girl in sleep mask
Ensuring patients stay on course with treatment
by Gary Sheehan

Being diagnosed with a medical condition is the first step towards a healthier life. The second step, however, too often gets in the way of the best health possible: effective and consistent treatment of the diagnosed condition. What use is a diagnosis if it’s not paired with effective treatment? Adherence to a treatment plan is a universal issue in health care; according to the World Health Organization, nonadherence accounts for 125,000 deaths and 25% of hospitalizations annually.  

Our goal as care providers is to partner with patients to effectively treat their conditions and improve their lives. But patients have free will. How do you ensure they take their medication and follow their treatment protocols? What role does patient engagement play in long-term adherence, and how do providers work to ensure their programs create engagement with their patient base? 

Let’s take a closer look at patient compliance in sleep therapy, a prime example of how patient engagement can help with therapy compliance. 

Obstructive sleep apnea (OSA) is a serious medical condition with well-understood treatment options that can be administered at low cost in the home. These treatment options are supported by strong science and are easily understood. Yet OSA therapy compliance is estimated to be below 60% nationally.

While compliance is ultimately up to the patient, I’d argue that a provider’s compliance rate—as measured by patients who continue with insurance-covered therapy after the initial 90 days—is a key performance indicator to determine how they are doing. Our team at Cape Medical Supply has spent years studying the issue and working on a variety of improvement efforts to help build and maintain an industry-leading compliance rate that we can be proud of and share with our referral and payer partners. 

I believe there are three high-level areas to focus on to ensure you are supporting strong results.

1 Set the table for success. 

As early in the the referral process as possible, you must work to engage patients. They need to understand that OSA is a serious medical condition and that positive airway pressure (PAP) therapy is the gold standard for treating and managing it. If they commit to the therapy, they will enjoy a higher quality of life and create a better chance at improved overall health. PAP therapy, especially in the early days of treatment, isn’t easy, so getting a patient to commit to sticking with it—even if it’s uncomfortable at first—is the key goal. Sleeping with a mask on your face is a major lifestyle adjustment, but pointing out the numerous health benefits of therapy will help patients commit to their treatment and set the table for a successful life with PAP therapy.

2 Embrace telehealth options. 

Telehealth is a buzzword in health care right now and a space seeing significant investments from payers, private equity firms and health systems. It has the potential to transform community-based care and is a valuable tool for patients requiring connectivity to adhere to therapies or care plans. Remote patient monitoring is supported by the manufacturers of PAP therapy devices, who have their own cloud-based environments to access machine utilization and monitor several points of clinical performance for patients. Having a dedicated function to analyze this data and intervene where needed is essential to being a good health care partner. 

Sleep coaches can encourage patient success and can frequently “rescue” patients who are struggling with therapy. The key here is stratifying patients into buckets and focusing your interventions where they will deliver the best possible outcomes. Some patients are self-driven and require no support, while others have no commitment to therapy and no amount of intervention will improve their compliance. Find the middle sweet spot, where intervention will deliver results.

3 Focus on data.  

Having a strong plan around how to use data strategically is the final point of emphasis as you build out a compliance program for your sleep therapy practice. What information do you have to present to referral partners on the success of your program? If a payer asked about your sleep therapy program, what would you give them as a point of differentiation? Data is everywhere; turning the data you have into actionable information for your team, your patients and your partners needs to be a focal point for progressive companies in the sleep therapy space. Durable medical equipment providers and the industry as a whole need to be able to demonstrate value. What better way to do that than to have a deep data repository that provides information to decision-makers who would benefit from it? A scientific, data-driven approach to health care delivery is required in a value-based environment; providers of all stripes would be well-served by ensuring their data capture and sharing practices are aligned with current macro initiatives within health care.

The modern health care system in the United States is riddled with inefficiency, waste and suboptimal outcomes. Much of that is due to system design and perverse incentives among current players. However, some comes down to patient nonadherence to prescribed medications or therapy regimes. Effective and involved compliance programs can ensure that sleep therapy providers, as a whole, provide system-level solutions for nonadherence.

Plato is credited with saying that human behavior flows from three main sources: desire, emotion and knowledge. If you apply that idea to our operating environment, you can focus on:

  • Creating a desire to commit to therapy because of the positive impact it will have on the patient’s life;
  • Building emotional buy-in that any discomfort is worth it, because feeling better and better health will follow; and 
  • Providing knowledge so that patients know how serious OSA is and how effective therapy can be. 

If you can do that, you will have set the stage for effective therapy and will have patients much more attuned to therapy and ready to work with your team to achieve their best possible outcomes. You will also be providing health care services with a higher level of effectiveness and more sustainability over a longer time horizon.

Patient engagement is the center of any effective compliance program. Taking the time to learn about your customers’ journey through the continuum of care becomes essential to understanding how to build a program that is patient-centric. Start by discussing and documenting that journey, and your compliance program will create itself from there.

Gary Sheehan is president, CEO and co-owner of Cape Medical Supply, a home medical equipment supplier focused on sleep therapy with 10 locations across New England. Visit