A data-driven model is used by CareCentrix’s iComply, which was developed by a team of respiratory therapists and sleep medicine physicians who applied the principles of behavior modification to patients with obstructive sleep apnea.
Improving therapy adherence is an ongoing challenge for clinicians treating patients with obstructive sleep apnea (OSA). So it’s noteworthy that a new program by benefits manager CareCentrix that allows respiratory therapists to support patients who are starting to use positive airway pressure (PAP) devices such as CPAP to treat OSA shows improved adherence as well as reduced patient and payer costs.
“The iComply program was inspired by the recognition that patients with OSA often struggle at the start of therapy,” says Michael Cantor, MD, JD, chief medical officer at CareCentrix and the person leading the program. “It can be difficult to acclimatize to therapy, especially to find a comfortable mask. Studies in the medical literature show that only about 50% of patients starting PAP therapy are adherent at 90 days.”
Using a data-driven adherence model—meaning the intervention is based on evaluation of data obtained directly from the PAP device in addition to self-reported information—the program separates itself from others that rely solely on self-reported information or other indirect measures of adherence. Cantor adds, “We recognize that some patients need more than 90 days to get acclimated to PAP therapy, and we provide a specific track designed to encourage these patients to use their PAP devices properly, which can lead to a greater percentage of OSA patients using the therapy they need.”
A team of respiratory therapists and sleep medicine physicians who applied the principles of behavior modification created iComply. “IComply staff are respiratory therapists with experience working with OSA patients,” says Cantor. “They understand the challenges of initiating PAP therapy and the importance of intervening early.”
The respiratory therapists work with the patients over the phone, using data from the PAP devices to guide the support. “They can see when patients struggle to use it for the proper number of hours or when masks are leaking,” says Cantor. “During the calls, they focus on the specific concerns of the patients and help them overcome any challenges they are facing.”
The program was developed with the goal of using data from the PAP device, which is automatically downloaded, to identify adherence issues and to collaborate with the patient, their treating physician, and PAP provider to correct them as soon as possible. “Without support,” he says, “patients often struggle to get questions answered and may require adjustments to their masks and equipment.”
IComply has improved the number of patients who adhere to therapy from 50% to 80% to 90% at 90 days, according to CareCentrix. This has been achieved by “having a standard program that is modified to meet each patient’s needs and by identifying patients who narrowly do not achieve the criteria for adherence,” says Cantor. For those “borderline patients,” he says iComply has a special pathway with additional support. “With this support, the majority of patients become adherent and get the benefits of PAP therapy. Even more importantly, patients may see improved wellness on PAP therapy and get more restful sleep.”
Not only is this program improving patient outcomes, it is also rapidly reducing patient and payer costs. “IComply can lead to greater adherence with PAP therapy, which leads to better health outcomes like more restful sleep, better blood pressure control, and better blood sugar control for patients with diabetes,” says Cantor. “Even though the increased use of PAP therapy has implications to out-of-pocket costs and coverage, over time these costs are more than offset by reductions in medical treatment costs, including from poorly managed complications of untreated OSA, like diabetes and high blood pressure. Studies in the literature estimate cost savings of $2,500-$3,000 per patient per year by avoiding complications of high blood pressure, diabetes, and other complications of OSA.”
Since iComply is part of the sleep solution CareCentrix sells to insurance companies and employers, only members of health plans with contracts with CareCentrix (like Cigna or Florida Blue), as well as some employers, have access.
Cantor offers a personal perspective as to why iComply is so effective. After putting off a sleep study for a good while, Cantor finally got tested and treated for OSA. With the program’s support, he was able to remain compliant with his therapy. “This program not only makes a difference in the lives of our population of patients, it really matters to people like me who benefit from the extra support they need to use PAP therapy,” he says. “And my wife is thrilled that my snoring has stopped!”
Dillon Stickle is associate editor of Sleep Review.
No other insurance company is willing to pay respiratory therapists to do this. It is not a new idea. It is what equipment companies should be doing in the first place. Have Medicare actually pay to improve compliance out to 120-180 days and other insurance companies will follow. In fact require companies (WITH ADEQUATE REIMBURSEMENT) to have respiratory therapists available to do this. My life would be easier and we would achieve better health!!!!!
Your exactly right. I was thinking how is this a new development. Our company has been doing FREE CPAP clinics for patients for over a decade. BTW, over the phone is lame. What if they want to try out a different mask. How they going to do that over the phone? I was thinking they should have an app where that can at lease do a tele-medicine visit.
You are absolutely correct. Companies do not want to pay for the expertise and specialty training of a Registered Respiratory Therapist so they hire non-medical personnel or medical assistants who have no clue about the modes, the masks or the device. I work in our sleep program as an RRT and deal with several equipment companies. When I have to call they either don’t have an RRT or the only one they do have is at lunch. As the only RRT I am inundated with work that one person cannot possibly handle alone resulting in patients falling through the cracks or not getting everything they need.
The biggest issue I experience in dealing with patients starting out with CPAP therapy is having therapy driven by the insurance companies and forcing people to start on Auto PAP. Most people cannot handle the continual fluctuation of the pressures and the only reason they are becoming compliant is people in the medical field, sleep labs, doctors offices, DME companies are doing a lot of free services to fix situation that they cannot be reimbursed for. Most patient need hands on titration studies to start process off in the right direction, those patients do much better in the long haul. I am one of them.
There is no doubt that hands on is easier for the patient and a sleep technologist or RRT to work together. However, many patients do not make the effort to contact their sleep lab or come in to be helped. Some cannot make frequent trips to the lab. But many times, they are willing to talk on the phone. Staying in contact is the key. The patient can benefit knowing someone is going to call and help them and listen. I think autopap is amazing and offers everyone a comfortable chance at adjusting to PAP. Learning how to help someone on the phone is challenging but possible. Sleep labs will need to change how they help patients.