"RPM can enable better access and enhance the standard of care to those who have the hardest time receiving it"

Q. Tell us a bit about Rimidi. What led you to start it?

Lucie: Rimidi is an Atlanta, Georgia-based health IT company focused on providing tools to the healthcare provider market and helping clinicians make data-driven, personalized, proactive decisions about patient care.
I’m a clinician myself but I started my career in data working for the federal government. Then, I spent a little time in medicine. When I became a clinician, I thought I’d be an academic physician and have a long career, there. But I was really intrigued with the workflow and data challenges that clinicians faced and decided to leave clinical practice for what I could do on the technology and informatics side to make that better for clinicians and their patients.

Q. As a doctorpreneur who’s coming into technology with deep knowledge of clinical needs, combining both has got to be challenging. But, with telehealth, remote patient monitoring etc., becoming mainstream ideas today, what according to you is the current adoption rate for these modalities specifically for your platform which is in the remote patient monitoring space?

Lucie: It’s been an interesting two years due to COVID and its impact on healthcare delivery. Telehealth and remote patient monitoring have been some of the major accelerations. We have worked in this space for a long time — in terms of innovation years, where 6-8 years is a lifetime — and we’ve enabled the sort of continuous models of care as I call it, right from in-clinic to at-home and all the touchpoints in between because that’s what it takes to manage chronic health conditions.

A patient lives with hypertension and/or diabetes or heart failure, every day, not just the four days that they happen to have an appointment each year. So, that’s always made sense to us. But, there were barriers to that like reimbursement that obstructed scalability to a larger segment of the market. So, a lot was capitated at risk for groups engaged in those activities because they felt it was the right way to deliver patient care. Now, while the reimbursements weren’t new, the pandemic helped tear the band-aid off for everyone. Their hesitation around adopting this novel, whether it’s telemedicine or RPM and overcoming the fear of doing something new saw two camps being created — the risk bearing entities for whom this is the most cost-effective and efficient way to deliver good care and achieve their quality measures. And the groups, who still live in a very fee-for-service world that have really embraced the reimbursement which enables them to do this work and deliver high quality patient care. So it’s still kind of a split market in our experience with our customers divided into groups.

Q. Who are your customers today? What is your ideal profile and what kind of entities do you work with?

Lucie: We do work with the accountable care organizations that bear financial risk. While I agree that everything follows the money in healthcare, I often say that CMS created these reimbursement models as an on-ramp to value-based capitated kind of behaviours.

When we first launched into the ACA world, it was a bridge too far for so many organizations to go from their fee-for-service decades of behavior to becoming a risk-bearing capitated entity. We have clients who’re able to take advantage of the reimbursement because they still live in a fee-for-service, do their remote patient monitoring, and start behaving in this more proactive, comprehensive way of delivering healthcare.

Q. Give us an example of one of your clients who’s used your platform. How do they derive value from it? How are they paid for it? How does it work for a patient with a chronic condition like diabetes or hypertension? Walk us through this from your platform’s perspective and how you’re pulling it all together?

Lucie: We’re working with a group called Leon Medical Group there in the Miami market, South Florida, the Medicare Advantage Group. So, they survey the risk on their patient population and have an older polychronic population. They use our platform to help them manage diabetes among their patients. They undertake RPM with the connected Glucometer and the data collated is monitored by the care management team of pharmacists who are engaging with those patients, educating them, adjusting the medication as they monitor the blood glucose levels, while also intervening on the clinical side.

Since it’s RPM it’s not really a thing unto itself. It is a part of understanding what’s happening with this patient, how to manage a condition like diabetes, have they had all their screenings, are they on the right classes of medications to decrease their cardiovascular risk, are their blood glucose levels controlled and are these successfully decreasing their cardiovascular risk of complications?

They target variations for poorly controlled diabetes defined by an A1C over 9, and they’ve been able to get 88% of those patients to goal by engaging them more intensely through RPM, but also more holistically because the whole platform is integrated with their Epic EHRs and so, that paints a much more complete picture of what’s happening with that patient.

Q. Let’s talk about the data because that’s at the core of how you actually deliver value. It’s a challenge putting all the data into the system or wrangling it to make holistic sense of it. What were the challenges that you had to overcome? Is it still a work in progress? What’s the State of the Union on that?

Lucie: We have been very early evangelists of FHIR for the HL7 FHIR data standard because this was always the vision — how do we get all of this into that workflow to the point of care? None of us as physicians are begging for more data. What we want instead, is the insight, the curated information. So, the question is what is this data telling me? What’s the story? What do I need to do?
When I first started the company, FHIR had just turned 10 years old. It was more an academic-level project than one of commercial relevance. We’ve been on that journey of standardizing APIs and interoperability and FHIR has become the dominant standard as the company’s grown. That’s been an important part of our story because now, we can finally achieve that vision of aggregating data into a consolidated experience for the physician.

A big part of what we do is clinical decision support so while I don’t need more information, I need to know. I need to do the right thing without missing something about a patient with that level of workflow.

Q. A number of companies are in the RPM space and approaching it from their unique vantage points. But the central message is the same — It’s the big use cases in chronic disease management, diabetes, hypertension, obesity, etc., where they collate data from the points of care through sensors, devices, monitors and apply intelligence on it to intervene. But where they differ is in the kinds of target markets they’re in. Is there a sweet spot today, or do they organically find the traction which makes the most sense for a company in the European space?

Lucie: It depends on the problem you’re trying to solve and the segment of the market you’re trying to solve that for. My passion has been in the healthcare delivery system because my firm belief is that’s where most of the healthcare is delivered. There’s a segment of the market where consumers, payers, and employers will embrace that sort of employer-driven health care.

Certain payers do a really good job of driving case and disease management by engaging their members. However, most of us receive healthcare from a doctor who’s part of a clinic or a health system and that’s the messy part of the market. There’s this desire to go outside of that and if there’s something more efficient, then, I understand and I applaud that, the other entrepreneurs in the market. My passion though, is, we’ve got to fix the system we have because that’s the majority and that’s the way most of us receive healthcare and it’s what’s driving a majority of the costs.

Q. In terms of numbers, what are the quantifiable metrics you’re looking for? Is there a certain threshold for sharing risk? Do you put some of your own revenue at risk? Walk us through the thought process behind those transactions.

Lucie: Every client we deal with is trying to achieve two, maybe three outcomes — clinical, operational, and financial. You really get to the financial one, but you should see the clinical and operational because the challenge of healthcare delivery is—what’s the outcome I’m trying to achieve? How much does it cost me to get there?

Historically, we’ve drawn people at the problem — more nurses, more doctors, and more case managers to engage and interact with patients and that isn’t scalable or cost-effective. In 2021, we’ve had half a million people leave the healthcare workforce. You can up for people, the problem, but people can’t hire nurses — they’re not there. This emphasizes the point that the technology has to make the delivery more efficient while still achieving that same outcome for the patient, because that’s the business we’re in. And healthcare must deliver better health to the people we care for. So that’s almost assumed and the lesson I’ve learned on this journey. I came in with a clinical background thinking the measure we’re trying to change is the clinical outcome. What I’ve learned over the years is let’s all assume that we’re going to achieve that clinical outcome, but the question is, how do we get there?

Q. Currently, we’re in the midst of this great resignation and healthcare is failing just as much as any other sector, probably more so. The consumers of healthcare are also equally impacted. The pandemic has also highlighted the disparities in access to care. Can you discuss how your platform addresses social equity, health equity, disparities in access to care etc.?

Lucie: We work with many federally-qualified health centers and safety net hospitals, which are caring for those most vulnerable patients in our system who have the most barriers to care for instance – “It’s hard to get off work”; “I don’t have transportation”; “I don’t have child care”; “I may not have the level of health literacy that other patients have” etc. Then we also know that these chronic health conditions tend to over index in that same population. So, it’s a big part of our business to enable better access and enhanced standard of care to those who have the hardest time receiving care. RPM is something new to a lot of those care delivery systems and clinics, but it’s something to really embrace.

There are some challenges to that from a reimbursement point of view currently, under Medicare – federally-qualified health centers cannot get reimbursed for RPM, so, they get grants from the FCC and from other private foundations to do this work that creates a sustainability problem. That must be solved and we’re involved with many others and advocating for that.

To your point, there’s this light being shine on health equity. I’ve been involved with a group this year called the Health Equity Access Leadership Coalition, which is a lot of digital health companies coming together and asking — What are the policy changes? What are the best practices we, as technologists, must follow to ensure that we’re building solutions that don’t propagate the same problems we’ve always had in terms of equity?

Q. You referred to the Federal Grant Program last year which set aside a couple of hundred million dollars so a number of health systems were able to access it and use it constructively. What needs to happen for this to become a sustainable model for the most vulnerable populations to continue to receive the care that they need and not on a one-off basis?

Lucie: Two changes concerning the restriction – Federally-qualified health centers and rural health clinics can get reimbursed for RPM along with providers of care for any other Medicare beneficiary and then, get the alignment of state Medicaid plans. It is a state-by-state kind of a hodgepodge right now, whether Medicaid reimburses because RPM is currently, on-ramp. We’ve got to give these organizations some runway — a couple of years of reimbursing them and giving them a financial model that works to deliver care in this way—is possibly how we can transition them to value-based capitated or tight contracting models. But we’ve got to give them some time to really build the systems and the people in the processes to do that.

Q. What are the big trends in digital and virtual care models for the coming year? Can you share some of the goals for your company?

Lucie: On the trends, you’ve touched on a lot of it. Health equity is on top of everybody’s mind. While it’s going to continue to be so, we must ensure that we’re being inclusive. How should these programs be designed and offered to patients so that they’re accessible? This hybrid model of care is here to stay. And how is that related to value-based care?

The Biden administration’s been looking at value-based care again, so what will be the next iteration of that value-based care 2.0? I think, hybrid models of care will be a big part of that. It’s how we get there because we’re really not there at scale one accountable care or any of that versus where I think a lot of us want it to be.

Our goal is to continue to grow. We certainly are focused on continuing to grow in this segment around community health centers, FQHCs and others and working out the sustainable model with then going forward. On the technology side, at the end of day, we are a technology and a healthcare company. So we’re really pushing forward with some exciting new things such as, FHIR advances, CDS hooks advances — all of that technology and really staying on the front-edge of that.

Q. The last two years have been huge for digital health funding. Are you an institutional funded company yet?

Lucie: We are. That’s probably part of our journey in 2022 as well as the next level of funding.

Q. What do you make of the 5000 or so companies that have been funded so far? Are you seeing any trends in terms of either breakout companies that are really making a big difference or a shakeout at the other end and everything in between? What are your thoughts on this whole explosive landscape of digital health farming seen this year? Will we end it at 20 billion, give or take?

Lucie: I think the factor there is sort of the sustainability issue. You’ve mentioned this huge number of companies that have been funded, yet, the market needs sustainable solutions, not all these point solutions. We’ve seen some consolidation this year, and that’ll continue, going forward. Some of the smaller point solutions will be aggregated into larger platform-based solutions. That’s been part of our journey over the last year and why we’ve moved from originally being focused on one disease state to multi-disease state to now outside of the chronic disease phase — because that’s what the market wants. So I think that’ll be some of the shakeout — what gets rolled-up and what doesn’t survive because it was a great technology that the health system didn’t want an app for.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity