Breaking down barriers to remote care, with Mount Sinai's Dr. Arshad Rahim

In a new episode of Cadence Conversations, Arshad Rahim, Chief Medical Officer of Population Health at Mount Sinai, spoke with Head of Legal and Chief Compliance Officer at Cadence Meryl Holt, about how to break down barriers to ensure remote patient monitoring gets expanded across the country for the benefit of patients, providers, and health systems.

In his role at Mount Sinai, Rahim is a champion of value-based care and responsible for a wide-ranging portfolio which includes provider engagement across the health system. He currently works with about 100 different primary care practices to drive access, accurate risk adjustment, and reducing acute utilization. "We've tried to make value-based care just care, just essentially believing that it's just the right way to deliver care," Rahim shared.

He has also been a proponent of leveraging new technologies to improve the ways in which Mount Sinai delivers care, including remote patient monitoring (RPM) technology. "I'm definitely a big believer in the value of remote patient monitoring. We have to prove and figure it out, disease state by disease state," Rahim said.

One of the ways that technology like RPM can help improve patients' experience with a health system, according to Rahim, is by allowing them to avoid unnecessary hospital or emergency room visits. "The ability to keep people out of the acute setting when not necessary, provide a better patient experience, I think that's what technology has allowed us to do further," he said.

Rahim has worked to ensure thousands of patients get enrolled in remote monitoring to help manage their chronic conditions. "We're trying to bring care upstream and be proactive, and that's very different than the kind of the sickness-based model that we've been working in for the last 35, 40 years," Rahim shared.

Thus far, RPM has led to positive clinical outcomes in patients, such as reducing systolic blood pressure for hypertension patients. "That's huge," Rahim said. "These are small things. It's a silent killer. But it's well-proven that if we make those changes and really support patients to achieve those goals, it can prevent strokes, prevent heart attacks, and prevent even cardiovascular related death."

Rahim said that approximately 2,300 patients have been enrolled in RPM to manage their hypertension, and he believes this has become a major differentiator and reason why patients are drawn to Mount Sinai. "Oftentimes, these don't necessarily get talked about, some technologies [that have] an ability to drive market share. But I truly believe, and I've actually seen some examples of certain employer groups or labor unions that I think took a maybe even deeper look because of some of the work we've done in remote patient monitoring and even specifically in hypertension," he said.

The challenge with implementing RPM across Mount Sinai thus far has been establishing a playbook since it is still such a new technology. "There's no playbook here at a very basic level," Rahim said. "Which disease states do you choose? How do you select your patients? Which particular actual technology vendor? There's a lot. It's just a newer area. But there's been a lot of enthusiasm, but there's a lot of figuring it out, and there's figuring it out together going on."

These are universal challenges across health systems that are also considering implementing an RPM program of their own. In that spirit, Rahim offered up several lessons learned based on Mount Sinai's experience to help educate others and set up their own playbook for success.

1. Establish a care standard for how to manage chronic conditions

According to Rahim, the first priority for Mount Sinai, even before implementing an RPM program, was to establish its own care guidelines for how to manage patients with chronic conditions. "I just colloquially term it "the Mount Sinai way" of managing certain chronic diseases," Rahim shared. For Mount Sinai, that meant developing its own ambulatory care guidelines across six chronic disease states. "That helped at least establish a foundation," he said.

With that foundation in place, the next step was to answer the question of "who can actually help ensure that that care standard is followed and do that in the most efficient way." "For us," said Rahim, "it really ended up being under the CDTM protocol, the Collaborative Drug Therapy Management in New York state, to be able to use clinical pharmacists with supervising physicians."

2. Set up the technology to enable clinicians to easily adhere to the standard

With the care standard in place, the next step for Mount Sinai was to build a technology layer that enables clinicians to easily follow that standard. "We've built registries and dashboards in Epic to really be able to track our adherence to the standard," Rahim shared.

Setting up the technology to be able to seamlessly support clinicians, while scaling up to serve a large patient population, is absolutely critical. "Ultimately, this is really about goal-directed medical therapy, and that could be medications, but very well not as well, and how do we implement that and really care for our population," Rahim said.

3. Build infrastructure to be able to track and measure outcomes

A third lesson is the importance of creating a comprehensive way to evaluate and measure program success. "If you're going to really try to transform care," Rahim said, "you need to have that competency and program evaluation and program measurement. And I think you need that to be able to do these programs because you'll also need the system financial support over a period of time. In general, their love language is numbers, so you need to show them some numbers."

Rahim said data is also one of the most important tools to be able to show the efficacy of RPM to policymakers and ensure the technology continues to get expanded for the benefit of patients and clinicians. Rahim said his conversations with policymakers typically revolve around seeing relevant clinical data that shows RPM's efficacy. He said that policymakers are often asking questions like: "What should we be covering? At what level? What should we continue to cover?" "I really think it comes down to the data now," Rahim shared.

For Mount Sinai, that means looking specifically at how RPM can improve specific patient outcomes across several key areas. "We're looking in two major areas, really acute utilization reduction and then really blood pressure control. Or blood pressure control and even blood pressure reduction. I would say specifically in that area, blood pressure reduction, then you can tie it to, and we're not measuring it yet, but you could predict some reduction as maintained in major adverse cardiac events, or MACE as a lot of people refer to."

Listen to the entire podcast above and to hear future episodes, subscribe to Cadence Conversations wherever you get your podcasts. Previous episodes of the podcast include Ardent Health Services CEO Marty Bonick discussing the health system's partnership with Cadence, CEO of Community Health Systems Tim Hingtgen discussing how CHS approaches digital innovation, and Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs, discussing the future of remote patient monitoring.

If you're a clinical or health system leader and you are interested in whether Cadence's remote monitoring program could be a good fit for your health system, please get in touch and you can learn more about our program here.