Introduction
Due in part to the outbreak of Covid-191, there is a trend in the healthcare industry to use consumer wearable devices to provide an additional layer of health monitoring for patients in between office check-ins. This real-time data is especially crucial for those suffering from chronic illnesses such as obesity, autoimmune, diabetes, and other “lifestyle” diseases.
To follow are helpful hints on how best to use wearables and other lifestyle monitoring applications as part of your healthcare management programs. In particular, we will highlight the most suitable wearables for the various disease conditions in terms of providing actionable data and are suitable for remote patient monitoring (RPM).
Integrating wearables and lifestyle metrics as part of your RPM strategy
Incorporating lifestyle data into a health management plan augments traditional medical treatment plans rather than replacing them. Lifestyle data helps improve outcomes by providing additional patient oversight, more meaningful recommendations, and healthcare delivery personalization. Enabling lifestyle metrics to enhance RPM needs an efficient and strategic approach, just like any business decision. Let’s take a look at a few key recommendations on how to integrate this data with your current RPM program.
Identify your goals
The first step to integrate lifestyle data into your care delivery model is to think about what you seek to achieve by making this change. Some questions you may want to think about include: How will lifestyle data to enhance your healthcare delivery? Better outcomes? More patient engagement? Greater adherence to programs? What data is most important for you? Furthermore, what are your goals in terms of time spent implementing and monitoring these new data sources? This could mean yourself being the ‘interpreter’ of the
1 Using wearables to provide for the early detection of covid. Wearables can also be used in treatment programs for preventable diseases by helping to improve outcomes and cut healthcare costs. https://www.mobihealthnews.com/news/pairing-wearables-data-self-reported-symptoms-could-improv e-covid-19-prediction
data, while an ancillary care team member might be responsible for reviewing the data and keeping the patient engaged. Quite often this responsibility will fall on the nurses, nutritionists, and health coaches. These team members tend to have the most contact with the patient/client so are in the best position to make use of the lifestyle data for monitoring the patient/client’s health status and progress.
Determine the offering model
You have a few decisions to make, once you decide to implement RPM in your practice using lifestyle data. How do you package it? Will it be a standalone program or combined with an existing program/protocol? Some clinics incorporate wearables into brand new programs/new revenue streams. For example, lifestyle medicine clinic GladdMD created a completely new ketogenic weight loss program that incorporated lifestyle data for monitoring progress. It was a premium offering, packaged with their normal ketogenic therapy guidance, that they then sold standalone, creating a whole new profit center in their business. You can learn more about GladdMD and their use of the Heads Up platform by watching Remote Wellness Monitoring for Keto Therapy Practices
How you do this, is up to you. Bottom line is, when used correctly, these types of insights pay for themselves.
How will you pay for the devices
Very few wearable devices are covered by insurance. This may change over time. The current list of devices that qualify for reimbursement are listed on the FDA website. Devices that are covered by insurance tend to have FDA approval.
So if they are not reimbursable, the question remains, how do you make these devices available for your clients? One option would be to buy the device and charge per month to cover the cost. This cost can be included into the program or offering you developed above. Or you may have your patient/client purchase the device. If they are covered by insurance, HSA/FSA plans allow for reimbursement of a wearable health device if the provider (yourself) issues an LMN (letter of medical necessity). If they are not, you can stipulate that the device is an additional cost to your program.
That being said, consumers are more engaged than ever which makes it easy to gain access to their lifestyle data.2 Currently, 21% of the US population uses a wearable device
2 The US population is showing a strong desire to learn more about their health and take ownership of their data. https://www2.deloitte.com/us/en/insights/industry/health-care/consumer-health-trends.html
on a daily basis and this number is growing rapidly. So finding clients who already use this type of technology will often not prove challenging.
Identify your messaging and positioning strategy to get your clients engaged
As with any new offering, you have to decide how to ‘launch’ this new healthcare delivery service. You will then need to strategize how to roll it out to your patients and get them engaged in using wearables devices and sharing the data with you. Here are a few recommendations on the best ways to position your new offering for success.
Discuss the benefit of using wearable data with your RPM service with your patients: Being able to demonstrate positive changes and outcomes drives behavioral changes and the creation of healthier habits. Similarly, this wearable data helps the practitioner personalize the delivery of healthcare to instill patient accountability, better patient engagement, provide frequent feedback loops, and drive better outcomes. Providing the patient with this data allows them to take control of their own health journey, which is extremely empowering.
Set expectations for their health journey: Some clients may be reluctant to share wearable data. It is a behavior change, as mentioned. However, communication is best when expectations are set on both sides for the health journey they are about to undertake with you and your clinic. Make sure they are clear as to the costs, their own time commitment, and the frequency of interactions with your team. The key is to meet the patient where they are. This requires close communication and a thorough understanding of the patient’s capabilities and needs.
Emphasize that using lifestyle data makes their wellness journey a collaborative team effort:
Today more than ever, people want to control their health and how sick care is delivered. They want greater access and ownership to their health data. Access to this data ensures the patient is engaged in their healthcare journey and will ensure better outcomes.
Choose the right tech stack
The use of lifestyle data in healthcare delivery is a powerful adjunct, but can also sometimes feel overwhelming. You need to understand what metrics are important, how you access these metrics, what burdens are placed on the patient to acquire these metrics, and how best to organize the data to help make meaningful decisions.
Health transformation is a collaborative process. More likely than not, if you’re running a practice, you’re the doctor in charge of prescribing protocols, running lab tests, and interpreting all of the results. These methods are best used when practiced with a health coach or ancillary professional who can handle the setup of the technology, and provide patient education, monitoring, and feedback on the lifestyle data. Heads Up allows you to invite team members and assign them specific clients, supporting easy delegation of duties to your team.
Your platform should save you time on administrative tasks and provide increased value to your patients. Saving you time on administrative tasks means centralizing information, and removing redundant work. Heads Up’s customizable dashboard allows easy access to lifestyle data for all of your patients. Heads Up also has a ‘Notes and Protocols’ feature, that allows you to save frequently used protocols as templates you can customize and reuse with your clients.
While data from wearables can be vast, your tech stack should allow you to measure specifically what matters to your practice, and derive insights from that data. Customizing your client’s dashboard through Heads Up is as easy as dragging and dropping. We recommend choosing 5 to 8 biomarkers to monitor. The Analyzer tools allow you to derive insightful correlations and build empowering reports to share with the patient. Data is only as good as what you decide to do with it.
Top biomarkers to measure for health optimization
Wearables provide easy access to a range of health metrics than was not previously possible. Wearables provide a more comprehensive view of the health status of a patient/client. Furthermore, the patient/client feel they are a part of the solution, working with their healthcare team to improve and optimize their health. This use of lifestyle data and traditional healthcare protocols provides better health outcomes.
Post chronic management health optimization metrics to monitor are as follows:
Sleep
There is a modern-day misconception about the importance of sleep. We’ve convinced ourselves that anything else is more productive and frequently hear the expression “you can sleep when you’re dead.”
Recently, though, sleep science has been gathering steam and proving what should have been intuitive all along–our bodies didn’t evolve to waste time. Sleep is central to your health and performance. Although we remember little from our time asleep, our brains are firing and our bodies are actively repairing. Your brain consolidates memories and removes toxins while you sleep, while your body stokes your immune system and regulates your metabolism.
This movement is starting to have a social impact, and people are waking up to the importance of investing in sleep. If you want to take better care of yourself, start by making your sleep a priority.
The research is clear that adults should get 7 to 9 hours of sleep per night. This range of sleep hours is based on years of research and is the standard set by the National Sleep Foundation. It’s been determined that chronic sleep deprivation can lead to accidents, dramatically increase the risk of cardiovascular disease, and lead to weight gain, to name a few.
Another important aspect of sleep that can help one maintain optimal health and performance is sleep consistency. Ensuring consistency in your bed and wake times can make a world of difference. For example, going to bed early and waking up early during workdays can help improve productivity throughout the week.
Some users will often wake up tired despite sleeping the appropriate number of hours. This is typically due to restless sleep.
Sleep Disturbances caused by wake-ups, get-ups, and restless time during your sleep can have a big impact on your sleep quality and daytime cognitive performance. Restless sleep is less restorative than uninterrupted sleep and it's usually the cause of daytime sleepiness.
Disturbances can be caused by various factors, such as stress, noise, partners, pets, or different foods. To improve your chances of getting restful sleep, have a look at the tips below:
● Optimize your sleep environment by making sure your mattress is comfortable and your bedroom is cool (~ 65 ℉/18 ℃), quiet, and dark.
● Avoid spicy, heavy meals, and alcohol close to bedtime.
● Avoid caffeine prior to bedtime and late in the afternoons.
● While regular physical activity can make your sleep more restful, try to avoid exercising at least 1-2 hrs before your normal bedtime.
● Help your brain and body to wind down by disconnecting from bright screens and dimming bright lights 1-2 hrs before going to sleep.
Recovery
From a circadian biology perspective, your day begins when you go to sleep each evening. Sleep allows the human body to recover from the physical and mental demands of the day.
Some of the top metrics related to recovery are:
Resting Heart Rate (RHR) - This metric captures the number of times your heart beats per minute while at rest. An abnormally high or low resting heart rate may mean you’re overly stressed and not getting enough rest, or perhaps your immune system is fighting something.
Heart Rate Variability (HRV) - As popular as the metaphor may be, a healthy heart doesn’t beat as regularly as a metronome—it changes its rhythm with each beat. This constant variation in milliseconds between your heartbeats is known as your heart rate variability (HRV).
Some situations increase variation (high HRV), while others cause the intervals between beats to remain constant (low HRV).
You may be unaware of these subtle variations, but they reflect your heart’s ability to respond to different situations. HRV can react to stress and/or illness before resting heart rate (RHR), which makes it one of your body’s most powerful signals—providing useful insights into your stress levels, recovery status, and general well-being.
As a rule of thumb:
● High HRV is associated with rest-and-digest, general fitness, and good recovery
● Low HRV is associated with fight-or-flight, stress, illness, or overtraining While individual days may be lower after high-intensity exercise, a night out, or a stressful day, if your recent HRV is on par with or better than your average, it’s a sign of good recovery. Monitoring HRV trends shows whether you are adapting or not to the “load” you are exposed to. This load could be new medications or treatment plans, or an increase in training load.
Body Temperature - Body temperature is a key signal, as your body constantly generates and sheds heat to hover around your ideal temperature. This metric can act as a warning, signaling cold or broader health development like hormonal fluctuations. Very few wearables track this wearable. One exception is the Oura Ring which monitors your skin temperature while you sleep. This form of measurement is very close to your core temperature only while you are sleeping. You can also use one of the many digital thermometers to check your temperature right after you get out of bed.
Respiratory Rate - This metric measures the number of breaths you take per minute and is typically measured while at rest. Average respiratory rates for adults at rest range from 12-16 breaths per minute. Respiratory rates that trend above a user’s baseline by a non-trivial amount can indicate impending illness or stress. Respiration Rate has proven to be one of the best early warning signals that a patient may have contracted the Covid-19 virus.
Movement
Sitting is considered by many to be the new smoking due to the rising evidence that prolonged sitting can contribute to a range of diseases and conditions including:
● Cardiovascular disease
● Type 2 Diabetes
● Anxiety and depression
Obesity
● Elevated blood pressure
● Higher cholesterol
The human body performs better with regular movement throughout the day. Even standing up once every hour and stretching or doing a few jumping jacks can bring enormous health benefits.
The features and trackable metrics of all of the most popular wearables
More and more wearables and health/fitness apps are showing up on the market with each passing year, each with a promise of helping the user to achieve greater health and fitness. Below is a link to a matrix that outlines what wearables are currently supported by Heads Up and the metrics each wearable provides:
https://headsuphealth.com/support-matrix/
Data from other wearables is also available within Heads Up via Apple Health or Google Fit. As long as a wearable not listed in the support matrix can share the data with Apple Health or Google Fit, you may be able to then pull it into Heads Up. For example, Omron Blood Pressure devices sync to the Omron App, which then shares the data with Apple Health in such a way that it can be pulled into Heads Up. The same is true for Nonin and Masimo PulseOx devices.
Some other devices we hope to integrate with Heads Up or otherwise enhance the integration include the following. (Note there are no guarantees as to when or if at all these integration will occur. )
● Halo is especially interesting due to its dynamic intensity minutes method (subtract excessive sedentary time) as well as the potential to use the Tone feature to detect depression.
● Qardio
● ForeCare
● Genetic and Epigenetic companies whose data can help fine tune treatment plans
● Additional CGM companies such as Supersapiens.
● API connections to existing devices will be updated to pull in additional metrics that have been added to newer devices. This includes Garmin’s 24/7 Stress, Body Battery, and Respiration Rate to name a few.
How
to determine what features/biomarkers are right for your practice and wearable pairings
Corporate wellness:
● Traditionally, corporate wellness programs have focused on movement/steps and are structured around short term competitions.
● The challenge is that these short programs do not result in the reduction of health insurance claims as 80% of the claims tend to be driven by a minority of the employees who are suffering from chronic disease.
● Reducing health insurance claims will require a functional medicine approach. This approach would require periodic blood labs and continuous lifestyle tracking (sleep, nutrition, and movement).
● Employment wellness needs apply to the entire organization and be ongoing rather than being tied to a short term competition.
● The employee wellness programs can continue to use friendly competition, but should also show cohort analysis to demonstrate success and build a sense of pride and empowerment among employees.
● Employers should consider subsidizing the cost of wearables that provide sleep and movement tracking. These devices include the Apple Watch, Oura, Garmin, and Biostrap.
Human Optimization Spas/Clinics
● There has been an increase in the number of Spas/Clinics offering advanced recovery modalities such as float tanks and cryotherapy.
● These clinics often have both traditional gym equipment and advanced equipment such as the Vasper and Carol Bike.
● Wearables that track HRV/Recovery help quantify which therapies and workouts provide the greatest benefit. These devices would include Oura, Biostrap, and the Apple Watch. Apps such as EliteHRV can also be used.
● The cryotherapy clinic in this case study did just that! Cryotherapy Case Study.
Fasting/Weightloss Clinics
● It is not a secret that obesity is on a rise. Confusing and conflicting dietary recommendations are compounding this problem.
● Luckily clinics focused on fasting and weight loss are starting to spring up and are showing great results.
● Most of these clinics monitor weight, BMI, glucose, ketones, blood pressure, sleep, movement, and nutrition. Devices used include wireless scales, KetoMojo, Biosense, Dexcom/Libre, Oura, Biostrap, Apple Watch, and blood pressure cuffs.
● Two clinics that have done just this are The Fasting Method and ThreeHealth.
Sports Clinics
● Sports clinics focus on high end athletes.
● The focus is on maximizing recovery, increasing fitness/resilience, and injury prevention.
● The data utilized by these clinics includes sleep, recovery, workout data, meditation/mindfulness, nutrition, and blood labs.
● Popular devices/Apps include Oura, Garmin, EliteHRV, Strava, and Dexcom/Libre.
● Podium Sports is a sports clinic that has helped many athletes on the PGA tour and Tour de France perform at the top of their sport through use of a functional medicine approach to sports medicine.
Health Coaches
● Health Coaches work on their own and are more commonly found at health clinics.
● The trend is to use Health Coaches to provide the front line support to the patients. This includes monitoring lifestyle data and calling patients as needed.
● Health coaching focuses on general health and wellness, but can also be focused on particular protocols such as a Ketogenic program.
● Health coaches focus on lifestyle data and blood labs.
● The devices most used include Oura, Biostrap, and Apple Watch. For metabolic patients, additional devices/apps such as wireless scales, Dexcom/Libre, KetoMojo, and Biosense are often used.
● As referenced above, functional medicine clinic GladdMD used this approach with one of their health coaches facilitating the whole program. Here is a recent webinar we did with them discussing the role of the coach in the program they implemented.
Conclusion
The data from wearable devices, in conjunction with a collaborative care team and patient centric care model, will drive the future of health. The rise of adoption of consumer wearables devices is showing the industry that there is now a willingness to utilize and act upon data that is readily accessible and insightful in terms of providing better outcomes. After all, true health doesn’t happen in the doctor’s office, it happens where we work, sleep, play and everywhere in between. Wearables devices present an effective way to gather information on your clients to use in your RPM strategy.
While some wearables might not be as accurate as others (clinical grade) they still present an opportunity for data capture 24/7, that allows providers like yourself, continuous insights into a person’a lifestyle, that can be used to personalise their treatment protocols.
As wearable technology presents a solution to an immediate need, to stay on top of trends in the future, practices now must adopt a wearable data strategy into their RPM plan. It’s coming time where this is an almost necessary piece of the puzzle to improve outcomes, that will only grow as time goes on...from data analytics capabilities, precision medicine, and AI based recommendations.
For more information on how Heads Up Health can help you achieve success in your practice using wearable data as part of your remote wellness plan, visit www.headsuphealth.com/functional-medicine for more information, or email support@headsuphealth.com to get started on your free plan!