Products & Technology

Sleep Strategy: 2018

Seven key trends sleep providers should consider for their businesses over the next 12 months.

Sleep StrategyOver the years, sleep providers have learned one thing about their marketplace: flexibility is the key to smart strategy. They must be able to adapt to changes in care, technology, and above all, the funding environment if they want to remain viable, relevant sleep therapy businesses. They have to constantly keep an ear to the ground to discover what trends are on the horizon for the sleep marketplace, and adjust accordingly.

To help you stay on top of a constantly morphing sleep market, we’ve identified seven key technology, care and business considerations you should factor into your strategic planning for 2018. Some you might have already handled, some you might know about, and some might be news to you, but all are pressing, pertinent issues that will impact providers to varying degrees during the months to come.

Connected Care

The numbers don’t lie: remote patient monitoring is absolutely fundamental to the continued success of sleep therapy providers. It is becoming a de facto requirement. The number of remotely monitored patients grew by 51 percent to 4.9 million during 2015, according to “mHealth and Home Monitoring,” a study from market researchers at Berg Insight that was released several months ago. (“mHealth” being Berg’s word for mobile health technology.) Looking ahead, the number of remotely monitored patients will grow at a compound annual growth rate (CAGR) of 48.9 percent to reach 36.1 million by 2020, according to the study.

Revenues for remote patient monitoring reached roughly $6.8 billion in 2015. That revenue includes revenues from medical monitoring devices, mobile health connectivity solutions, care delivery platforms and mobile healthcare programs. Berg reported it expects remote patient monitoring revenues to grow at a CAGR of 32.1 percent between 2015 and 2020, to eventually reach $27.4 billion.

And where the home medical equipment market is concerned, connected medical devices, such as sleep therapy equipment, accounted for a whopping 71 percent of total remote patient monitoring revenues in 2015, according to Berg. That said, revenues for mobile health connectivity solutions, care delivery platforms and mobile healthcare programs are growing at a faster rate and will account for 46.3 percent of total revenues in 2020, up from just 29 percent in 2015.

Berg’s report says that the sleep therapy segment of remote patient monitoring has been growing at the fastest rate of all, with the number of remotely monitored sleep therapy patients grew by 170 percent during 2015. Moreover the report has pegged sleep to outpace cardiac rhythm management (CRM) — traditionally been the largest segment of the remote monitoring market — by about the time you are reading this. In fact, sleep equipment maker ResMed reported at the outset of 2017 that it had hit a landmark moment in monitoring sleep patients: 1 billion nights of sleep data have been downloaded using its AirView patient monitoring platform.

Why is remote monitoring taking off? Because sending patients home with a PAP therapy device that lets them, the HME provider and the referring physician or clinician track their care delivers results. They can see how they are performing against various performance metrics on a daily basis; trend that data; and work to correct events that are happening during their sleep and improve overall compliance. It can help patients manage their care, give referral partners actionable data on patient compliance and progress, and create real business value for providers in the process. Providers must continue to sharpen their remote monitoring game during 2018, and if they aren’t implementing it to a broad degree, they must make it a top priority.

Referral Development

Depending on which studies you read, we know that despite difficulties with funding, patient compliance and other barriers, sleep providers continue to see growth in the volume of their businesses, but they also know that growth is slowing, according to most reports. This flies in the face of other studies showing the massive scale of OSA patient populations. So what’s the story? Why are providers seeing volume growth taper if the patient population is still huge?
Referral development. For 2018, providers must place a premium on driving increased patient volume. The question is how do they approach that?

ortunately there are a lot of ways that providers can increase their referrals. To start, they can increase their efforts to regularly educate prospective and existing referrals about their business. This isn’t just talking about how they help patients and the sorts of products and services they provide, but providing actual hard numbers about their patient outcomes. Referrals want data that helps them make smart decisions, and providers that offer that information will get the business.

Playing up the provider’s connected care services is a good way to advance this kind of data-driven approach to sleep therapy. Once a provider shows the numbers it is generating, if it can then start communicating how it is collecting that data, it should strike a chord with referral partners. The kind of hands-on care offered by remote patient monitoring and management is revolutionary, and any provider offering it should use that as a business differentiator.

Also, providers should strive to help referral partners educate patients. They should provide physicians and other sleep therapy specialists with educational resources regarding sleep apnea, treatment options and solid, how-to reference materials. This will not only help the referral partner reinforce its relationships, but hopefully driver referrals and establish the providers’ expertise in the patient’s mind.

Put Patients in the Driver’s Seat

Speaking of patient education, sleep providers must strive during 2018 to help their patients better manage their condition and care. This effort should combine both education and technology tools.

Where education is concerned, it must be the foundational element of the patient relationship. Some basic considerations: Once a patient is referred to the provider, staff should help the patient understand the funding process, financial responsibility and answer any questions they might have. Give a complete tutorial on the device and its use and cleaning in explicit detail. Help them understand which items can be replaced and how to set up their resupply. Work on not only instructing the patient regarding the use of their sleep therapy device, but on identifying what will help motivate that patient to stick with his or her therapy.

Then as the patient starts on therapy, technology can start to step in and enhance that patient’s care. For starters, many sleep equipment makers now include smart phone apps that help patients self-manage their care. And of course remote monitoring and management solutions will help the provider, sleep specialist and patient fine tune the patient’s care. But the key is to put the patient in the driver’s seat. The more ownership he or she can take in terms of care management, the more invested that patient will be in his or her compliance and outcomes.

Balanced Resupply Programs

Just about any sleep provider recognizes the absolute importance of resupply when it comes to the sustainability of their business. They know that in order to get past any reimbursement cuts they must maximize the revenue derived from each patient, and that means ensuring that those patients are getting the allowable resupply items coming to them. And providers are working to get their patients enrolled in their resupply programs.

The problem is that a poorly designed or managed resupply program can actually chase off patients. There’s a disconnect. If a provider continues to sign up new patients, but is churning them on the back end of the business, the resupply program is likely failing at some point.

The problem might be automation. Providers are using all sorts of methods such as outbound and inbound IVR calls and email to get patients enrolled and set up in resupply programs and to help them self-manage their resupply. This has been a phenomenal advance that has helped drive cost from the management of resupply programs and helped wide margins for those programs. At the same time, it might be turning off some patients that might need more specialized customer care or have a problem that requires some hands-on attention. If they can’t get that assistance, they’ll go elsewhere for that care.

This means that providers still must provide some live assistance for a percentage of their resupply patients. Some patients will need it all the time, some patients will need it on a case-by-case basis, and some won’t need it at all, but live assistance still must be factored into the resupply program. The provider can either offer that help on-staff our outsource it, but the provider must strike a balance between technology-based cost savings and service that includes a human touch. Otherwise they could be shooing off patients they spent a considerable amount of time and money to win over in the first place.

Comfort Remains King

There have been a variety of innovations when it comes to sleep therapy over recent years. The technology behind PAP devices has grown so nuanced that it can help assist an OSA patient’s breathing in essentially customized fashion. Patient monitoring systems allow providers and physicians to pinpoint patients’ specific problems and fine-tune their care. Patients have their own technology tools to manage their conditions.

However, at the end of the day, fit remains king in terms of fostering compliance. The format of the mask, the cushioning, the straps, the tube, the ease of donning and doffing the mask, adjustability — all of these elements of a mask are make-or-break factors when it comes to therapy compliance. If the cushions don’t feel right, the patient won’t use the mask. If the adjustability is finicky, the patient won’t get the full benefit. If materials feel weird to the patient, the mask will sit on the nightstand. Comfort remains king.

Which is why providers must stay on the lookout for new masks through the next 12 months. Now is not the time to be married to one manufacturer over all the others. Providers must take a more agnostic approach and constantly try and test out new masks to see if they work better for their patients. At the end of the day, it’s the patient who will call the shots, because if that patient doesn’t like his or her mask, that patient will move on down the road.

Sleep Patients Are on the Go

Sleep device manufacturers are keenly aware of the fact that sleep therapy patients need to travel and want to take their devices with them. Patients are looking for smaller, more portable devices with longer lasting batteries that they can not only use in a hotel room, but on cross-country, red-eye flights, as well. Fortunately vendors are responding with some really unique solutions that are coming in very small form factors.

This is a key product trend that sleep providers will want to monitor during 2018, because it could translate into considerable added retail revenue for them. While a patient’s home PAP device will likely be funded, a tiny travel device is likely to get billed to their credit card. Moreover, since the batteries on travel sleep therapy devices are smaller, the patient is likely to buy some backup batteries as well.

We’ve profiled some of travel sleep therapy devices in the sidebar, “Sleep Products That Will Help Fuel Your Business Through 2018.” Make sure to take a look at the options available and continue to keep an eye out for new travel friendly units to get unveiled during 2018.

Prioritizing Patient Re-engagement

Sleep providers need to get used to the idea that they sometimes fail patients. As of 2014, an estimated eight million people who had been diagnosed with OSA were not engaged with therapy, according to analysis from Philips Respironics of data from the Centers for Disease Control, Health Market Science, Acxiom and Forrester.

When a patient doesn’t comply with therapy or drops off the face of the map, the provider must take responsibility for that. That said, make no mistake, this isn’t about fault or blame, this is about patient care and business opportunities. If patients are dropping off, then so is revenue, and providers are obliged by their bottom lines just as much as their care concerns to pick those patients back up and get them back on their therapy programs.

This means that for 2018, providers should be analyzing their wayward patients that are either struggling to a considerable deal or have stopped therapy altogether and developing campaigns that are aimed at re-engaging them and getting them re-involved with managing their condition. These campaigns should provide a mix of information on managing their condition, the dangers of untreated sleep apnea, the technology advances, improved product comfort, and the ability to self-manage conditions. In other words, they must provide any “hooks” possible that will recapture patients’ interest and get them back on their therapy.

CPAP Bundling

This issue first came up when CMS announced competitive bidding Round 2019. As you might recall, CMS announced Round 2019 in late January 2017, but then quickly put a hold on those plans in February 2017. CMS announced that it had decided to “temporarily delay moving forward with the next steps of the Round 2019 … to allow the new administration further opportunity to review the program.” As a result, CMS removed all information that was on the website and the Competitive Bidding Implementation Contractor (CBIC) website.

However, as part of that initially released information, CMS released plans for testing a bundling program in 10 geographic areas. The test would fund a single payment for bundled CPAP devices and resupply items, such as masks and tubing. The plan also would see beneficiaries perpetually rent their devices, rather than own them. This raised eyebrows among sleep providers not only due to funding concerns, but due to the nature of a rental relationship. For instance, what problems would this cause for traveling and relocating patients? Also, what was the likelihood that such a plan would disrupt access to resupply and support services in the 10 areas by imposing financial disincentives to furnish these supplies and services?

So, a bi-partisan sign-on letter regarding CMS’s plan to move forward with mandatory bundling of CPAP devices was sent to CMS Administrator Seema Verma in September, asking delay the plan to test the bundling program. The letter, which can be found online at, cataloged the concerns regarding such a program, and also noted that CMS doesn’t appear to have the authority to test alternative payment models. Specifically, the letter reads, “The general competitive bidding statute does not authorize CMS to test alternative payment models or other configurations of items and services beyond the clearly elineated categories of equipment subject to the bidding process.”

It’s unclear when CMS would continue with such a plan, but it is critical for sleep providers to keep CPAP bundling on their radar for the coming year, and quickly respond if it arises by backing any advocacy responses that are put into play by their state associations and the American Association for Homecare.

This article originally appeared in the January 2018 issue of HME Business.

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