Unbelievable Outcomes from Chronic Care

Paul Huffman

Sure, thanks for having me, appreciate it. And I think if there’s any positives during, from COVID right, it’s that healthcare was forced to embrace technology very quickly, both patients and providers. And, and with that, it was Telehealth, it was remote patient monitoring, it was wearables, it was using smartphones and secured messaging. All that had been available, it just wasn’t utilized. So I mean, you, as a Physician, still want that one-on-one patient relationship. Well, that’s not going to go away. 

There might be different modalities to get there, but what we’re really interested in, in my background, which I’ll get into is, is how do we direct that traffic in the background and have a lot of mini to mini ratio connections behind the scenes while you’re still practicing medicine one-on-one and making that meaningful and enhancing your one-on-one relationships with your patients? And so our company was founded actually in 2014 by a cardiologist who at that time was really focused on wearables and integrating devices. And from a fitness aspect, from a holistic kind of input and real measurements from the patient in real time between visits. And then in 2015 CMS, then that’s when those chronic care management codes were released and that’s when the company kind of became a chronic care management company, because they already had the platform. 

But we were always developed to accept vitals. We always thought that that was important for chronic care management in general, even when it wasn’t required. And so for the last three years, we’ve been able to connect the Fitbit to any healthcare device. We connect to Validic, but then these codes came out for general supervision for actual remote patient monitoring in the eyes of CMS, and so that’s where we are today. And our platform can actually accept tasks, except vitals, can spit out care plans based on those tasks, and can handle multiple services for the same patient, but at the same platform and the same integrations. And so in the start of 2020, we did a lot of soul searching and review with a lot of different device companies. And we do have a preferred device and launched that right before COVID. And so not many offices or health systems were ready to launch anything new during COVID. 

We were all just trying to figure it out day to day. But now that that dust is settled, obviously that’s our focus, is how do you scale getting devices inside people’s homes and get them to use them? And that that’s where we are right now is really that scaling, but also now adapting and implementing some machine learning in that and focusing just on patient engagement. If we can get the patient engaged, whether it’s chronic care management, whether it’s remote patient monitoring, then we can now do what I think is where we’re headed in the next five years, is just value-based care. It’s already here, it’s a percentage of how you get paid as a Physician, as a private practice doctor. But it’s not going away and it’s only going to become more and more of a leverage from the payers. But then we’re trying to bring some of that leverage back to the providers with data and having some good outcomes.

Cheng-Huai Ruan, M.D.

So Paul, I mean ever since COVID, I get bombarded with remote patient monitoring companies and programs and demos and all this stuff like that. And there’s a lot out there, right? And we’ve done, I want to say over 30 demos already, just within my practice, of looking for something that’s unique. And we’ve adopted already three different programs before in the past and took them away. So tell me, what should doctors really be looking for when they’re approached with a company that wants to say, “Hey, here’s a remote monitoring. “We integrate all these devices.”. Like what should we be looking for?

Paul Huffman

Yeah, so most companies want to just sell devices and have the Physicians handle the alerts in the service, right? It’s not my problem, Here’s the devices, good luck if they integrate with everything, pass them out to patients. Right? Well, with COVID that became harder, where you were people weren’t coming to the office. So we kind of had a list of, we knew we already had the platform, we have an engagement platform that can integrate with many devices, handle vitals. We’re already integrated with several different DHRs to get results and create claims. All that was already there. Now we just, we didn’t want to be in the device business, so we had to pick a preferred device. 

And so when we went down that list, there’s things that a Physician should look for is a company, is it a remote patient monitoring company? What is their experience? Have they been doing chronic care management? Have they been doing some type of service for the patient? It’s really hard to scale these programs as a Physician, it’s really hard for our hospital systems to scale it. And so our enterprise clients have the same issues that a private practice doctor has, and that’s when you’re dealing with equipment, there’s usually a big upfront investment. We have skin in the game, you know? We are aligned with your efforts to get these codes billable, and that’s how we bill. So no upfront costs, and that’s, I think, pretty big. You’re not buying devices, you’re not doing inventory management, you’re not passing them out, trying to get them back.

Cheng-Huai Ruan, M.D.

We’ve done all of the above before. It’s painful.

Paul Huffman

Yeah, it’s painful. And then the second thing is, just because a patient has a device doesn’t mean that they’re using it. Passing out a device or giving a device or shipping a device is the easy part. Getting them to actually take their vitals on a regular basis is hard. And so we price based on those services, not on devices. We price did we get 16 connective points each month with the patient? Did we successfully set up, connect, and get a vital? Is the patient using it, are they engaged? Are we in reviewing it for 20 minutes? So all of those are a shared responsibility and we’re taking most of that heavy lift to scale it and making sure that it’s turnkey. And that’s the last thing, is we can drop ship to a clinic and have you pass them out and activate them, or we can directly ship it to the patient’s home, or in some markets, some more populated markets, now we are staffing people in those regions to help with setups as well.

Cheng-Huai Ruan, M.D.

Okay, so let’s get into exactly what remote patient monitoring really means to different practice. And I feel like it means different things to different practices. I mean, you’re an Interventional Cardiologist, it means something completely different. To a Primary Care, to Integrative Health Practice, to Endocrinologist, right? And so I think the most important thing, and this is what we get into trouble earlier on, is relaying the value. Like the deliverable, what is the deliverable to the patient? What does the value add to the patient’s side? And a lot of times, you know, people get a little overwhelmed with devices and stuff like that, with monitoring, a little scared about that. So what we had to do was really change our delivery message. So, anybody who does remote patient monitoring, who’s done it before, knows that this is a main pain point for a lot of us who try to take care of our patients. That we want to deliver value to the patients. We want to make sure that they’re okay, but talking about prevention is really hard. But talking about it in a way where it’s relating to their disease is more powerful. So how do you guys kind of relate to the patient a little bit of the value that that really is?

Paul Huffman

Yeah. I mean, there’s scripting, but there’s only so much we can do on the phone, when onboarding a patient, right? So some of the outreach we do, we do a lot of prep work beforehand. Whether that’s marketing materials, whether that’s pamphlets inside the office, whether we also can send out postcards, informational, all co-branded with our partners. And then with that, the messaging, we always like to get a recording from the providers, explaining the program, why it’s important, and that somebody will be calling you to discuss further. And then lastly, it’s really making sure that we have buy-in with either a Physician champion and/or an executive champion. 

So they’re the ones telling the staff this is important, they’re the ones telling the clinical team that this is important. And then the messaging then trickles down. So all that as has developed over time and we’ve refined it. But if we have all those pieces in place, and then we help with the physical outreach, we’re always going to have better success. You know, you’re busy, your staff’s busy. 99 out of 100 offices right now are understaffed. And so let us be an extension of the practice, but also do the heavy lifting and help scale. And that’s the hardest part, is scaling these programs and getting out and going. And we can actually, so we’re shipping these kits. We know when they’ve been shipped and dropped off. We call the next day, and that’s when we set it up and explain. And we can put marketing materials in those boxes when it does get shipped and instructions. And so taking advantage of all those touch points are extremely important.

Cheng-Huai Ruan, M.D.

Yeah, from a Physician standpoint, we want to be able to do what’s best for our community. We want to be able to prevent hospitalizations, get patients access to health care they wouldn’t have access to. Some of them are home bound, they’re literally at home, and giving them accessibility and devices to do virtual medicine and stuff like that, for us, that’s what’s really going to be key moving into 2022 or the latter part of 2021 and 2022, right? So there’s a program that you guys have, I believe it’s called Rev Up. Can you kinda describe what that really is?

Paul Huffman

Sure. So Rev Up is our proprietary platform and by its essence, it’s a patient engagement tool. We want that to be what drives patient engagement. And so it engages, it drives our Care Coordinators, it drives our nursing staff. It’s what is integrated with DHRs to pull information and to push information back. My biggest initiative right now is trying to integrate with population health companies to get gaps in care. And so when we get that information, we can translate those gaps in care into tasks for our Care Coordinators. So if there’s a certain population one month that needs colonoscopies, we can then task that to the Care Coordinators. And then we can report back on how many gaps did we close? 

How many tasks did we complete from having that data back and forth? And what’s neat about Rev Up too, is what we implemented a few months ago, is to start our machine learning process of we don’t want to… We want to engage patients and we want to know how they’re engaged. So learning then on a certain patient level, what are they responding to from alerts and reminders to take their vitals? When are they normally taking their vitals when they take them and how to time those alerts prior to when they’re taking them, or when they’re not taking them. And learning the path of the patient’s behavior, so we can increase engagement. You can get them to use the devices and take their vitals, and log in and record any type of metrics. And so that way we get more, we have better over time, as opposed to patients tuning out over time.

Cheng-Huai Ruan, M.D.

So just to elaborate a little bit, what is the AI or machine learning actually learning? Is it learning behaviors, interactions, what the patients say? Like, what is it exactly learning?

Paul Huffman

Yeah, so we’re not to the level yet of like voice recognition or language recognition, but what it is it’s looking at alerts and then actions by the patient with those alerts, or inaction from the patients. And then tasking additional alerts. And so then we can do one or two things. We can task the Care Coordinators and Health Coaches based on that learned information and behavior, or we can automatically task it through a digital message. Those boxes inside patients’ homes are connected at all times, and so we can send program alerts to them and make it a smart alert, not just tagging it for every Monday at 2:00 PM. And just a blanket alert to everybody. It actually gets more and more individualized to those patients based on their habits over time.

Cheng-Huai Ruan, M.D.

And is that extrapolated by like diagnosis or chronic conditions?

Paul Huffman

It starts as diagnosis and chronic conditions, but then it extrapolates over time to get better at the engagement. And so we have over 150 different care plans and set protocols in place already on the platform. And so we had all those already for CCM, and now just adapting those for CCMA and RPM and slicing and dicing the patient based on that patient’s needs. And we have prioritized it based on open tasks. So in our business, more open tasks probably means more conditions or more needs, and those get prioritized each month for every patient.

Cheng-Huai Ruan, M.D.

Okay. So there are health coaches and like human staff, like looking over the stuff, right?

Paul Huffman

Yep, there’s still a human factor for any escalation, intervention phone call. All the direct messaging inside the app actually does go to a nurse. So any patient interaction is by a person. Any alert, reminder, automated messages, is where the learning is going on in the background.

Cheng-Huai Ruan, M.D.

Okay, that’s good. I mean, the more we get alerted from our population, the more we can triage anything that comes up, prevent hospitalization. So it sounds like you guys are trying to collect this data and see gaps in care, like you said, and hopefully bridge over that to see how much better we do. So overall, there’s no upfront costs, and then you’re also a lot of your billing is based on who we actually get on the platform to interact for that 20 minutes, 40 minutes, whatever. And so you’re kind of de-risking it for the Physician, which I really like. But let’s talk about something just as interesting is, let’s say that I’m a doctor, which I am, I’m a Physician, and I have a very busy medical practice . All my staff is optimized and doing what they’re having to do, there’s no extra minute. Am I able to adopt something like this into the remote patient monitoring, chronic care management, starting a program and then scale it? is that doable?

Paul Huffman

It’s doable. Very little practices have done it. A lot say they’re going to do it. You know, I can point to some Physicians who went and bought a bunch of blood pressure cuffs. And there’s one that I’m friends with in New York that still has them in his trunk and was trying to get rid of all of them. And so it is a risk, right? With more risks comes more reward. My just suggestion is always, you know, use a company like ours to scale and ramp it up. And then once we’ve saturated that, or we’ve come to kind of a plateau in the patient basis, as we feel, then build your own team. It’s really easy, it’s a lot easier to build a team when you know how many patients are in the program, right? It’s that, it’s that ramp up time that’s really hard and it is a risk for the practice, too.

Cheng-Huai Ruan, M.D.

Right, right. So in business it was predictability right, in market share. So we basically have an exact number on how many people are going to be engaged, how many customers are going to be engaging on this, what the revenue model looks like from historical data, and kind of go from there? So right now what do you think are your biggest takeaways after a lot of these practices of onboarding with you guys? What have you guys learned through this process?

Paul Huffman

Most pain points are the same, you know, it’s logistics and new equipment. The feedback we’re getting, our devices that we chose also have a personal emergency response service. So when you’re talking about value to the patient, I think we got a lot better usage on our devices because of that. We don’t require a Bluetooth device, we don’t require wifi, we don’t require a smartphone. We have all those tools available if the patient has them, but it’s not a requirement. So adoption has been very easy and fast. So what I’ve learned is that it’s still hard to scale. So setting expectations as well. If you have 2000 patients in your practice that are eligible, it doesn’t mean we’re going to get 2000 patients enrolled in the first two months, right? You’re dealing with a shipment of kits. They have to actually use them. 

All of that goes into consideration when you’re starting these programs. So we mapped that out. We have a really set escalation as far as what we expect based on historical data for the ramp up time and for the practice, and making sure that they’re all aligned. So I think what I’ve seen across the board is that the time is now. Patients are more accepting with it, and so are providers, we’re are more accepting about having a digital platform inside of the patient’s home. And then it’s easier to do Telehealth visits as well. So take advantage of that. I mean, a nurse practitioner can do a Telehealth visit and as long as an MD is available via Telehealth right now, you can bill under the MDs NPI. So there’s all these things that take advantage of at least through the next year in order to make all of these services more meaningful.

Cheng-Huai Ruan, M.D.

Right, so yeah, and you bring up a good point. I think outside of like remote patient monitoring is that a lot of times, we do so much Telehealth, especially over the last year. And we don’t have vitals for these patients and they’re on blood pressure meds and stuff like that. And then a lot of times, like today, earlier today, I had someone where their cuff is actually too small for their arm and all these different things. And we had to get their blood pressure taken at CVS and whatnot. And I feel like Telehealth would be better if we actually had adequate data that’s that’s coming through.

Paul Huffman

Yep.

Cheng-Huai Ruan, M.D.

And then the other thing is it’s getting patients to say, “Hey I want to know what your blood pressure is “every day for the next two week so we can trend it.”. It’s better if they actually have the device. And so for us, it actually brings in a lot of value when that occurs, even outside of remote patient monitoring. And so whenever patients… One of the hesitations in a lot of practices that I’ve talked to is that they don’t know what to do with information because they fear that information is coming in too quickly. And so how do doctors or practices sort what information comes in and how to triaging?

Paul Huffman

So our escalation protocol for remote patient monitoring did a complete 180 after our first six months of launching. And the reason is is everything you just said. Fatigue, alert, or alert fatigue sorry, is a real thing. That’s not what we’re here for. We’re not here just to pass on information back and forth. If we were, then you should just pay for, just get our software and our equipment, right? We’re here based on the protocols to get that information, evaluate it, and then make a decision whether it needs to be escalated or not based on the protocols that we established. 

So a lot of what we send is FYI only, and it could be in just the documentation every month. It might not be as an alert. It might just be as a note, and then escalating what needs to be escalated. We want it to be meaningful for the patient and meaningful for the providers as well. And with that, a lot of that is filtering and taking care of those alerts and making sure that we’re just passing it on. So when we integrated with iWatch, the health kit app, we got, I think it was 25,000 inputs in the first 15 minutes, and that was only about 50 patients that were using the watch. So a lot of what we do is filtering and making sure that it’s meaningful back to the practice.

Cheng-Huai Ruan, M.D.

Okay, yeah, because that’s a lot of data, given 50 patients.

Paul Huffman

Yeah, it’s like every few seconds it was taking your steps, your blood pressure, your heart rate, and then just continuing on.

Cheng-Huai Ruan, M.D.

And this is, we’re talking about through Apple health data?

Paul Huffman

Yeah, The health kit, yeah, the health kit applications, yeah.

Cheng-Huai Ruan, M.D.

Okay, yeah, sounds good. So obviously some people already have their own devices. They have Withings blood pressure cuffs and Apple watches are, you know, there’s 50 million of them out there.

Paul Huffman

Right.

Cheng-Huai Ruan, M.D.

And so are they able to connect their current devices on the platform?

Paul Huffman

Yep, I mean, as long as they have a smartphone and obviously if they have those devices, they probably do. And so they would just connect that through our app as well. But we label those separately. So if they have… It’ll say what device the value came in on. And then our app allows people that patients to manually report vitals as well, but that would come in as a manually reported value. So it’d be flagged differently if they punched it in manually.

Cheng-Huai Ruan, M.D.

Okay, are there, I don’t know the answer to this. Are there like FDA allowable devices for remote patient monitoring and ones that are not? Or what’s the categorization here?

Paul Huffman

Yep, so now it has to be an FDA, not FDA approved, but it has to be registered as an FDA device. So an iWatch is not . EKG actually on the iWatch, is the only thing that’s allowed.

Cheng-Huai Ruan, M.D.

That’s only on the Apple watch six currently.

Paul Huffman

Yeah, yeah, yeah. And Fitbit and things like that, those are lifestyle devices. But devices like Withings, those count and a lot of people have bought those. A lot of the glucometers that are on the market that are Bluetooth connected, obviously, those as well can just be connected if the patient already has them, and be used for remote patient monitoring.

Cheng-Huai Ruan, M.D.

Okay, so wow, so we’re getting good quality data. And not only we’re getting good quality data, we’re getting alerts that has a filter attached to it. So you’re not going bonkers shift trying to triage it. And so how, how has the patient response been when you onboard patients, what do they say? I’m curious.

Paul Huffman

Yeah, so it’s varied, and like chronic care management, we’re talking about a tangible item in the home.

Cheng-Huai Ruan, M.D.

Right.

Paul Huffman

And so there’s two things that we really want to stress. That somebody is watching it, and then that providers, at least for remote patient monitoring, are viewing the monthly vitals and give the feedback to the patient that you are looking at it, and it is valuable. And we did a survey of 400 patients just recently the ones that have devices that are connected. And the biggest feedback was just being able to adjust some of those alerts that we’re doing. And as we adjust them, they they want a little bit more control of, they don’t want to feel like someone’s telling them to take their blood pressure, they want to just do it. And knowing that they don’t necessarily have to do it every day, we just need some connectivity every day, or 16 days of the month. And educating the patient. So we’re getting better on those alerts. And like I said, the machine learning is helping as well to tailor it to the patient’s needs. So we don’t want a fatigue alert to the practice, and we don’t want the reminder alert to the patients.

Cheng-Huai Ruan, M.D.

No, absolutely. And so going back into the devices for a sec, so earlier we’re talking about modern devices. So I guess what I didn’t know is that there’s actually FDA categorizations of these that can be used for remote monitoring. So even if a patient has an Apple watch six or four or whatever, they that can’t necessarily use that as a dataset right now, right?

Paul Huffman

Yeah, we wouldn’t recommend it, right.

Cheng-Huai Ruan, M.D.

Okay. And so I know these rules are always changing and I know they changed during COVID too. There’s a laxity that came on and there’s a new rule now. But these are always changing. Because I’ll give examples, because right now, our electronic medical record, we use eClinicalWorks and their Apple watches, Apple health, actually integrates with our EMR. But we can’t necessarily use that as a remote patient monitoring platform, per se, and bill out those CPD codes is because they’re not necessarily on a FDA definition of a medical device, right? These are lifestyle devices. And so whenever we’re getting this data, we have to know that it’s quality data. And we have to know that we’re getting data in the intervals that we can actually handle. And that when patients know their vitals and their data, that we get to triage sooner rather than later, if it’s something in the outlier, right? So our patients, they have their own access to their own portal to see those vitals, or how does that work?

Paul Huffman

Yeah, they can use our patient app. Again, it’s not a requirement, but it’s nice to have, not a need to have, and they can see their all history of their vitals.

Cheng-Huai Ruan, M.D.

Okay.

Paul Huffman

Manually input vitals for other devices or connect other devices to their service. And 99% of the monitoring every month, we’re going to handle. It’s doing that monthly summary of review when the patient is there in the office. If we didn’t alert you, then so far so good. If we did alert you, then there’s probably an action that’s been taken. To adjust meds, to prevent somebody from going to the ER and booking or getting an appointment and coming back into the office. We’re doing a lot of medication adjustments, obviously, with the blood pressure, high blood pressure, or sometimes too low blood pressure. And so that’s been our main intervention so far. And then the emergency response service has been used. And there’s been some pretty amazing case studies that it saved people’s lives or that needed an emergency. And so a lot of patients pay for that out of pocket. Now they get that with this service, and we have tangible service and tangible product that creates value to the patient.

Cheng-Huai Ruan, M.D.

You keep thinking about that Life Alert commercials you see on TV all the time. So they have-

Paul Huffman

We should have our own. We should have our own, yep.

Cheng-Huai Ruan, M.D.

But yeah, that’s true, because a lot of senior citizens paid out of pocket or they have their family pay out of pocket. They’re living alone. But let’s talk about a bit of a different demographic. Let’s talk about the disabled. Because Medicare, you have senior citizens, you also have the disabled. And so in our practice we have a very large disabled population. So they’re on Medicare because of the disability and not necessarily because they’re 65 and older, right? And so these people take lots of energy to take care of from my whole staff. And a lot of them, we actually have them log their own vitals and devices and stuff like that. So from a lot of these patients, we see them pretty frequently because they have chronic unstable conditions. Most of them, this is cardiovascular or congenital malformities and stuff like that. And so this population can really benefit as well. So I’m curious to hear your thoughts on a lot of this population, they don’t necessarily have internet or wifi and stuff like that. So how do the devices communicate with our platform if there’s no wifi? What system does that go through?

Paul Huffman

Yeah, so our system is a cellular connected system. We drop ship them to the home and they’re already integrated for that patient when they’re delivered. So they there’s instructions in the box. So they literally just plug it in. And it actually has batteries, if they didn’t plug it in and just turned it on. And there’s a button to call our care team on it. So it works like a cell phone speaker phone system. So again, the smartphone connecting additional devices, all that is nice to have, but not need to have for functionality with our platform.

Cheng-Huai Ruan, M.D.

Okay, so that’s great. So even if the people don’t have access to resources, digital resources, it still goes through like no matter what, and we can still reach out to them, yeah?

Paul Huffman

Yeah, and that’s important, right? If it’s on wifi, then we’re only connected when they do a vital. When we’re on cellular, we’re connected at all times. So that connectivity and that ability to send alerts and reminders and pushing that to a hub device, because it’s really important to engage the patient and learn when they’re going to take their vitals, because we know it’s on at all times. If it’s wifi, if it’s a chip inside of a blood pressure cuff, you’re only as good as how much they use it. You don’t have the ability to call that device. You don’t have the ability to set a reminder to that device. We do with the hub.

Cheng-Huai Ruan, M.D.

Got you. Well, sounds great. So the last thing I want to touch on, I’m going to put on my business hat for a second, because the people watching this are pretty much private practice Physicians. But putting the business hat on for a second, we’re really talking about the first time where a practice can be scaled on a digital platform that’s outside of the one-on-one doctor visit. So from the business side, with your company, like how much roughly is a Physician generating? Let’s say if they have two, 1000 patients who qualify for remote patient monitoring. What does that look like, like just from a rough estimate?

Paul Huffman

Yeah, so I always, my general role is typically a private practice Physician, one provider equals usually about 500 eligible patients. On average across the board. We’re seeing a little bit more with cardiology, obviously with remote patient monitoring. But when you’re looking at a program like CCM and RPM together, 500 patients, typically we’ll get 400 of those enrolled. And it can be a net of over six figures a year for the practice and then some. With little to no investment, we want the providers to be involved in the staff to be engaged and everyone’s on the same page. But that’s in addition to what you’re already doing and what you’re doing with those visits via Telehealth or, in the office as well. So it it’s just an add on, and it’s a pretty good add on when you’re doing both services.

Cheng-Huai Ruan, M.D.

Yeah, so not small numbers, so that’s great. And plus I think it really allows us to practice the best of our ability as Physicians as well. Right?

Paul Huffman

Yeah, yeah. And that’s the added bonus, or the added bonus is the revenue, either way you look at it.

Cheng-Huai Ruan, M.D.

Right. You know, when we first did remote patient monitoring in chronic care management, we learned a lot. So yeah, we were the practice that we had a bunch of devices. I think I still have some and stored away somewhere in a garage somewhere. The hard part was always tech support. Dock my devices and connecting, and that we’ve gotten a bazillion different messages and the technology breaks down, right? So can you address some of that as a concern? How reliable is the tech and what you guys do to help for tech support?

Paul Huffman

Yeah, so that button calls our care team, so there’s that type of support. And then there’s a phone number to the manufacturer on the bottom, if there’s actually a route problem with the device. And so any devices that are returned, we do send a return label to the patient, and then they can drop it off at a UPS store, or even scheduled for a pickup as well. And same if there’s any damages or anything wrong with the device itself. We had very little issues because it is this hub device, that’s the central hub for all the connection. And then the peripherals themselves are pretty easy to use, but also pretty durable as well. And the only issues, we’ve had a couple issues with the blood pressure cuff or someone’s thinking that the readings were off a little bit, and there’s some error codes that pop up that are from the manufacturer that if there is an issue, and those just get swapped out. 

Our biggest challenge is obviously just patient compliance, and just trying to get better at that every day. And what I mean by that is people that opt in for the program, say they’re in, we know that there’s a device that’s been shipped, but it hasn’t been plugged in yet. And we can’t get ahold of the patient, even though we know one of our devices is still sitting there in a box not plugged in. So now we’re working on efforts of how do we reduce those numbers and have like a second wave of just calling them five times, it doesn’t work for those patients. So that’s another reason we will be putting people in regional areas, to help set up in the home, to get kind of those stragglers that aren’t connecting and getting some help from the practice reaching out to make sure that they just open the box and plug it in.

Cheng-Huai Ruan, M.D.

So it sounds like you speak from experience. 

Paul Huffman

Well. Bringing in a blood pressure log, you know, patients aren’t always 100% truthful, right?

Cheng-Huai Ruan, M.D.

Absolutely, absolutely.

Paul Huffman

So the last part is seeing what people’s real vitals are and noticing that, well, maybe your blood pressure was not controlled like you said it was.

Cheng-Huai Ruan, M.D.

Right, right. So, all right. So we’re gonna, I’m gonna end the interview with probably my most asked question from people. What are three things you wish you knew when you first got into remote patient monitoring technology and CCM?

Paul Huffman

Yeah, I can tell you the one that came up right when you said that was no one ever anticipated how hard this business is. Everyone thinks it’s going to be easy. I got 1,000 patients, we’re going to sign up 1,000 patients, and there are going to be 1,000 patients every month that are going to be on these programs. You know, you’re always going to have an attrition rate. It’s just what is it going to be? And you always got to add new patients. So that has been definitely challenge number one from day one from all of these companies. And you’re seeing a lot of chronic care management companies that are not around anymore, that raised a lot of money. We’re still doing well. And then number two is don’t go into any of these services or any healthcare startup of how medicine or healthcare should be. 

Solve how it is and work in those parameters. Telehealth is, again, it’s how it should be or should have been. And now we’re kind of catching up because of COVID, the embrace of technology inside healthcare. It’s starting to get there now, but it wasn’t in 2016, 17, it was still a fax machine. And then thirdly, your EMR is not going to solve everything for you and being able to find those plugins or that software that does one thing really well. That’s either remote patient monitoring or CCM. But also knowing that a software that does scheduling really, really well online or in reminders online might not be the one that’s in your EMR. So I think, going into, I have some experience in the lab business, so I know how important integration is. But not realizing how the efficiencies for integrating can help us and also help the providers. So interoperability is extremely important and even more so now. And so not maybe realizing that as much going into it, of how much it’s needed, is really, really important.

Cheng-Huai Ruan, M.D.

That’s a lot of lessons, man. And I’ll tell you my three lessons that I learned. I wish I knew a few years ago. Number one is I wish I knew how hard it was. Just like your first one. You know, there is an attrition rate, but it’s also, we want to do well for our patients from the Physician side, honestly. But sometimes it’s that language is really hard to get through, until there’s a global pandemic, then everyone wants to be monitored. The second thing that I really learned working with our remote patient monitoring companies is, again, I know a lot of those companies that are no longer around, that it sounded great at the very beginning. One of the downfalls of being an early adapter is that you make a lot of mistakes. 

One of the greatest things about early adapters that you make a lot of mistakes and you learn from it and you get back up, right? And so that’s what we’re having this conversation. And the third thing that we really learned is that, my gosh, if we have to assume the costs of these equipment upfront, it could be very detrimental. It could be extremely risky because so many things are really unpredictable and you really have to work with a RPM or CCM company who’s gone through all those mistakes. And it sounds like you have, Paul, and learn from those and continue to move forward. Because whichever vendor that you choose as a private practice doc, you don’t want to be at the mercy of impairments of technology and leadership and the main core value, which is providing an absolute phenomenal service to the patients, to the community. So awesome. Well, thanks, Paul. Well, how do people find you and how do people find your company?

Paul Huffman

Yeah, So Mdrevolution.com. And we’re on a lot of different EMR marketplaces, like ECW, like you mentioned, Athena, Greenway Health, are fully integrated with as well along with Epic and some of the larger enterprise systems as well. And so a lot of times, if you look into your EHR, we might be the engine driving it in the background. But obviously our website would be the best place to go to just initially get some inquiries, and we’ll go from there.

Cheng-Huai Ruan, M.D.

Great, there’s a link below, go ahead and click on that for the inquiry, if you’re interested. Thanks a lot, I appreciate your time.

Paul Huffman

Thank you.

Cheng-Huai Ruan, M.D.

Thanks.