Understanding the RPM Market: Where It's At & Where It's Going

KEY CHARACTERISTICS OF THE PANDEMIC-ERA RPM MARKET

Though RPM usage increased during the pandemic years, Sanjula Jain, PhD, senior vice president of market strategy and chief research officer at Trilliant Health, notes that more nuance is needed in the conversation surrounding RPM.

Market research firm Trilliant Health data shows that RPM volume increased about 249 percent from the third quarter of 2020 to Q3 2022. But, as Jain points out, that is just the percentage change, and total volumes per quarter are still relatively low, especially compared to other virtual care modalities that saw more significant increases, like telehealth.

This is where the nuance comes in. Though RPM use is falling behind other digital tools in terms of growth, it appears to be concentrated on certain clinical use cases, Jain said. These include use cases related to circulatory system diseases, as well as endocrine, nutritional, metabolic, behavioral, and neurodevelopmental disorders.

"So, an ongoing question that my team and I are constantly looking at is how does the demand for RPM kind of stack up against the supply?" Jain said. "The demand is still pretty discrete, right? And the rate of change for demand hasn't really moved to the way that I think a lot of the supply side investors and players have maybe hoped that it would be."

This mismatch in demand and supply has resulted in a market where RPM vendors must emphasize the specific impact of their program to stay in the game, according to Oleg Bestsennyy, partner at McKinsey.

Currently, RPM solutions and players can be divided into three categories, he continued. The first is infrastructure, which includes the devices themselves that enable RPM; the second is intelligence, which are the solutions that ingest signals from RPM devices and analyze them; and the third is health tech-enabled services, which is the care team that takes the data insights and decides on the appropriate clinical intervention.

"We've seen a lot of proliferation around the intelligence and the health tech services layers, where there's been growth and proliferation of disease-specific vendors, especially in the space of diabetes…And around musculoskeletal care, where a lot of virtual physical therapy vendors are doing remote patient monitoring as a core part of their offering. And more recently in cardiovascular, for people to manage late-stage hypertension, cardiovascular disease, and some specific use cases like heart failure," Bestsennyy said.

As vendors double down on differentiating their offerings, healthcare providers and payers are honing in on the efficacy of the solutions.

RPM programs are costly, as they involve shipping devices, onboarding patients, processing data, conducting analytics, getting the devices back, cleaning them, and so on, Bestsennyy noted.

"These are not cheap programs to deliver to payers, to employers, and that also means that both payers and employers will be asking questions, well, is this really efficient and effective?" he said. "Probably starting now within the next two, three years, I think the market is going to clear from a perspective of some solutions will emerge as more clear winners than others."

HEALTHCARE PROVIDERS' CURRENT EXPERIENCE WITH RPM

As RPM solutions multiply, researchers are looking into healthcare stakeholders' experiences and where current tools are falling short.

KLAS recently published its Remote Patient Monitoring 2023 report, which aims to answer two questions: which vendors are best suited to meet current provider needs, and what customer experience looks like for those using these solutions right now, according to KLAS report lead author Ciera Black-Walker.

Overall, the KLAS research team interviewed the customer organizations of 10 RPM vendors over a 12-month period.

The report shows that providers are looking for more than just basic RPM software or devices, noted KLAS report lead co-author Schafer Jackson.

"What does the inventory management of some of these devices look like? Who's handling that? Is the vendor helping with that? Does the provider have the resources to handle that inventory and clean and wipe those devices and get them back out to the appropriate parties? Who's monitoring the patient data and that information?" he said. "And then, the patient facing support. If someone's having a problem connecting their device, or if the Bluetooth isn't working, who's helping a patient walk through some of those things?"

Even some of the most popular solutions in the market may not be living up to these growing provider expectations.

For instance, customers of Health Recovery Solutions (HRS) — which has won the Best in KLAS award for RPM multiple years in a row — expressed their concern that the company's innovation hasn't kept up with that of the market, the latest KLAS RPM report shows. The customers also noted that they would like capabilities added to HRS' solutions, including continuous monitoring and better inventory management.

The demand for additional features points to the growing concern among providers that the staffing requirements for operating an RPM program may be overwhelming.

"There are staffing concerns wrapped up in that in order to make these programs effective," Black-Walker said. "So, understanding the role of those additional services needed is crucial, as well as understanding things that aren't specific to remote patient monitoring, like account management or the level of support or service that you're seeing from the vendor you work with."

The report shows, for example, that more than half of VitalTech's customers plan to replace their solution, citing unreliable support, a lack of proactive account management, or the solution's lack of more advanced functionality.

In addition, the demand for revenue cycle support is growing, with more providers looking to vendors to offer services that can help them track and complete RPM reimbursement requirements, Jackson noted.

Not only are operational support services critical in the RPM arena, but so is EMR integration to make data gathered accessible and actionable. The report shows that 93 percent of customers of HRS, which was noted for its EMR integration capabilities, would buy its solutions again.

For clinicians, clinic leaders, and care managers, seeing data in one location versus multiple is vital as it helps smooth workflow, Black-Walker noted.

Further, there is a need for interoperability between RPM and other patient-facing tools, as well as non-patient-facing solutions.

"If there's an additional patient engagement SMS tool, how likely is a provider or a patient to use some of those [RPM] tools if they have to have multiple apps or downloads or exit an app to then communicate with a care provider? So how well does that interoperability happen?" Jackson added.

WHAT'S NEXT FOR THE RPM MARKET

Amid evolving demand from healthcare providers, RPM companies must work to understand potential barriers to adoption.

According to Trilliant Health's Jain, this is especially important because RPM is provider-driven, versus telehealth, which is both provider-and-patient-driven.

"I think this is where survey data would be very powerful to see," she said. "What are the factors that influence a clinician to adopt such a technology? Do they not think it's clinically appropriate? Do they not think it's a good substitute? Do they view it as a complement to care? And if so, is it because it requires a whole redefinition of the care pathways and the protocols that their teams are used to?"

Proving the clinical efficacy of RPM will be especially critical moving ahead. Jain noted that there are still unknowns regarding where the technology will be most impactful, both in terms of clinical use cases and patient demographic factors, such as where the patients reside.

For instance, these tools could act as physician extenders, enabling one physician to oversee numerous patients. However, whether care quality can be effectively maintained at scale through RPM is yet to be seen.

"If we don't know that for things like telehealth, which is more widely adopted, to me, RPM is also in the same category of 'it's a great technology, it's powerful technology, but I don't think we know enough about the total impact it's going to have clinically on the care journey,'" Jain said.

McKinsey's Bestsennyy echoed this notion, stating that providers will not deploy RPM tools they do not believe in.

Thus, proving efficacy is crucial. And RPM companies will need to implement patient engagement strategies to acquire enough outcomes data to do so.

"[But] continuous engagement with the member becomes more and more difficult the more fragmented these vendors are," he noted. "Meaning the more narrowly focused you are, you are fighting for attention with 10 or 20 different apps on a member's smartphone. So how do you potentially fight for members' attention and continue to get them engaged? It's not a trivial problem, especially when you have the proliferation of these solutions."

Another challenge related to building clinical evidence surrounding RPM is data management. With continuous remote monitoring comes a wide array of data. But more data doesn't necessarily mean better and more actionable data, KLAS' Black-Walker pointed out.

To ensure the data is clinically impactful, RPM must be combined with powerful analytics and a knowledgeable care team that can act on the insights generated, she said.

But perhaps the biggest deciding factor for the future growth of RPM will be reimbursement.

"Having that payer involvement, and that can be from CMS or private payers, that's the big question in my mind going forward — how can we make sure that reimbursements are such that fee-for-service providers can continue to offer these programs and see those outcomes?" Black-Walker said.

Providers have noted that current RPM reimbursement is insufficient to grow these programs.

According to KLAS' Jackson, reimbursement, or the lack thereof, may result in more consolidation in the market as companies work to address multiple patient needs.

"If you're monitoring for diabetes, can you also monitor for some of the other diseases that are shown there? And are there things like peripherals, video connection to escalate care? Those are things that I think will start to differentiate some of the offerings we see in this RPM space over time as well," he said.

Differentiation will be key moving forward, Bestsennyy reiterated.

Current business models for RPM include the vendor keeping a portion of the revenue. This means that if solutions are not differentiated, there could be a situation in which vendors will compete on the revenue split with providers, he said. For example, if one vendor decides to keep 30 percent of the revenue, another can counter by saying they will only keep 25 percent.

Still, the clinical use cases, the technology, and the intelligence and analytics services associated with RPM are good value propositions for payers and providers, Bestsennyy said. And thus, it will continue to grow.  

"None of us have a crystal ball, but I think the growth will continue to be a lower double-digit growth, so probably north of 10 percent," said Bestsennyy. "And this is what we've observed in the past few years...I wouldn't call it a mature industry, but it's a multibillion-dollar total addressable market industry, we think."