How Cardiac Remote Monitoring is Evolving Beyond Episodic Models

Summary

---

Podcast Summary: How Cardiac Remote Monitoring is Evolving Beyond Episodic Models

Podcast: Becker’s Healthcare Podcast
Host: Brian Zimmerman
Guest: Todd Butka, Co-founder and CEO of Merge
Date: April 9, 2026

---

Episode Overview

This episode explores the ongoing evolution in cardiac remote monitoring, with a particular focus on moving beyond traditional episodic models of care. Brian Zimmerman interviews Todd Butka, CEO of Merge, who shares insights on shifting to interval-based, data-rich care and the organizational, technological, and reimbursement challenges that come with this transition. The conversation is aimed at healthcare professionals seeking to understand and navigate advances in cardiac patient management.

---

Key Discussion Points & Insights

1. Background & Approach to Medical Innovation

• Todd’s Background (00:23 – 01:40):

  • Todd describes his career journey, starting at Apple and eventually moving into the medical device field.
  • Emphasizes how Apple’s product-focused, problem-solving mentality shaped his perspective on healthcare solutions.
  • Observed challenges in managing cardiac data and patient care, which inspired the founding of Merge to create more efficient, impactful monitoring solutions.

  “My time at Apple had a profound impact on how I thought about products, how we develop things there and solve problems.” (00:35, Todd)

2. The Need for Evolving Remote Monitoring Models

• From Episodic to Interval-Based Care (01:40 – 03:58):

  • Cardiac remote monitoring has grown, but increased data and devices don’t automatically equate to better care.
  • Traditional models are manual, scheduled, and typically based on in-person follow-ups.
  • Payment models often only reimburse for a single event per set interval, even if multiple interventions are made.
  • Interval-based care shifts from fixed appointments to continuous patient monitoring, acknowledging that “care” isn't a static moment.

  “It no longer is I schedule you, I see you and I write a report…It’s evolved to this interval...care and remote monitoring is no longer based on a schedule, it’s based on a period of time or what we think about is called interval based care.” (02:39, Todd)

3. Achieving Continuity in Care & Addressing Barriers

• Continuity & Hurdles (03:58 – 06:09):

  • True progress requires continuity—monitoring patients over time, rather than discrete episodes.
  • The largest barrier is reluctance to disrupt existing workflows, especially due to compliance and reimbursement concerns.
  • Automated systems can compile all care provided within a reimbursement window, reducing staff burden and improving accuracy.

  “Change is hard, right. I think thinking different in healthcare can be a bit nerve wracking, especially to a compliance officer... you don’t want to disrupt reimbursements at the healthcare system.” (04:28, Todd)

  “I've looked at 10 reports over 90 days, but because something didn’t come in on the 90th day, I don’t get paid. Like that doesn’t make any sense.” (05:10, Todd)

4. Guidance for Organizations Evaluating Monitoring Solutions

• Key Questions & Aligning Values (06:09 – 08:07):

  • Decision-makers should critically assess vendor motivations and revenue models to ensure alignment with their organizational goals.
  • Don’t just accept feature claims—question where vendors’ incentives are rooted.
  • Organizations must first clarify their own needs and priorities before seeking out partners.

  “When you want to see the true behavior of someone, look at their revenue model. Where are they driving revenue? What is their behavior?” (06:53, Todd)

  “You really have to understand what are the needs of my organization and are they best aligned for me through my journey.” (08:09, Todd)

5. The Future of Cardiac Remote Monitoring

• Staff, Technology, and Information Flow (08:43 – 10:42):

  • Future-ready organizations must support staff in adopting technology and evolving workflows to handle continuous streams of data.
  • Technology should fundamentally enhance patient care and operational efficiency, not simply digitize old processes.
  • Managing ongoing data flows across populations—rather than isolated devices or patients—will become key.

  “Changing, selecting software doesn’t actually always equate to…being future ready if it hasn’t really changed the way in which the behavior is moving for patient care.” (09:27, Todd)

  “As you’re thinking about the future, you really have to think about is this technology being disruptful in a way that is helpful and not just buying technology to do the same things I’m doing today, but really shaping how we might do something more efficient with a better impact to patient care and again, a return on that investment.” (10:15, Todd)

6. Closing Thoughts: Iteration, Literacy, and Change Management

• Continuous Improvement & Digital Literacy (10:42 – 11:37):

  • Emphasizes the need for ongoing evaluation and adaptation—both in technology choices and internal practices.
  • Digital literacy isn’t just about using tools, but understanding the right questions, assessing workflow impact, and preparing staff for behavior change.

  “Adopting technology doesn’t mean you have digital literacy. Do you understand the right questions to ask someone? Do you understand thoroughly how it impacts the workflow of your staff?” (11:01, Todd)

---

Notable Quotes & Memorable Moments

• On looking deeper into vendor partnerships:

  “If those actions deliver revenue that aren’t aligned with your intentions, then…a lot of people need to really look deeper into that and recognize the intentions of an organization.” (07:37, Todd)

• On adopting technology:

  “Selecting software doesn’t actually always equate to…being future ready if it hasn’t really changed the way in which the behavior is moving for patient care.” (09:27, Todd)

• On the importance of iteration:

  “We always talk about digital literacy… it’s, do you understand the right questions to ask someone? Do you understand thoroughly how it impacts the workflow of your staff?” (11:00, Todd)

---

Key Segment Timestamps

• Guest Introduction & Background: 00:23 – 01:40
• Need for Model Change & Interval-Based Care: 01:40 – 03:58
• Continuity in Care & Practical Barriers: 03:58 – 06:09
• Evaluating Technology & Vendor Partnerships: 06:09 – 08:07
• Preparing for the Future & Organizational Readiness: 08:43 – 10:42
• Iteration, Digital Literacy, and Change Management: 10:42 – 11:37

---

Summary Takeaways

• True transformation in cardiac remote monitoring requires a move from episodic, in-person, and manual models to continuous, interval-driven, and automated care approaches.
• Success is tied to both technological and behavioral change—aligning reimbursement, staff capabilities, and organizational structures with evolving care paradigms.
• Due diligence when adopting new technology should focus on vendor incentives, organizational needs, and the actual impact on workflows and patient care.
• Continuous assessment and digital literacy are essential—technology must drive improved care, not just replicate old models in a digital format.

---

This episode provides actionable insights and important strategic questions for health systems advancing cardiac remote monitoring and seeking to future-proof their care delivery.

Transcript

[A]

Hi everyone, this is Brian Zimmerman with Becker's Healthcare. Thank you so much for tuning into the Beckers Healthcare podcast. Today we're going to talk about how cardiac remote monitoring is evolving beyond episodic models. Joining me for today's discussion is Todd Butka, co founder and CEO of Merge. Todd, thank you for being here today.

[B]

Hey Brian, thanks for having me to get started here.

[A]

Can you share a bit about your professional background and Merge for folks that may be less familiar?

[B]

Sure. Not to digress too far, but I started my work career at Apple and somehow found my way into the medical device world. And ultimately I think my time at Apple had a profound impact on how I thought about products, how we develop things there and solve problems. Right. Created different solutions, thinking differently about the problem you're trying to solve and getting exposure to the implantable cardiac space and spending a number of years observing how data was handled and how patients were managed, there just seemed to be an opportunity to reshape how we approach care and managing patients. So I started Merge and I think we've done a good job in sort of progressing this industry to think differently about how to monitor patients and manage the data, enhance care and ultimately seek a higher, you know, reimbursement of an roi.

[A]

Yeah, appreciate that background, Todd. And I think we'll dive into that sort of problem solving mentality here in just a bit. Thinking specifically in this remote cardiac monitoring space, it's certainly expanded quite a lot in the last decade. So more devices, more data, more patients being monitored across more settings. But this growth doesn't necessarily mean clinical progress by itself. Todd, from your perspective, what is the most fundamental thing that needs to change in how health systems manage cardiac patients over time in order to see that really truly meaningful clinical progress?

[B]

Yeah, great question. We, we see a lot of clinics providing great care on a daily basis and the workflows that are in place become very familiar and almost automated in a sense. But they're very manual and they're, they're, they've evolved over time with what I would call like a premise based solution or in person follow up. So when you think about this remote monitoring and these, this proliferation of devices and capabilities from implantable cardiac devices to heart failure monitoring and physiological data monitoring, what's changed is it no longer is I schedule you, I see you and I write a report. It's more, it's evolved to this interval. You're looking at a patient over time on a frequency that is the variable they could transmit once, they could transmit 10 times. The fact is you only get paid once for a duration of monitoring. And to think that you have to schedule that patient and not get reimbursed for all of the other times that you've actually provided care if it didn't happen on that specific day, I think is misplaced. And what has really shifted in care and remote monitoring is no longer based on a schedule, it's based on a period of time or what we think about is called interval based care.

[A]

Yeah. And what you're talking about here too is really sort of over time achieving genuine continuity in care. Right. Can you talk a little bit more about what that looks like in practice? When that is able goal to be achieved, when it's not just, you know, monitoring a patient through a discrete episode of care, but achieving that, that program, that continuity. And given that that is so obviously beneficial for patients, why is it so hard to bring that into reality?

[B]

Oh well, change is hard, right. I think thinking different in healthcare can be a bit nerve wracking, especially to a compliance officer who's, you know,

[A]

has

[B]

a model of being reimbursed and the one thing you don't want to do is disrupt reimbursements at the healthcare system. So, so change in that philosophy of how you're being reimbursed for the care provided creates great pause and, and, and so those are hurdles where it takes time and understanding of the evolution of remote care again versus sort of this scheduled base that you're not managing one moment in time, you're managing a cadence that is ongoing in perpetuity for patients with implantables. So it's not a static moment that you look at. And I think that's where we've reshaped how people think because they realize now, like, wait a second, I've looked at 10 reports over 90 days, but because something didn't come in on the 90th day, I don't get paid. Like that doesn't make any sense. These patients have had VT and AFib and care has been provided and the ability for software to look back, see the activity taking place, coalesce that, summarize that and be able to automate the charges. It really removes a manual burden from staff to track all of those elements and it allows them to really just focus on delivering care. And you know, it's a novel idea for a physician.

[A]

Yeah, it's, it's easy to picture the way you describe it, Todd. It's like just this very beneficial thing for, for both patients and physicians staff too. So I guess for someone listening to this, who's maybe thinking about evaluating a cardiac monitoring strategy, whether from a technology decision standpoint or an intern perhaps, or even them just interrogating perhaps a vendor relationship. What questions should they be asking? What advice would you give those folks in terms of what should they be asking that maybe they're overlooking right now?

[B]

I think it can be difficult to understand the intentions of an organization when you're being sold. And you know, one, one thing I've always learned was, you know, when you want to see the true behavior of someone, look at their revenue model. What, where are they driving revenue? What is their behavior? And so does that organization align with yours in the behavior you're seeking with this technology? I think that gets overlooked because there's a lot of opportunities to sell. Say, hey, we do this and oh yeah, we do that too. But in the end when you, when you really pull back the curtain and say, well, okay, well as a company, where do predominantly you make your revenue? And, and if those actions deliver revenue that aren't aligned with your intentions, then I, I think, I think a lot of people need to really look deeper into that and, and recognize the intentions of an organization.

[A]

Is it fair to Todd to say that to ask that question of another organization you have to be able to answer it for yourself? Right. Is there, it really, is there an internal question asking that you need to begin with before, before you take that question to someone else?

[B]

Yeah, absolutely. It can change and that's okay too. But you really have to understand what are the needs of my organization and are they best aligned for me through my journey. Right. Because my needs will change as an organization and we see it all the time that healthcare staffing changes and they fluctuate. So needs changing. Can this organization enable me to continue to deliver high standards of care through periods of time that fluctuate in staffing needs?

[A]

Excellent. Todd, it's been a pleasure having you on. We're going to close with a forward looking question, sort of challenging you to get out your crystal ball over there. But looking to the future, what do you believe will define the next generation of cardiac remote monitoring programs? For someone listening to this right now, who wants to get sort of ahead of that curve also, where should they start? So, two part question. What's going to define the next generation of cardiac remote monitoring and how can leaders get sort of advance on that, on that curve, on that, on that path towards that future?

[B]

Well, I believe you have to take a look at, you know, look in the mirror and look at your staff to understand what is their capabilities to adopt new technologies and new ways of thinking. Look at your institution as a whole to say, can we adopt this? You know, changing, selecting software doesn't actually always equate to, you know, being future ready if it hasn't really changed the way in which the behavior is moving for patient care. So in an example, I would say something around, you know, you can. You can be future ready, but. But can you manage the data flow? You're no longer managing, you know, devices or a specific patient per se. You're managing a flow of information that is just ongoing and coming at you, and it's across your entire population. So, you know, as you're thinking about the future, you really have to think about is this technology being disruptful in a way that is helpful and not just buying technology to do the same things I'm doing today, but really shaping how we might do something more efficient with a better impact to patient care and again, a return on that investment.

[A]

I think a theme that's running through this conversation is just this need for iteration. This need for nothing is static, constantly interrogating your own organizational behaviors and technology as well. Is that a fair assessment of a portion of our conversation today, Todd?

[B]

It is. It is. We always talk about digital literacy, you know, and again, adopting technology doesn't mean you have digital literacy. It's, do you understand the right questions to ask someone? Do you understand thoroughly how it impacts the workflow of your staff? Because that's where the technology is going to get really used. And again, does the staff have the ability and the health system the ability to enable the change in the behavior shift of the workflows to make improvements? I think those are all things that you have to consider before you make too many changes too fast.

[A]

Well, Todd, thank you so much for coming on the podcast today. It's been a pleasure speaking with you.

[B]

Hey, Brian, thank you as well. I really appreciate the opportunity and the conversation we had.

[A]

Absolutely. I also want to thank our podcast sponsor, Merge. You can tune into more podcasts from Becker's Healthcare by visiting our podcast [e-mail].