CrossTx, a leading cloud-based health-and-human-services-provider network platform, facilitates specialized referral management, patient orchestration, closed-loop-care coordination, and Chronic Care Management for Medicare reimbursement. With an emphasis in enabling and empowering rural digital health networks, this includes palliative care in these underserved areas. From state health and human services departments to academic medical centers, from rural hospital networks to private sector care providers, digital health will sweep through palliative healthcare in a big way. CrossTx provides a brief survey of this trend, introduces some examples, and shares some of the technology solutions involved in this important transition that will impact all of us at some point.

Palliative Care Under appreciated?

With growing numbers of individuals headed toward the end of life, they and their loved ones are due the most compassionate, humanistic, and comfortable way to live out their lives we can collectively provide. Now that an integrated, digital health-driven care-management system can oversee these patients “24×7” in the comfort of their home, we have powerful new ways to drive improvements to patient experience while lowering the total cost of what can be a very expensive phase of one’s life. While hospice and the concept of palliative care become of paramount importance in family discussions and among caregivers, few really know the distinctions between the two. Although hospice and palliative care are similar, they differ in material ways. While 90 percent of hospice is reimbursable by Medicare—of course patients must meet the Medicare eligibility requirements—palliative care has a differing set of requirements. One of the most rapidly growing fields of healthcare in America over the last decade, clinical trials prove that these services can lead to increases in patient and provider satisfaction, superior symptom control, greater deference to patient and family about the process of death, and importantly, fewer disruptive, painful, and costly hospital visits during the end of life. The result: less anxiety, less pain and depression, lower caregiver stress, and cost savings.

Digital Health Out Front

Are palliative care requirements the same as hospice? While the latter conjures up compassionate comfort care (as opposed to curative care) for folks facing a terminal illness with a six-months-or-less prognosis, palliative care represents compassionate comfort care at all stages of curative treatment. The world of digital health increasingly merges these functions, partly by bridging the gap between providers and the home or clinic. Due to the way this care evolved, the resultant care-management ecosystem for a given patient can be siloed, fragmented, and even haphazard in some economically challenged rural communities, leading to delays and formidable challenges hindering the patient and family from accessing seamless, instantaneous, or near-instantaneous-based care. The results are the loss of human life, with premature, painful death as a real outcome for many. Digital health, combining remote patient monitoring and telehealth with health network and care coordination technologies, provides a compelling, seamless platform synthesizing what are often siloed service providers, and fragmented care management activities into a more uniform, orchestrated experience for patients and their loved ones.   We follow with some recent examples of the digital health movement in palliative care.

Colorado TRU Community Care

TRU Community Care was launched back in 1976 in Boulder, Colorado at Boulder Hospice, and it now serves several counties offering both hospice and palliative care services. Recently the group embraced a telehealth and remote patient monitoring platform called Vivify Health to offer monitoring and virtual care platforms supporting on-demand services for the individuals served. In a recent press release the Colorado-licensed, Medicare and Medicaid-certified non-profit healthcare organization which offers a continuum of care for individuals living with advanced illness, agreed to adopt this particular vendor’s telehealth and remote patient monitoring services as foundational technology for the new TRU Telecare program.

According to Michael McHale, president and CEO of TRU Community Care, “Our mission is to affirm life at every step of patients’ and their families’ journey through illness and loss.” McHale continued that, “That mission can be difficult to accomplish when care is provided in the home setting, and we want to be available in real-time 24/7. We wanted to create an ability to monitor vital data and our patients on a daily basis, visualize their disease progression without having to dispatch personnel to their homes each time, and communicate visually as well as verbally on-demand.” Apparently, according to this particular group Vivify Pathways offered a compelling approach based on their public feedback.

Activities in the Rural South

According to a recent article in mHealthcare Intelligence by Eric Wicklund, the University of Alabama at Birmingham (UAB) recently started collaborating with a couple of Alabama-based community hospitals to develop a virtual-care platform targeting African American patients. Started back in 2018, the academic medical center acknowledged in a press release that about 60 million rural Americans lack access to palliative care. In an unfortunate observation, even when these mission-critical services are available in rural areas, UAB found that African Americans lack the same quality end-of-life care that Whites receive, based on ongoing research demonstrating the social determinants of health.

Ronit Elk, PhD, co-principal investigator and associate director of the Southeast Institute for Innovation in Palliative and Supportive Care at UAB, shared that unfortunately, “By living in a rural area, people with serious illness have a very high risk of not getting the right care.” Highlighting some of the challenges, “There are long distances to treatment centers, not enough health care professionals, and of those who are health care providers, there are very few with palliative care clinical experience,” in the rural areas at least in the South.

So many states are embracing telehealth, remote patient monitoring and care coordination, and Chronic Care Management tools, integrated and bundled to extend palliative care programs throughout rural regions. Another example is the Medical University of South Carolina  which has embarked on a three-year initiative to investigate the feasibility of a statewide, telehealth -driven palliative care platform. Backed by a $1.3 million grant from the Duke Endowment, the program starts with a Charleston-based hospital investigating the feasibility of a connected care platform for those patients with serious to terminal illness.

NYC’s Mount Sinai Expands Urban-Based Palliative Care Service

From rural areas to the most densely populated ones, in the US digital palliative care becomes ever more central in discussions. Recently, Joyce Famakinwa writing for Home Health Care News shared that the preeminent Mount Sinai Health System was “doubling down” with its Contessa alliance in a bid to expand community-based palliative care service. The eight-hospital campus including the Icahn School of Medicine at Mount Sinai partnered up with Contessa, based in Tennessee, to augment and improve how these major urban hospitals provide hospital-level care directly in the home. This via its Home Recovery Care Model, reports Ms. Famakinwa. Now called, “Palliative Care at Home” the evolving service offers integrated care for a range of patients from those with complex chronic conditions to end-stage diseases of various kinds. Niyum Gandhi,  executive vice president and CFO of Mount Sinai, notes, “For the estimated 2 million Americans living with serious illness, many of whom are confined to the home by their physical limitations, the final frontier of care is in the community.” In addition to its Contessa deal, Mount Sinai also recently partnered with Current Health, a remote patient monitoring platform in Boston to provide real time at-home cancer care.

Need for Digital Hospice Services Rises

According to Home Health Care approximately two-thirds of palliative programs  in the US offer in-home palliative care. Typically, hospices and hospitals oversee these programs, and with advancing remote patient monitoring, smart phone and devices technology, telehealth and bundled network management, referral management as well as reimbursable Chronic Care Management; a wave of palliative digital health adoption will follow as a confluence of market drivers and federal incentives converge.

With most patients (and their families) wishing to remain at home the trend at home-care, fueled by reimbursement, will only intensify. The overall hospice market in America is large, headed to about $30 billion or more and growing at 9% CAGR according to some analyst accounts. With the US population of elderly (65+) growing markedly from 52 million in 2018 to an estimated 95 million by 2060, growing prevalence of cancer, dementia, cardiovascular, and respiratory disease will only contribute to these growing palliative care needs. Also, a major factor is Medicare reimbursement for home care, with payments amounts from both Medicare and Medicaid on the rise.

Breaking Down Telehealth, Remote Patient Monitoring & the Network Platform

Telehealth was a growing market in healthcare even before COVID-19 ,but since the onset of the pandemic it has become the status quo in healthcare. With COVID-19, a mad rush ensued to enable telehealth across all 50 states. Literally hundreds of telehealth technologies and specialized solutions compete in what most definitely will lead to a sizable, and in some cases painful consolidation.

While an essential tool, telehealth isn’t sufficient by itself for seamless end-of-life digital palliative care. And it requires Remote Patient Monitoring (RPM), essentially hardware and software providers offering advanced devices at the point of care with real time cloud-based data to drive care coordination activities. This market has become ever more specialized and nuanced as a diverse array of vendors lead to myriad RPM technology architectures and solution types.

Generally the following elements identified in Wikipedia are involved, including: 1) Sensors on a device enabled by wireless communications to measure physiological parameters; 2) Sensors connected to a central database via Wi-Fi or cellular communication protocols based on manufacturer specification; 3) Local data storage at patients’ sites which interfaces between sensor and other centralized data repository and/or health systems; 4) A centralized repository to store and manage the data originating from the sensors, local data storage, diagnostic applications, and other healthcare systems; and lastly, 5) Diagnostic application software that supports the development of treatment recommendations and intervention alerts based on the actual analyses of data collected.

While considerable limitations to RPM exist, this market is growing at a double-digit rate. Market size varies from several hundred million to $1.6 billion in revenues by 2026. Vendors in this space are numerous, from the previously mentioned Vivify and ConnectAmerica  to TeleRey, Healee, NexHealth,  and Luma Health and many more.

The Health Network—Key Prerequisite for the Digital Palliative-Care Platform

While telehealth and RPM are in fact key drivers powering the digital palliative care movement, a mission-critical technology contributor must be present for a truly end-to-end, seamless digital experience. While the market now combines telehealth and RPM for various nascent palliative care solutions mentioned, the introduction of a health network—based platform completes the digital, end-to-end solution.

Why is this the case? Because the delivery of health and related human services necessitates a ready and able network of providers aligned, incentivized, and committed to the individual patient’s experience in the palliative environment. Seamlessly connected to both the network of providers and the specific palliative care RPM and associated telehealth solutions, these networks merge and synthesize practices and data, to represent true seamless digital palliative health.

Such a technology adds not only the ability to rapidly configure various specialist and care provider palliative networks—all dedicated to the individual patient at home—but also to properly manage closed-loop care coordination, referral management, and Medicare reimbursable Chronic Care Management.

The combined technology suite generates real time health data, or what’s known as “patient-generated health data” (PGHD) that is connected to and accessible with the entire care network, not just some of the providers. There is no need for phone calls anymore, as those connected to the palliative network receive real time notifications, alerts, and messaging. Put another way, the PGHD generated by patients and/or family members and care providers, when combined with a tailored, purpose-designed provider network, then care coordination and CCM form a true digital palliative care platform. Whole patient records are now managed across the spectrum of providers on behalf of the palliative care patient.

Digital Rush for Government Reimbursement & Better Patient Experience

Now that the US Centers for Medicare and Medicaid Services (CMS) established remote care as a separate billable service, inclusive of three codes affiliated with Chronic Care Remote Physiologic Monitoring (CCRPM)—i.e., Remote Patient Monitoring (RPM), a vendor rush is one to offer this revenue-generating service to organizations offering end-of-life services. Providers can have a “win-win,” boosting reimbursable revenues while improving patient care and outcomes and also achieving other key performance indicators associated with patient engagement and satisfaction.

Now, CCRPM can increase per-patient per-month revenue up to $144 and for those providers add a CCM up to $186 per month. Remote patient monitoring and telehealth vendors now piece different products together in a quest for a bundled, seamless, end-to-end solutions, to not only capitalize on revenue opportunity made possible by the federal government but most importantly, to provide patients facing end of life and their families a more compelling, human and dignified integrated service.

With most physicians and medical professionals are at or near capacity—worsened by the COVID-19 pandemic, integrated digital-of-life care will become more of a norm than an exception moving forward. The CrossTx platform ensures that these digital health solutions come loaded with robust, extensible provider network management, closed loop referral management, and in-depth partnership with HealthtechS3, the rural market’s leading Chronic Care Management consulting specialist for Medicare reimbursement.

With the recently developed “digital heath” API, CrossTx turns any remote patient monitoring and telehealth platform into a comprehensive, robust care coordination platform, purpose-designed for capturing the necessary data for CCRPM and RPM to ensure CCM reimbursement. All while bringing an entire network of appropriate care providers to the end-of-life patient on demand.

Daniel O’Connor, Chief Business Officer
CrossTx. Inc.