigger well-defined events.

A clear example is the work of Propeller Health in the respiratory space. They have inked partnerships with leading pharma and more recently they also made available an API called Air to better characterize asthma conditions in various neighborhoods.

The data that emerges from RPM programs represents a rich source of potential evidence on how patients are managing their disease, how their behaviors are changing, and the role of environment. Risk-based contracts or outcomes-based reimbursement models between payors and pharma will undoubtedly need to include novel data sources from Internet-of-Things devices, aspects of the medical home of the future, and other innovative data sources to come. To date it has been challenging to deploy RPM approaches with ease, but this is beginning to change.

For example, Validic has recently launched a lightweight remote patient monitoring solution called Impact. The solution makes it easy for various stakeholders to deploy RPM programs with their own clinical workflows, the devices of their choice, and the ability to capture meaningful contextual data.

The Future

We are early in our understanding of how data streams that emanate from various environments will impact how research is done and care is delivered. What is known, however, is that our sensor-embedded environments will increasingly modulate and guide, not just impact, our behaviors.

While it is probably a stretch at the moment that pharma will prescribe “therapeutic environments” instead of drugs, pharma is taking note of the various aspects of our everyday living that impact disease and outcomes and opportunities it means for “real-world evidence.”

Stay tuned for part three of this series where we will provide some specific recommendations on how pharma and the rest of the health ecosystem may work together.

Carlos Rodarte (@crodarte) is founder and managing director of Volar Health LLC, a digital health strategy consulting practice enabling a range of innovators to better utilize novel data sources to enhance their products and services. Disclosure: Carlos Rodarte is on the editorial board of Digital Biomarkers; Volar Health, LLC has a client relationship with Validic.

About the Blog Poster: Dan Limbach

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