Why Ochsner & Humana struck an RPM partnership for chronic care

April 03, 2024 - Remote patient monitoring (RPM) tools and services have proven remarkably effective at improving chronic disease management. However, access to RPM programs can be challenging, particularly for underserved populations. One strategy to break down barriers to RPM access for chronic care is collaboration between healthcare providers and payers.

A recent example of such a partnership is between Humana Healthy Horizons, Humana’s Medicaid plan for Louisiana, and Ochsner Digital Medicine, part of New Orleans-based Ochsner Health. In February, the organizations announced a partnership to extend access to Ochsner’s RPM programs targeting type 2 diabetes and hypertension for Medicaid beneficiaries across the state.

Six in 10 Americans have at least one chronic disease, according to the Centers for Disease Control and Prevention (CDC). Diabetes and hypertension are among the most prevalent chronic diseases in America, with diabetes affecting 38.4 million and hypertension affecting 119.9 million people across the country.

RPM-based programs have been shown to improve outcomes in these areas. RPM enables providers to collect patient data remotely and adjust treatment plans in real time rather than wait for an in-person clinic visit. Thus, healthcare provider organizations are increasingly turning to RPM to improve outcomes for populations with chronic conditions.

A survey of 141 healthcare executives conducted in May 2023 revealed that healthcare organizations primarily deploy RPM programs for patients with hypertension (26 percent), diabetes (25 percent), and heart conditions (20 percent).

Through the new partnership, Humana Healthy Horizons aims to bring the benefits of RPM-based care to its Medicaid members with type 2 diabetes and hypertension. However, the organizations must address various hurdles in deploying the program among high-risk populations.

A LOOK INTO THE RPM PROGRAMS

Ochsner began its remote care programs for chronic conditions nearly ten years ago. What started as an internal quality improvement program became an external program almost by accident.

“It was originally an internal quality initiative that worked so well that it kind of broke the fourth wall,” said Dan Shields, CEO of Ochsner Digital Medicine, in an interview with mHealthIntelligence. “And we started saying, okay, there are employers that are interested in it. There are other carriers that are interested. And we started selling it probably about four years ago or so to employers and to carriers around the same time.”

Ochsner Digital Medicine operates the type 2 diabetes and hypertension programs, which integrate digital devices, personalized care plans, and lifestyle support to enhance chronic care outcomes. Patients in the programs receive wireless blood pressure cuffs or glucometers to track health metrics. This data is automatically sent to the patient’s care team via a smartphone application. If their readings are not within the normal range, patients receive guidance from their care teams. They can also use the app to connect with health coaches who help them make lifestyle changes.

“In traditional primary care, you don't have a ton of time with your patient, and you're also asked to be a mile wide and like an inch deep,” Shields said. “You deal with what that patient is coming in with... And then while you have them also start talking about their diet, their exercise, are you eating too much salt? Oh, and by the way, have you been taking your medications? Have you been checking your blood pressure at home? It's a very inefficient way to manage these conditions.”

Even when chronic condition patients are engaged in their care and visit the clinic regularly, those visits happen every six months or so.

“You're getting a snapshot in time in a six-month period, another snapshot in a six-month period,” Shields said. “And you can ask your patient, ‘Hey, have you been checking your blood pressure?’ And they'll all go, ‘Yes.’ It's kind of like flossing at the dentist. They're saying yes, but they're not really doing it.”

Employing RPM tools in chronic disease management allows clinical care teams to collect real-time data and make treatment plan adjustments, reducing the risk of unplanned emergency department (ED) visits or use of other services, Shields added.

Ochsner Digital Medicine released promising results of its hypertension and type 2 diabetes remote care programs in 2022.

Since the pilot of these programs launched in 2020, about 50 percent of all out-of-control hypertension patients reached a control level at the 90-day mark. Further, 59 percent of patients with poorly controlled diabetes reached control levels. Both results exceeded the clinical standards of usual care.

“We've been able to show exceedingly high levels of control, which should check the box in and of itself,” said Shields. “But we've even had it studied beyond that and said, ‘Okay, are we seeing less utilization?’ Yes, we are. And where we've been able to access data, especially on some of the earliest patients, we've shown those patients ultimately in those shared savings models are less expensive.”

ADDRESSING PROGRAM DEPLOYMENT CHALLENGES

As the remote care programs were made available to employers and health plans, the health system launched a pilot to assess whether the program could work for Medicaid populations, Shields noted. The state has a large number of Medicaid beneficiaries, totaling 1.57 million as of December 2023. Ochsner’s Medicaid pilot enrolled more than 7,000 patients between 2019 and 2023. The health system then took these results to Medicaid plans in the state. 

“Humana was one of the first ones that said, ‘This is great,’” Shields said. “So now they've contracted with us directly to start enrolling more of their patients into it because they've seen the value in this underserved community, their patients, and obviously as a carrier have a vested interest in keeping these people healthier as well.”

Humana Healthy Horizons began enrolling Medicaid patients in the remote care programs in mid-January.

Shelly Gupta, MD, chief medical officer of Humana Healthy Horizons – Louisiana, explained that the organization identifies eligible members with hypertension, type 2 diabetes, or both and sends a list of patients to Ochsner.

“Once they enroll, [Ochsner lets us] know which of our members have accepted, and then we essentially get data and co-manage with Ochsner,” Gupta said.

Medicaid beneficiaries face several social determinants of health (SDOH) challenges, including low-income/income instability, food insecurity, and housing instability. As Ochsner and Humana enroll Medicaid patients in the remote care programs, they are navigating these challenges to ensure patients can reap the benefits of digitally enabled care.

A critical consideration of program deployment was ensuring the needed technology was accessible to the program participants. One way the organizations addressed this was by only enrolling patients with a smartphone.

They also ensured that data collection from the RPM devices was manageable.  

“The idea being keeping that data packet very small,” Shields said. “So, when someone submits a blood pressure or a glucose reading, it's essentially the same as a text message when it goes through that app. When you're dealing with a Medicaid plan where they might be using a Medicaid phone, and its limited data plan and limited time, we were kind of cognizant of that.”

Additionally, the organizations are focusing on raising awareness of the programs and the benefits of RPM. According to Gupta, making sure that members understand the programs, how to use the devices, and how to engage with the app is vital.

Humana has monthly meetings with program participants and bolsters patient education through its care management program.

“I think a lot of it's just education outreach to members and then having frequent touch points where we're sharing data and making sure that we get the members what they need,” Gupta said.

SHORT-AND LONG-TERM GOALS

Humana Healthy Horizons and Ochsner Digital Medicine believe the program will move the needle on chronic care access and outcomes.

“When you look at any patient population, the idea is to identify a problem or a need and then really give wraparound services to the best of our ability to make sure that they're getting not only care for that disease but care for other aspects of their life, whether it be coaching, medication management, identification of other social determinants of health,” Gupta said.

This type of wraparound care is expected to enhance patient experience, he added.

Not only does the partnership aim to improve patient experience, Gupta explained that the partnership also aims to boost overall engagement in care. For example, the organization will examine whether engaging members in managing their chronic disease can boost patient visits to their PCP. This is critical as the remote care programs are not intended to replace PCPs but to complement PCP visits and address issues between visits.  

“It all boils out to more data, more touch points, more engagement to where we can identify what needs they have and prevent them from going the hospital unnecessarily,” Gupta said.

Expanding access is another important goal of the partnership. According to Shields, the fact that patients can participate in the remote care programs from their homes without having to travel to the clinic is a significant benefit.

Further, the frequent collection of data points enables clinicians to provide better care while alleviating traditional care challenges.

“There's a study that came out last year — long story short, for the average primary care provider to give excellent care to an average patient panel, it would take about 27 and a half hours,” Shields said. “So, it is a time and data issue. Digitizing this takes the burden off of primary care.”

With data from Humana, the organizations will also be able to determine whether the program impacts healthcare utilization. They plan to examine whether patients in the program use other services less, making their care less expensive. Additionally, they will explore the clinical and cost data by race and ethnicity.

Ochsner Digital Medicine is actively seeking additional RPM partnerships with other managed care organizations in Louisiana and neighboring states.

“And working with a partner like Humana is obviously a great feather in our cap to say if they believe in it — and Humana is known to be pretty discerning — so, if they see value in it, others will as well,” Shields said.

Patients appear enthusiastic about remote care programs, adding another advantage that Ochsner can extoll. Shields noted that the program achieved high net promoter scores, which are measures used to assess member or patient satisfaction.

“The Medicaid population really, really liked this program,” he said. “It was actually one of our biggest [talking points] when talking to the Humana’s of the world about the value of this program. Not only does it drive really good outcomes, not only is it kind of easy to use, but look at this number over here. They like it. You know what I mean? It's a population that's traditionally really hard to engage [that] really likes this service.”