By Lucienne Ide

Patients diagnosed with diabetes or asthma find themselves in a unique position. While under the care of doctors for these chronic diseases, these individuals self-manage their condition day to day. For patients with diabetes, this means regularly checking their blood glucose and learning how to manage food and medications, including injections, to keep their blood glucose in range. Similarly, individuals with asthma learn to monitor themselves with peak flow meters and properly use maintenance and rescue inhalers to ensure asthma stays under control.

People with diabetes and asthma have had self-management tools for years to help them minimize the risks of their condition's serious side effects. Now, with greater adoption of digital therapeutics, patients do not have to go along this daily journey alone. Connected insulin pens, continuous glucose monitors (CGMs) and digital inhalers have made it easy for clinicians to see if their patients are properly managing their diseases. And with the reimbursement for remote patient monitoring, remote therapeutic monitoring, and CGMs, as well as the integration of the data from these devices into electronic health records (EHRs), clinicians can be more proactive in managing these conditions between clinic visits and helping patients lead healthier lives.

Asthma: The next frontier for connected health care
Pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD), rank among the top chronic diseases impacting Americans. About 26.5 million people – 8% of the population – have been diagnosed with asthma, while another 12.5 million are contending with COPD. Asthma alone accounts for more than 1.8 million emergency department visits and nearly 439,000 hospital inpatient stays. The impact of asthma is high, with about 10 people dying each day from asthma and healthcare costs totaling about $50 billion annually.

For something as potentially deadly as asthma and COPD, it seems counterintuitive that patients are largely responsible for managing their diseases on their own. They must monitor their respiratory function with peak flow meters, try to identify and avoid triggers and rely on regular drug therapies, including bronchodilators and anti-inflammatory agents, like inhaled corticosteroids, to maintain quality of life and prevent severe attacks. Taken as directed, these medications can improve asthma control and normalize lung function. However, as many studies have shown, a majority of patients – ranging from 50% to 80% – do not use their inhalers correctly, despite years of educational initiatives.

Luckily for patients with diabetes, there have been great strides in using connected glucose monitors and insulin pens to improve patients’ ability to properly monitor their blood sugar properly and self-deliver the right dose of medication when needed. Now, there is an opportunity to do the same for patients with pulmonary diseases, with the introduction of digital therapeutics for asthma and COPD.

These solutions are showing great promise in helping patients. Connected pulse oximeters allow patients to monitor their oxygen saturation levels, and new Digital Inhalers take asthma management a step further by supporting improvements in techniques used to administer medication, which ultimately improves the efficacy of the treatments and decreases adverse effects of the disease. One recent study, published in The Journal of Allergy and Clinical Immunology: In Practice, compared the use of standard inhalers to digital inhalers that worked in conjunction with a smartphone app and digital health platform. After three months, patients using the digital inhaler had more than an 85% chance of achieving improvement in asthma control vs. the use of a traditional inhaler.

Proactive care through easy access to remote patient data
Improvement in pulmonary disease control when using digital therapeutics can be attributed to real-time insights that are generated, which give both patients and their clinicians the ability to make adjustments when they’re most impactful. With these tools, patients can see their progress and when they may be outside of normal ranges. As mentioned above, this isn't just a tool for better self-management, clinicians can see this data as well in between their patients' in-clinic visits, and more easily detect patients who may be at the highest risk for complications, and proactively intervene before the disease progresses or emergency care is needed.

The key to clinician intervention is integrating the data generated by the digital therapeutics devices into the daily workflow. Not only should the patient-generated data be viewable within the workflow, but care teams should also have the ability to configure alerts, filter and risk stratify based on those alerts so clinicians take a proactive approach to address immediate concerns. It is also critical that remote, patient-generated data should appear within patients’ EHRs so clinicians have context about other health information, test results, lab work and notes for a holistic view of the patient’s health. This data should also be able to fuel clinical decision support with regard to implementing treatment guidelines and escalation of therapy.

Reimbursements foster greater remote patient monitoring
All told, including those used for asthma and COPD, there are at least 40 digital therapeutics approved by the U.S. Food and Drug Administration (FDA), with more coming down the pike. While use and consumer acceptance of these products became more prevalent during the pandemic, ongoing reimbursements for the work associated with remote monitoring left questions about continued viability.

Progress is being made, however. In its Medicare Physician Fee Schedule (PFS) for 2023, the Centers for Medicare and Medicaid Services (CMS) included updates for remote therapeutic management (RTM) reimbursement that will cover the cost of using digital therapeutics. This includes monitoring non-physiologic data for respiratory systems, which would allow insights into therapy response and patient adherence to treatment regimens. Most importantly, the 2023 digital and remote therapeutics codes now allow clinical staff to perform RTM activities, similar to how remote patient management (RPM) and chronic care management (CCM) are being addressed.

The use of digital therapeutics for those with asthma and COPD is a great starting point for helping patients better manage pulmonary diseases. But the key to these devices living up to their full potential is reimbursement and integration. Reimbursement will enable practices to dedicate the needed resources to enhancing patient care, while data generated from the devices must integrate with daily workflows across the continuum of healthcare and be available for use in clinical decision support to ensure patients receive the right treatment and achieve optimal outcomes.

About the Author: Lucienne Marie Ide, M.D., PH.D., is the Founder and Chief Executive Officer of Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences and achieve quality objectives for chronic disease management. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.