A Business Plan for a Remote Patient Monitoring Startup

Abstract

Purpose: Obstructive sleep apnea (OSA) is a sleep disorder characterized by complete or partial airway closure during sleep. The treatment for OSA is positive airway pressure (PAP), but 34% of patients who are receiving this treatment are non-adherent. One proven method of increasing adherence is through remote patient monitoring (RPM), or in other words, staying connected to patients through real-time monitoring of their physiologic data. Medicare, as well as other insurance companies, have become aware of the benefits of RPM, and have recently introduced new billing codes to incentivize clinicians to incorporate RPM in their clinical practice. However, the current systems for RPM are described by clinicians as being unfriendly and time-intensive, resulting in little to no monitoring of patient data. Thus, I developed a business plan for an RPM platform that keeps sleep medicine physicians updated on their patients’ response to therapy, with the goal of improving adherence and overall patient outcomes. Methods: To better understand the pain points in RPM, I developed a survey which I sent to board-certified physicians of sleep medicine who treat patients with OSA. The survey was sent to physicians in both private practice and academia (primarily within the Harvard hospital system including Brigham and Women’s Hospital, Massachusetts General Hospital, and Beth Israel Deaconess Medical Center). The survey was completed by eleven clinicians (see Appendix for sample survey). Additionally, I interviewed four of the clinicians individually to better understand how they integrate RPM in their practice. The combination of survey responses and interviews provided me with a better understanding of the pain points in RPM, which I then used to design a startup responding to the clinicians’ needs. Results: Of the eleven clinicians who responded to the survey, nine (81%) were in academia and two (19%) were in private practice. Seven (64%) of them used RPM in their practice to track their patients on PAP therapy. Three (27%) reported that they did not know that RPM was billable by Medicare or other insurers. When asked about pain points, seven (64%) reported that time was a constraint and eight (73%) reported that software issues were another constraint in their ability to engage in RPM. Overall, there were five major pain points commonly reported by clinicians: 1) RPM is not worth the effort, 2) I do not have the time to monitor all of my patients, 3) It is difficult to know who is doing well and who is not, 4) I cannot keep track of patients I monitored or contacted, and 5) I did not know you could bill for RPM. Conclusions: Using the feedback I obtained from physicians, I developed a business plan for “MonitAir” – a startup that aims to improve RPM for the treatment of OSA. MonitAir consists of two parts: 1) a software that allows physicians to keep track of their patients’ sleep data, and 2) an outsourced monitoring service. Outsourced monitoring refers to contracting medical staff (i.e., nurses and medical assistants) who can keep track of patient data remotely, make interventions as needed, assist in billing, and provide updates to physicians. This two-part design solves the problems of time and software constraints, providing clinicians with a solution that is directly targeted at improving adherence to therapy and overall patient outcomes. Other RPM startups have emerged in this area and are focused on tackling other diseases like hypertension and diabetes, but MonitAir is the first startup focused on OSA. The vision for MonitAir is to eventually dominate the untapped respiratory care segment, beginning with OSA and expanding into the more prevalent COPD and Asthma populations once the current business model is proven.