When do medical device companies sound like parents proudly touting how their toddlers eat vegetables? When they can demonstrate that thousands of patients are adhering to a difficult therapy using their technology.
The technology, in this case, is a combination of remote patient monitoring and self-monitoring to make it easier for patients with obstructive sleep apnea to stick with their CPAP (continuous positive airway pressure) therapy. The two companies who are at the forefront of this effort are ResMed and Philips Respironics. Several executives from ResMed presented at the recently concluded annual meeting of the medical device industry, AdvaMed in Minneapolis.
When Investment Rhymes with Canada
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CPAP machines, which use positive air pressure to keep breathing passages open, have been around since the 1980s. The National Institutes of Health estimate that obstructive sleep apnea affects 2% of women and 4% of men in the middle-aged work force in the United States, with higher prevalence rates among the elderly and African Americans. Untreated, it is associated with impaired cognition and mood, high blood pressure and vascular disease, and raises the risk for diabetes and traffic accidents.
So although patients know it’s in their best interest to use the machines, studies have shown that many give up within days or weeks of starting the therapy.
CPAP manufacturers have made the breathing masks less cumbersome and claustrophobic, and the machines less noisy, yet adherence remains abysmal. They and durable medical equipment companies are also under pressure from the Centers for Medicare and Medicaid Services, which in 2013 began requiring a minimum of four hours of CPAP use over 70% of the nights during a consecutive 30-day period within the first 90 days of use.
“That’s a significant challenge,” said Jeremy Malecha, vice president of healthcare informatics at San Diego-based ResMed, one of the two top companies competing in this sphere. “We started to see a pretty big appetite for using wireless monitoring.”
Sleep apnea is also very costly for employers and health systems. Billions of dollars could be saved if more people were diagnosed, treated and adhered to their therapy programs, according to Jane Sarasohn-Kahn, a health economist and advisor at THINK-Health, a Philadelphia-area strategic health consultancy.
“It’s really important in this particular diagnosis that you have very positive consumer experience and feedback,” Sarasohn-Kahn said.
Resmed and its chief competitor, Philips Respironics, based in Murrysville, Pennsylvania, have been pulling out all the technological stops lately to improve the consumer experience and adherence. Each produced a study within months of one another, showing how their remote patient monitoring technology, paired with apps and phone calls, helped patients stick with the program.
Philips Respironics, a division of Royal Philips, debuted its Patient Adherence Management Service (PAMS) in June. PAMS uses software and predictive modeling for workflow and communications with homecare providers; the company’s PAP devices, connected via cellphone or Wi-Fi; a patient engagement app, and live coaching.
In a company study (link or press release) , Philips analyzed data from 4,383 new CPAP patients who used PAMS and a control group of 54,455 new patients not using PAMS but who were registered with the company’s database. The analysis showed that 79.5% of the PAMS participants reached the Medicare definition of CPAP adherence within 90 days, compared with 63% in the control group. The PAMS patients attained nearly 66% and 75% CMS compliance adherence rates at 30 days and 60 days respectively, compared with 50% and 59% of patients in the control group.
ResMed had a prospective, randomized, controlled trial done at the Kaiser Permanente Fontana Sleep Center in Fontana, California and to evaluate the impact of a pair of telehealth programs on adherence to CPAP therapy: a web-based educational program, and automated follow-up through ResMed’s U-Sleep patient engagement platform, which provided individualized feedback via text, email and/or phone.
Of 1,455 randomized patients, 556 were prescribed ResMed CPAP machines with built-in cellular communications, 164 received telehealth education, 125 received telehealth CPAP monitoring through U-Sleep, 138 had a combination of telehealth education and CPAP monitoring, and 129 were placed into the usual care arm.
The study found automated coaching through U-Sleep significantly improved 3-month CPAP use (a 21 percent relative increase) without additional provider intervention. Web-based education on its own did not cause a statistically significant impact on 3-month CPAP usage, although it did improve attendance to initial clinic evaluations.
Just this week, ResMed released the results of an observational study of more than 128,000 CPAP patients whose devices allow for their therapy to be remotely monitored by their clinician or by the patients themselves via ResMed’s cognitive behavior–based patient engagement app. More than 87 percent were compliant on therapy when using both self- and- clinician monitoring, compared to 70 percent compliance for those monitored remotely alone.
Philips, a much larger and more diversified company, is assembling a platform-style digital health business, including respiratory health and cardiac imaging. ResMed commercialized the first CPAP therapy 27 years ago and has since built a connected care platform for diagnosing, treating and monitoring the disease. CEO Michael Farrell has been in the position since 2013 and is the son of the founder Peter Farrell, now the company’s executive chairman.
Both companies’ attempts at raising adherence will benefit patients as well, according to Sarasohn-Kahn.
“We need to have these kinds of programs that engage people in their own care and yes, absolutely, it’s digital plus analog,” she said. “The human element having that call center, that nurse or other practitioner at the end…. You bond with the program more that way and over time you actually might not call as much.”
Photo: viridian1, Getty Images
