Cosan Group
Remote Patient Monitoring Emerges As Key Components Of Better Virtual Care

Whether you ask a physician working on the front lines or take a 30,000- foot view of the industry as a whole, we know that improving the U.S. health system will require the simultaneous pursuit of the triple aims: improved experience of care, improved health of populations, and reduced costs. Several challenges have hindered the industry’s progress towards these goals, including: the costs associated with adopting, implementing and learning new technology, specifically in the older adult population; a lack of reliable revenue sources; and the limited adoption of virtual care methods by providers and patients alike. All of this changed in 2020.

In large part due to the changes forced upon us by the COVID-19 pandemic, the traditional barriers blocking remote patient care diminished. Virtual care went from being an intriguing option to becoming a mission-critical, and often preferred, necessity of care delivery. Nearly overnight, providers— some of whom had been reluctant to incorporate telehealth for years— were essentially required to embrace these tools in order to continue providing care to meet their patients’ needs. Meanwhile, patients of all ages were left with no other choice but to adapt to these new models of care delivery as stay at home orders, fear of infection and care delays disrupted traditional care delivery. Perhaps no group was more challenged by this change than seniors, among which only 1 in 10 patients used telehealth prior to COVID-19. While rapid adoption was necessary in ensuring non-physical care delivery, it became clear that not all solutions are created equal in terms of quality and accessibility of care for aging adults and the providers who specifically care for them.

Already at the forefront of addressing gaps in care and advancing virtual care for this patient population is Cosán Group, an industry-leading healthcare organization focused on creating new pathways to modern aging with technology-driven preventative care services, through concierge virtual care for older adults on behalf of their provider partners. Since 2015, their team has been developing technology solutions and services to improve the delivery of preventative care for at-risk older adults which support successful aging in place. Never knowing how large and complex these gaps would become in 2020, Cosan’s advancements in the market in years prior had positioned themselves, and their partners, for enhanced success as they responded to this shifting care landscape.

Now that the pandemic has thrust telehealth into the mainstream across all of healthcare, Cosán continues to look ahead at how they can build on telehealth’s momentum to further improve the outcomes for at-risk, aging, and chronically ill patients. At the same time, their approach is also increasing practice efficiency, introducing new sources of fee-for-service revenue, and enabling the shift towards value-based care for providers. The key factor is driving remote patient monitoring and remote preventative care management for more patients.

“Cosán strives for excellence in preventative care services for at-risk older adults to support successful aging in place. In collaboration with providers, Cosán uses advanced technology with a network of healthcare methods to analyze, evaluate, and coordinate care plans to reduce the cost of care, increase practice revenue, and improve outcomes and quality measures while enhancing the quality of life for the individuals we serve and the overall experience of aging,” says Dan Hirschfeld, CEO, Cosán Group.

By building off their rapid adoption of virtual care, Cosán continues to integrate other emerging technologies like AI and machine learning to develop evidence based risk stratification for more efficient, engaging, and easy-to-use tools for this at-risk patient population— the most critical being remote patient monitoring, or RPM.

With over 70 percent of all healthcare dollars in the United States spent on those with multiple chronic conditions— including the 60 percent of seniors who deal with more than one condition— and as our elderly and aging population continues to explode, it’s hard to understate how critical the needs of seniors will be to the future of the overall healthcare technology landscape.

Cosán strives for excellence in preventative care services for at-risk older adults to support successful aging in place

These factors have made RPM technology for seniors a market ripe with opportunity, and transformed their place among providers as a priority rather than an afterthought. In fact, experts predict the market for this solution will experience major growth due to an increasing adoption rate, moving its valuation from $745.7 million this year to more than $1.7 billion by 2027.

Powered by Technology, Driven by Expertise

Cosán enables users with chronic conditions to connect more frequently with their doctors or healthcare providers in between scheduled visits. When deployed by a provider, patients are assigned one of Cosán’s care coordinators, who assist the patient’s primary-care doctor with developing and refining a complete care plan based on his or her condition and goals. Over time, patients then receive periodic check-ins from their care coordinator, based on need or remotely-monitored signals from the company’s mobile/ smartphone-enabled virtual care assistant, known as “VAL” (Virtual Assisted Living). Depending on the care plan set by the physician, Cosán provides patients with all the devices needed— including pulse-ox, weight scale, glucometers, blood pressure monitors, etc.— as well as a tablet that collects all vital readings, which are then compared to the patient’s predetermined thresholds.

This technology provides the care coordinators with alerts, to address identified risk, and, if needed, proactively trigger live engagement between care team members, providers, and appropriate community resources. Cosán also offers robust reporting dashboards that provide real-time data on key performance indicators and ensures that every care management activity is time-tracked and pulled into an audit trail that meets Medicare’s chronic care management requirements.

“This collection of information is monitored and analyzed in real time to proactively and virtually enable the care coordination team to triage high risk conditions with successful clinical interventions,” says Hirschfeld. “Our care support features allow patients to make video calls or send texts or email messages directly through the tablet to their healthcare provider or clinical care coordinator, enabling collaborative clinical support to help actively manage their health to support functional independence.”

However, what truly makes Cosán unique is their network of skilled, coordinated care professionals, acting as an extension to current care models. These coordinators not only fill the gaps of care between in-office clinical exams or telehealth visits, but use innovative technology to offset/ relieve the strains on providers. They monitor, assess, and evaluate each patient’s health to minimize risks and improve overall well-being, while keeping charts up to date for a comprehensive and enhanced doctor’s visit. They deliver positive, caring, concierge services using real-time analytics, fully supporting providers in administering the best preventative care treatments possible.

The company also provides a quality payment support program, advanced care planning and medication management solutions, scheduling/call center support technology, and a complete clinical staffing solution, among other offerings. Cosán primarily provides its services to physician groups, post-acute care and assisted/independent living organizations.

In addition to positive financial outcomes for practices, healthcare organizations, and payors, including Medicare, Medicaid, and commercial beneficiaries, Cosán also empowers organizations who are participating in alternative payment models with a formal platform to foster care coordination, quality measure success attainment, advance care planning, care transitions, medication reconciliation, and a number of other success-driving factors.

Infusing AI to Passively Collect Patient Data

Cosán’s services also include a comprehensive behavioral health integration platform supporting individuals with depression, loneliness, cognition and other challenges. Realizing the value of a rehabilitation episode is lost during the weeks after discharge, as older adults often experience a decline in health once therapy stops, Cosán recently partnered with MyndYou – a health-tech company using AI to assess brain activity and provide insights into the evolving health status of at-risk and older adults – to leverage voice analytics to detect anomalies through Cosán’s remote care coordination platform. MyndYou offers a customizable, automated voiceBOT, that conducts telephonic check-in calls and speaks with members to detect health anomalies, which are elevated to the care team for intervention before emergent care is required. The passive monitoring solution is a new approach to identify physical deterioration and hospitalization risk – allowing for improved care delivery and potential cost savings.

Cosán also utilizes Myndyou’s AI-based voice analytics and remote therapy, in collaboration with traditional physical, occupational, and speech therapies to monitor potential anomalies that may indicate a decline in a patient’s functional and cognitive health. This enables Cosán to deliver risk stratification, which is another key component of advanced modern care. Cosán takes all the data from conversations with patients and physicians and readings from bed sensors or devices to first develop a benchmark of what optimum health means for that patient. With AI, they run voice analytics while talking with patients to check if there is a change in their voice or behavior that could indicate pain, discomfort, confusion, depression, loneliness, or other issues.

This data is collected in real time and provides an understanding of when to intercept or how often to collect the data to mitigate risk or adverse events. If Cosán sees a pattern that may lead to avoidable hospitalization, they can intervene immediately and coordinate with the physician on the appropriate action. Through secure, remote access into the provider’s EMR, Cosán’s care teams provide ongoing review and updates to medical records to identify and inform of changes in condition, movement status for evidence-based risk assessment scores, changes in health status including medications, falls, hospitalizations, and specialist visits. All of these components, working in harmony, provide physicians with visibility into the gaps of care between office or telehealth visits.

The Perfect Solution for the “New Reality”

The fact that Cosán’s offerings are delivered virtually makes them the go-to partner during the current pandemic crisis, and well into the future, as more providers look to support better outcomes by activating increased patient engagement. Over the last few months, the company has seen a 3x increase in revenue, and as of today, Cosán operates in 32 states across the United States, with plans to continue expanding its services to the rest of the country.

"We aim to move the needle in healthcare, making it more value-based than fee-for-service"

“We aim to move the needle in healthcare, making it more value-based than fee-for-service. We will introduce new cognition programs as well as transitional care services, coordinating care with patients prior to and post-surgery to ensure a safe and successful discharge,” concludes Hirschfeld.

As 2020 ends, it is safe to say that RPM has successfully marked a prominent place for itself in the U.S healthcare system. It helps keep high-risk patients at home and redefines the future of value-based healthcare. We know the technology works, patients and physicians are readily embracing it, and CMS is ready to pay for it. What’s needed now is innovation; and Cosán is leaving no stones unturned to deliver just that.