The Problem
With 6 in 10 adults living with one or more chronic conditions, chronic disease is today’s leading cause of death and disability in the U.S.
Several weeks after Cathy Burnet underwent a routine gallbladder procedure in the summer of 2019, she began experiencing a sharp pain in her stomach followed by chest pain. Cathy, a 70-year-old woman living in Lacey, Washington, went to see her doctor for a round of blood tests and an EKG and promptly learned that she was in the midst of a massive heart attack.
She rushed to the emergency room and received lifesaving care, but Cathy was later diagnosed with hypertension. Cathy’s doctor emphasized the importance of controlling her blood pressure, but she had difficulty doing so and began experiencing periodic dizziness, heart palpitations, and chest pains. This was her new normal – attempting to manage her hypertension from home, Cathy constantly worried about her health and feared another heart attack was on the horizon. Because she lives alone, Cathy had nobody to turn to for support.
Last year, Cathy’s primary care provider ordered Cadence for her to bring her peace of mind and help manage her hypertension from home. Cathy now wakes up and takes her weight and blood pressure each morning, which transmit automatically via cell towers to her medical team. Whenever she experiences symptoms, she no longer has to guess whether they require medical attention; Cadence clinicians monitor her vitals daily, check-in with her as needed, and titrate her medications in consultation with her provider. After one year on the Cadence program, Cathy’s weight and blood pressure are now in target ranges.
Managing her hypertension from home, Cathy was constantly worried about her health and feared another heart attack was on the horizon.
There are millions of Medicare-age Americans living with a chronic health condition who are not getting the care they need today.
With 6 in 10 adults, or 133 million Americans, living with one or more chronic conditions, chronic disease is today’s leading cause of death and disability in the U.S. and the leading driver of the nation’s $4.1 trillion in annual health care costs.2 For seniors, that figure is more pronounced, with a staggering 65% of Medicare beneficiaries suffering from hypertension, congestive heart failure, and/or type 2 diabetes.3
The unfortunate reality is that patients who are managing chronic conditions – such as hypertension, heart failure, type 2 diabetes, or COPD – require far more touchpoints and care than our primary care physicians have time to deliver. The result is countless health emergencies and costly ambulance and ER visits that could have been prevented.
Our workforce shortages and lack of streamlined technologies make it difficult for health systems to give every patient with chronic disease the attention they need. Many health systems have sophisticated heart failure clinics and diabetes programs, but access and capacity are major challenges. The data is clear. For example, the vast majority of patients with heart failure do not achieve guideline-directed medical therapy (GDMT), a treatment that saves and improves the quality of lives for chronic disease patients. According to a recent study, only 1.5% of all heart failure patients achieve guidelines after hospitalization. Achieving GDMT increases lifespan by 5 years for the average 70 year old with heart failure with reduced ejection fraction.4
Our workforce shortages and lack of streamlined technologies make it difficult for health systems to give every patient with chronic disease the attention they need.
1 (2022). Chronic Diseases in America [Infographic]. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
2 (2018). Multiple Chronic Conditions: Prevalence State/County Level: All Beneficiaries by Age. Centers for Medicare & Medicaid Services. https://www.cms.gov/data-research/statistics-trends-and-reports/chronic-conditions/multiple-chronic-conditions
3 (2007). Health for Life. American Hospital Association. https://www.aha.org/system/files/content/00-10/071204_H4L_FocusonWellness.pdf
4 (2022, September 6). Chronic Disease Rates and Management Strain the US Healthcare System. Life Sciences Intelligence. https://lifesciencesintelligence.com/features/chronic-disease-rates-and-management-strain-the-us-healthcare-system
5 Bozkurt, B, Savarese, G, Adamsson Eryd, S. et al. Mortality, Outcomes, Costs, and Use of Medicines Following a First Heart Failure Hospitalization: EVOLUTION HF. J Am Coll Cardiol HF. (Oct. 11, 2023) (10) 1320–1332.
The Cadence Solution
Our mission is to deliver life-changing treatment to 1 million people living with chronic conditions by the end of the decade.
Our mission is to deliver life-changing treatment to 1 million people living with chronic conditions by the end of the decade.
Cadence partners with the leading academic medical centers and health systems in the U.S. Together with our health system partners, we’ve built a virtual heart failure clinic, virtual diabetes clinic, and virtual hypertension clinic that deliver guideline-directed care to patients 24/7 and produce world-class outcomes.
Today, we care for over 13,000 patients in 18 states, collect more than 450,000 vitals per month, and have conducted over 97,000 remote visits with patients to date.
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Cadence is just getting started, and we have a lot of work to do to improve and increase adoption. We are presenting Cadence’s first annual Outcomes Report to share our learnings on the profound impact of scalable, technology-driven chronic disease care programs.
The data show that Cadence’s remote monitoring solution is a win-win-win that: Positively impacts outcomes and leads to more effective primary care for chronic disease patients; reduces healthcare costs for patients, hospital systems, and the U.S. healthcare system at large; and helps physicians deliver better clinical care while also saving them time and alleviating burden.
Improved clinical outcomes and more effective primary care for patients with chronic disease, as the number of Americans with chronic diseases accelerates
of care
Reduced Total Cost of Care for patients, as U.S. health expenses for chronic diseases balloon
Vastly improved workflows from team-based care, when physicians are burned out and leaving the workforce in record numbers
Patient Impact
The data show our approach is resulting in improved clinical outcomes.
Hypertension
In a study of 4,006 hypertension patients enrolled in Cadence from February 2022 to April 2023 in 11 states across the U.S., we saw a ~2x increase in the number of patients at goal blood pressure (BP<130/80) at follow-up, compared to baseline (31% vs. 15%; p<0.001).6
Heart Failure
In a study of 367 patients with heart failure with reduced ejection fraction (HFrEF) who were enrolled in Cadence from August 2021 to April 2023, the percentage of patients on more than 50% dose of all four pillars of GDMT significantly increased. Additionally, there was a 3.2x increase in the percentage of patients on all four pillars of GDMT at follow-up.7
In a study of 215 patients with heart failure with preserved ejection fraction (HFpEF) enrolled in Cadence from December 2021 to April 2023 in 11 states across the U.S.,8 we saw a 12x increase in the percentage of patients on all four pillars of GDMT as a result of using Cadence. Additionally, there was a ~300% and 70% increase in the percentage of patients on sodium glucose cotransporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonist (MRA), respectively. Improved adherence to these key medications, as well as all four pillars of GDMT, significantly improves clinical outcomes and quality of life for heart failure patients.9
Diabetes
Using Cadence’s program, 43% of type 2 diabetes patients achieved their blood glucose goal.10
The data show that Cadence has helped prevent health issues before they escalate. We have seen an 18% reduction in the number of emergency department visits for patients after 6 months of participation in the Cadence program, compared to those who have not enrolled.11
Patients enrolled in Cadence are highly engaged and become more actively invested in improving their health over time. For example, 84% of enrolled patients engage with Cadence’s program by taking their vitals 16+ days per month. Additionally, 80% of patients remain actively engaged after 6 months of participating in the program.12
PERCENTAGE OF ENROLLED PATIENTS engage 16+ days per month
PERCENTAGE OF PATIENTS remain actively engaged after 6 months in the program
Patient testimonials
“Cadence is looking out for me, like another set of eyes. It gives both me and my wife peace of mind and security that I am okay.”
CADENCE PATIENT, WASHINGTON
“I haven't missed a single day of weighing and taking my blood pressure since I've been on Cadence because I know somebody is monitoring it.”
CADENCE PATIENT, ALABAMA
6 Feldman, D. I., Campbell, M. L., Babikian, S., Curnow, R., Feldman, T., & M. F. (2023). A Nationwide Remote Patient Intervention Hypertension Program: Can Remote Patient Monitoring and a Multi-Disciplinary Team of Clinicians Improve Blood Pressure Control? Circulation: The Journal of the American Heart Association, 148. Doi: 10.1161. https://www.ahajournals.org/doi/abs/10.1161/circ.148.suppl_1.12950
7 Feldman, D. I., Campbell, M. L., Feldman, T., Curnow, R., & Fudim, M. (2023). Breaking the Status Quo in Heart Failure: Leveraging Remote Patient Monitoring to Effectively Put the Heart Failure Guidelines to Practice. MedRxiv. Doi: 10.1101/2023.12.11.23297939. https://www.medrxiv.org/content/10.1101/2023.12.11.23297939v1.
8 Feldman, D. I., Repnikov, D. L., Campbell, M., Sanchez, D., Sharma, A., Curnow, R., Feldman, T., & Fudim, M. (2023). A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Benefit HFpEF Management? Circulation: The Journal of the American Heart Association, 148. Doi: 10.1161. https://www.ahajournals.org/doi/abs/10.1161/circ.148.suppl_1.14872
9 Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063.
10 Data under review pending formal publication. "Blood glucose goal” is defined as less than 154 mg/dL (Hemoglobin A1C < ~7)
11 A difference-in-difference analysis using ACO data collected from 2019-2023 compared 545 patients enrolled in Cadence to 10,305 patients who never enrolled in the program.
12 "Actively engaged" is defined as transmitting at least one vital per month. Data based on the last 12 months of enrolled patients.
Lower Cost of Care
Our remote monitoring solution significantly reduced the total cost of care for chronic disease patients.
In a study of patients and eligible patients with heart failure, hypertension, and type 2 diabetes, the data show that Cadence’s solution resulted in a 51% decrease in patients’ total cost of care, inclusive of the incremental costs associated with RPM services.13
In a study for hypertension patients, there was a 50% reduction in the total cost of care. In a separate study for heart failure patients, there was a 52% reduction in the total cost of care.15
The data show the Cadence program resulted in a 51% decrease in patients’ total cost of care.
Cadence’s solution reduces care costs across the board. For example, there has been a 63% reduction in the number of ambulance rides for patients enrolled in the Cadence program.16
The case study below shows the impact of Cadence on a patient with heart failure. The data shows positive clinical outcomes, such as lowering the patient's weight and blood pressure, while reducing the total cost of care by decreasing Emergency Department visits and Inpatient Admissions.
13 Calculated as average reduction in total cost of care between patients enrolled in Cadence versus eligible but never enrolled and patients enrolled in Cadence versus ordered but never enrolled in Cadence. Based on ACO data using patients enrolled in Cadence in 2022 inclusive of over 9,000 eligible patients with congestive heart failure, hypertension or type 2 diabetes.
14 Feldman, D. I. (2023, November 13). A Nationwide Remote Patient Intervention Program: Can Remote Monitoring and A Multidisciplinary Team of Clinicians Improve Blood Pressure Control? [Conference presentation]. American Heart Association. https://docsend.com/view/h8ai9bseqv6ka445
15 Feldman, D. I., Campbell, M. L., Feldman, T., Curnow, R., & Fudim, M. (2023). Breaking the Status Quo in Heart Failure: Leveraging Remote Patient Monitoring to Effectively Put the Heart Failure Guidelines to Practice. MedRxiv. Doi: 10.1101/2023.12.11.23297939. https://www.medrxiv.org/content/10.1101/2023.12.11.23297939v1.
16 Results based on a difference-in-differences analysis using ACO data using patients enrolled in Cadence in 2022 inclusive of over 9,000 eligible patients with congestive heart failure, hypertension or type 2 diabetes.
Clinician Impact
Cadence’s solution helps physicians deliver better clinical care while saving them time.
Patients with chronic disease place particular stress on primary care physicians, including a high volume of calls and EMR messages, given the high-touch interactions that these conditions require.
With a staggering 79% of physicians saying that paperwork and administrative burdens are the top challenge they face in their practice, Cadence’s solution is helping physicians deliver better clinical care while also saving them time and alleviating burden.17
Cadence’s team of nurse practitioners, registered nurses, and clinical navigators act as an extension of physician practices. Using national guidelines and mutually agreed upon clinical protocols, the Cadence team titrates medications, orders labs, and provides education and lifestyle coaching to patients. Patients have access to Cadence’s team 24/7, thereby increasing access without burdening primary care physicians.
Over 95% of Cadence patients had an order placed for RPM by their primary care physician.
Working as an extension of their physician, Cadence’s clinical team has managed and resolved over 59,000 alerts based on patient vitals to date. Only 0.2% of patient alerts and interactions require escalation to partner physicians. Moreover, there has been no measurable impact on the volume of EMR messages in providers’ in-baskets after placing orders for Cadence.18
Additionally, there was a 7% reduction in the number of no-shows to partner clinics for Cadence patients.
Participating providers are highly satisfied with Cadence’s program, giving Cadence a 77 net promoter score in satisfaction surveys. Moreover, 97% of patients say they feel more connected to, and supported by, their provider after enrolling in Cadence.
Provider testimonial
“Cadence gives me the ability to have a peek into my patients’ lives at home and to reach out to patients when there is an issue. It saves my office staff time and also saves me time.”
FRYECARE GENERATION
17 (2018). What's ruining medicine for physicians: Paperwork and administrative burdens. Medical Economics Journal, 95(24). https://www.medicaleconomics.com/view/whats-ruining-medicine-physicians-paperwork-and-administrative-burdens
18 Data compares PCP EMR message volume for 3 months before and after launch. Data showed a nominal increase of 0.1 EMR messages per patient per month.
19 Data collected across a sample of 903 patients at one partner clinic and compares patient clinic visits and no-shows "pre" and "post" enrollment in the Cadence program, over a 10 week time period.
Outlook
We must collaborate to solve the accelerating chronic disease crisis in the U.S., and our data show that Cadence can play an important role at scale.
It has been more than one year since Cathy Burnet enrolled in Cadence, and according to Cathy, things are going much better with her health: “I’m so happy my doctor recommended Cadence to me,” she shared.
Because she lives alone, Cathy no longer lives in a constant state of worry as she manages her hypertension in between visits to her primary care provider. Her vitals are now in target ranges, and whenever she experiences dizziness or chest pains, Cadence clinicians are available to help her diagnose her symptoms and determine the best course of action. “Cadence is my lifeline if something goes wrong on a daily basis,” she shared. Moreover, Cathy says she now feels more invested in improving her own health. “The program motivates you to take better care of yourself,” said Cathy.
“Cadence is my lifeline if something goes wrong on a daily basis.”
The tidal wave of seniors living with chronic disease is only accelerating. We must meet the moment, by deploying new technologies, new care models, and modernizing the patient experience to tackle this crisis head on. This is especially true in rural communities, where underserved patient populations can particularly benefit from this technology that enables them to better manage their conditions from home.
Providers, patients, and policymakers must collaborate to solve the chronic disease crisis in the U.S., and the data show that Cadence can play an important role at scale. Together, we look forward to much needed transformation on how chronic disease is managed over the next decade.