Sleep Medicine Goes to Work
SleepMed’s vision of reaching patients through corporate health and wellness programs is becoming reality—with interesting implications for sleep medicine overall.
What if, instead of waiting for patients to complain to their doctors about sleep problems, sleep medicine could catch patients 5 to 10 years earlier and get problems managed long before poor sleep created other health problems or worsened comorbidities?
Sean Heyniger, CEO of SleepMed, the largest private sleep services provider, says this vision is possible. He has seen evidence of this in the early results from SleepMed’s employer health and wellness product, which launched nationwide this year. He says proactively screening people for sleep disorders through employer-based health, safety, and wellness programs may be the key to demonstrating the value of sleep medicine in an era of declining reimbursement. It also will allow for greater reach into the growing population of people with undiagnosed sleep disorders.
SleepMed, based in West Palm Beach, Fla, has been collecting and analyzing historical sleep data for almost 20 years from patients at its more than 200 managed sleep facilities across the country. The data indicates most patients wait to seek medical help until their sleep problems get so bad they have no choice but to ask their doctor for a referral for sleep testing, Heyniger says.
Richard Bogan, MD, PCCP, D.ABSM, SleepMed’s chief medical officer, says, “The data from our lab business shows that a very high percentage of people who come through labs for PSG [polysomnography] studies have high AHIs….The majority is really the severe OSA [obstructive sleep apnea] presentation.”
While he is quick to give credit to the national awareness and media outreach campaigns run by the National Sleep Foundation and the American Academy of Sleep Medicine for advancing the understanding of the importance of sleep and helping create a market among employers for sleep wellness, he adds that it is not surprising that better awareness alone often doesn’t change individual patient behavior.
“You have to feel pretty bad to proactively seek medical consultation for sleep problems, particularly when you may have to go sleep somewhere other than your home for testing,” he says.
In contrast, SleepMed’s new employer program has the potential to identify patients at risk before they develop severe sleep disorders or accelerate into complex health conditions. Patients with hypersomnolence or insomnia could benefit from earlier treatment to prevent their sleep disorders from contributing to more serious medical conditions such as diabetes or hypertension.
“By actively engaging employees through a comprehensive sleep program, we can identify and appropriately treat people maybe 5 to 10 years earlier than we traditionally would have been able to in our sleep testing facilities. Most importantly, research indicates that you could achieve as much as a 50% reduction in comorbid medical costs if you get these people diagnosed earlier and manage them with the proper therapy or treatment plan,” Bogan says.
A Long Time in the Making
Creating a comprehensive sleep medicine product that could address a whole range of sleep conditions was part of the vision for home sleep testing company Watermark Medical, which Heyniger cofounded in 2008 with John Sculley, a former PepsiCo president and Apple CEO. As Watermark’s CEO, Heyniger had numerous discussions with employers, insurance companies, and benefit consultants about designing an integrated sleep program to meet the demands of all stakeholders. However, it was not until Watermark merged with SleepMed in April 2013 that it became possible to meet important criteria his discussions had uncovered: national reach, scalability, and a fully integrated suite of sleep health services.
“When Watermark and SleepMed first came together, it was to offer our clients—sleep physicians, employers, and payors—an integrated end-to-end solution for diagnosing and treating sleep disorders,” he says. “Building upon our services capabilities and strengthening and expanding our community reach have been instrumental to our growth as a combined company.”
Heyniger realized from years of market research and experience that no matter how good the enterprise sleep product and employee wellness plan were, the company would only get so far without having sophisticated data collection abilities and the ability to serve patients across the country.
“Now, because of this unique offering and extensive national capabilities, we are starting to have meaningful conversations with the largest employers in the country and their benefit consultants, as well as the top 20 insurance companies,” Heyniger says. “We’ve been extremely busy, and we are very excited about the progress that we’ve made.”
The Time Is Ripe
Part of the reason employers, insurers, and benefit consultants are responding positively to SleepMed’s employee wellness sleep program is the research that shows sleep is a critical component in preventing costly care tied to poorly managed chronic conditions. In addition, sleep health has the potential to improve productivity—people with insomnia take more sick days and come to work too sleepy to function effectively (presenteeism), for example. Until now, there had not been a national company that could help employers figure out how to offer sleep wellness to employees, especially in a way that encompassed all possible sleep problems instead of focusing primarily on sleep breathing disorders, says David Kaplan, MD, global leader of clinical services and solutions at Mercer, a national benefit and human resources consulting company based in New York. “It’s just too difficult to work a different program in every part of the country,” he says.
Mercer has worked with SleepMed for two and a half years and spent well over a year helping it develop and refine its sleep medicine product to meet the specific needs of the type of large national employers Mercer advises.
“When we took it out to employers, we certainly heard from them that we were hitting the right issues, which was very reassuring,” Kaplan says. “What I think attracts people to SleepMed is that it is offering a full broad-based sleep solution, including one of the most common causes of poor sleep, which is just poor sleep hygiene.”
Concern about fatigue and sleepiness in employees with jobs that demand a high degree of alertness to avoid potentially catastrophic errors has of course been around for more than a decade and led to work-hour regulations for truckers, pilots, and medical personnel, among others. However, the incorporation of sleep in the employee wellness trend is new.
“From a wellness perspective, there are four legs to the stool of wellness: exercise, diet, sleep, and what we call resilience,” Kaplan says. “We’ve done a fabulous job, I think, of imparting to employees the importance of getting active. We offer a broad range of programs to encourage exercise. We also have good healthy eating programs. But the sleep leg of the stool was being completely neglected and missed, and yet, when we talked to employees about their health, we were hearing recurrently, ‘Well, I don’t sleep well.’”
As a result, some employers Mercer consults with were finding that despite putting in great programs for weight control, exercise, and even chronic disease management such as diabetes control, there were employees—typically those with the most comorbid conditions, Kaplan points out—who were unable to derive true benefit from these programs because the sleep leg of the stool was not being addressed.
“The data is fairly clear that if you have underlying sleep apnea, you don’t have the same type of production of appetite suppressing hormones that allow people to lose weight successfully,” Kaplan says by way of example. “It is almost impossible for them to lose weight without addressing the underlying sleep disorders.”
Heyniger and Kaplan both say they’ve seen interest from companies that employ highly valuable knowledge workers, such as software engineers, and want help in addressing sleep issues that impact the productivity of such employees. While the nature of the work will not change, forward-thinking companies are starting to recognize the importance of sleep and of giving their knowledge workers the tools to recover from missed sleep when a particular project may require long hours.
How Sleep Employee Wellness Works
While employers from a broad range of industries are now interested in offering sleep wellness to their employees, they can differ a great deal in exactly what they want that offering to look like. Therefore, SleepMed’s program is highly customizable based on the needs of the employer, Heyniger says.
“Some are more concerned about safety, if they are in an industry such as transportation,” he says. “Those programs can be mandatory and delivered through the safety department at the company. Then we have a sleep health product that is a combination of wellness and health because of the comorbidities associated with sleep breathing disorders and insomnia, and the tie-in to the other comorbidities.”
In general, employers SleepMed is contracting with are addressing sleep on two fronts, Heyniger says. First, they are using wellness dollars to screen and identify who is at risk. Then, SleepMed works through the healthcare administrator, which is traditionally a large insurance company, to make sure the employees identified as at risk are properly diagnosed and put on treatment with long-term follow-up and management.
Wellness dollars also can be used for screenings integrated into an employer’s employee assistance programs or health risk assessment programs for education campaigns and assistance. “There are a number of ways we can communicate directly with an employee,” Heyniger says.
On the back end, employers also are typically interested in data that might help them determine down the line what the return on investment associated with sleep wellness will be. SleepMed is therefore heavily invested in gathering analytics on treatment and outcomes.
“We know data is fact, and the more data we can get, the more we can get into doing predictive analytics,” Heyniger says.
Wellness offerings through employers can be linked with the overall healthcare reform shift toward proactive disease prevention, instead of sitting back and waiting to diagnose and treat advanced or chronic illness. In this regard, sleep wellness is a way sleep medicine can begin to make the leap to an outcome-based healthcare reimbursement model ahead of slower-moving reimbursement changes to traditional fee-for-service that is constantly under pricing pressure.
“Traditionally, in sleep medicine, we as specialists have waited around for a referral from a primary care provider and, on the employer side, where they are self-insured, they are looking ahead,” Heyniger says. “Instead of waiting for the patient to complain about having daytime sleepiness or shift work disorder, they are taking a proactive approach with our program and risk-stratifying an entire population of who is at risk based on clinical guidelines and we provide that data back to their physicians.”
A Bigger Pie for All?
Changes in reimbursement and the move toward greater use of home testing have challenged the traditional sleep lab model that was primarily focused on diagnosis. Moves by companies like SleepMed that use PSG and home testing for sleep diagnostics are sometimes interpreted as direct threats to traditional sleep medicine.
However, in SleepMed’s vision, that ignores what could be gained through change. “Well-managed sleep labs are essential. SleepMed empowers our network of sleep experts to provide appropriate care, balancing the use of screening, home testing, and lab-based testing. The ability for sleep medicine to partner with large national companies on employee wellness is a really big opportunity and transformational,” Heyniger says.
“It has been very clear from the discussions we’ve had [with employers] that they don’t want to roll out a program that applies to only 5% to 10% of the market,” he says. “They want consistency and continuity from a national reach perspective and that is what SleepMed brings to the table. Any physician or health system that partners with us gets those benefits.”
Earlier this year, SleepMed rolled out its SleepMed network, which is a limited or overlap accountable care organization (ACO) that brings together boarded sleep physicians. SleepMed hopes to work with these experts in the provision of patient care, in traditional ways, and as its sleep wellness program expands. The SleepMed network specialists retain the ability to deal directly with the patient they are treating and managing, as well as being paid directly by insurance plans.
“Being able to offer this in every zip code is important [in winning contracts with employers] and we want to support the local community sleep specialists,” he says. “We are inviting all sleep boarded physicians to join the SleepMed network. We don’t require them to buy new software or to change the way they provide quality care, but we do expect them to deliver an exceptional patient experience and customer service. The advantage of joining is we are not going to wait around for a referral. Instead, we are using our partnerships and contracts to actively identify those patients at risk and then getting those patients appropriately diagnosed, treated, and managed.”
The Challenge of Wellness
If there is an opportunity in employer wellness programs to gain more patients in an era when lab volumes have declined, there is also a challenge. Wellness by definition means keeping people healthy, and sleep medicine has traditionally performed better in diagnosis than in treatment follow-up and management, Heyniger says. Tracking outcomes and showing that patients are complying with treatment and seeing improvement in overall health is a task that can no longer be handed off to others, such as the durable medical equipment vendors. In his view, that lacks continuity of care and puts effective treatment and overall health and wellness of the patient at risk long-term.
“Employee wellness programs that catch patients with sleep disorders early, facilitate referrals to SleepMed network providers, and then use data to help manage the health of this patient population are better for everyone and especially the patient,” Heyniger says.
“Providers need help with data integration, and interoperability has been challenging for providers traditionally. Patients’ files, even basic compliance data, within a health system with several touch points are fragmented. The SleepMed community network and employer sleep program working together in identifying and treating those who may be at risk is a very exciting value proposition. Using technology and proven clinical protocols in sleep medicine is a welcome change and opens up the 80% undiagnosed,” says Dennis Hwang, MD, medical director of the Sleep Medicine Department at Fontana Medical Center in Fontana, Calif. “The more we can get people with sleep problems treated before they become complex and have a positive impact on their quality of life, the better, and why sleep wellness is important. SleepMed is clearly one of the industry leaders in innovation, the sleep specialties have started to shift, and it’s an exciting thing to be involved in.”
In addition, it could potentially give sleep medicine a way to write its own destiny instead of having healthcare reform dictate its future. “It is not out of the question that at some point we will go to Medicare’s Innovation Center [with our data],” Heyniger says. “They are looking for integrated solutions that help reduce costs while simultaneously increasing access to quality care, and we have that.”
Lena Kauffman is a freelance writer and editor based in Ann Arbor, Mich. She covered the SleepMed-Watermark merger in 2013.