Musculoskeletal care is an enormous drawback for the U.S. healthcare system, digital well being firms say. Problems are common and costly to deal with, however care that might lower down these excessive prices is inaccessible to many who want it.
That message is resonating with buyers. Over the previous yr, they’ve poured lots of of thousands and thousands of {dollars} into the digital MSK area. Unicorns Hinge Health and SWORD Health each closed a number of rounds of funding in 2021, some price nine figures.
However they weren’t the one firms competing for enterprise {dollars}: Kaia Health, RecoveryOne and SpineZone additionally raked in thousands and thousands of {dollars} in offers final yr. In the meantime, DarioHealth, which additionally presents instruments for managing continual circumstances like hypertension and diabetes, purchased its manner into the area by acquiring Upright Technologies. It introduced the launch of its MSK platform, called Dario Move, in October.
“It’s a part of the macro increase that we see inside digital well being,” Boris Kheyn-Kheyfets, senior supervisor at Deloitte Consulting, advised MobiHealthNews. Nevertheless, he added that “musculoskeletal, particularly, deserves particular point out inside that, as a result of musculoskeletal is a particularly giant complete addressable market. And the truth is you can save fairly a bit to employers and plans round surgical procedure avoidance.”
Musculoskeletal problems are expensive to deal with within the U.S. In line with a study published in JAMA analyzing the nation’s healthcare spending, low again and neck ache led 154 circumstances in healthcare spending in 2016, costing an estimated $134.5 billion. And the quantity two spot? Different musculoskeletal problems, coming in at $129.8 billion.
The evaluation famous that simply over 57% of the low again and neck ache spending got here from personal insurers and was related to working-age adults. In the meantime, spending for that situation elevated almost 7% between 1996 and 2016, although the variety of prevalent instances solely elevated by simply greater than 1% yearly.
Mark Luck Olson, CEO of RecoveryOne, argues surgical procedures are too common within the U.S. and that intervening early with bodily remedy would lower your expenses. However the purpose for digital musculoskeletal care must be extra than simply transferring a bodily remedy appointment to a digital atmosphere.
“That end-to-end journey is what we’re making an attempt to innovate. We’re not making an attempt to digitize the go to. Positive, visits may be a part of many episodes, however that is not the purpose,” he stated. “The purpose is to enhance the associated fee and high quality of that journey from ouch to all higher, not digitizing the go to.”
The COVID-19 issue
The COVID-19 pandemic modified distant care and telehealth typically, pushing extra suppliers and sufferers to simply accept care delivered nearly. The Division of Well being and Human Companies reported a 63-fold increase in telehealth utilization in the course of the pandemic, with 840,000 Medicare visits performed through telehealth in 2019 to 52.7 million in 2020.
Rachel Anderson, principal, portfolio partnerships at Cigna Ventures, an investor in RecoveryOne, stated the pandemic confirmed the business that sufferers need care that is simply accessible and handy.
“Persons are not solely snug accessing care from house, however additionally they have an elevated expectation to have the ability to achieve this. By means of digital MSK care, we not solely cut back the burden on suppliers however create extra entry factors to care,” she wrote in an e-mail.
Todd Norwood, a bodily therapist and director of medical providers at Omada Health, which not too long ago introduced its musculoskeletal care program, noticed a 250% increase in year-over-year member enrollment. Omada additionally presents digital instruments for diabetes, hypertension and behavioral well being, and stepped into the MSK area with its acquisition of Physera in 2020.
Norwood stated it may be a radical change for PTs to take such a hands-on job right into a digital setting. However when COVID-19 hit, immediately nobody may get in-person bodily remedy, they usually had been out of different selections.
“For no matter cause, within the U.S. as a career, we’ve not been welcoming telehealth with open arms,” Norwood stated. “After which I can let you know, even in 2017-2018, going to conferences was like, ‘What’s that? It is probably not PT, it is bought to be arms on. That does not rely.’ So, I actually suppose COVID and the pandemic modified issues rather a lot, modified affected person perceptions, but in addition modified supplier perceptions.”
Digital MSK firms argue there have been boundaries to bodily remedy entry even earlier than the pandemic. Hinge Well being President Jim Pursley notes it may be onerous for sufferers to get to an in-person appointment, notably in the event that they stay in a rural space. Plus, value may be prohibitive, particularly for hourly staff who could have to take day off for bodily remedy.
“COVID did not trigger folks to be pissed off with the established order, affected by continual ache, unable to get assist, driving big prices. And so, I believe these adjustments had been coming. I believe the pandemic simply accelerated them,” he stated. “I imply, if you cannot go in and see an in-person PT as a result of the entire world is locked down, then digital turns into not only a higher possibility. It could be your solely possibility.”
The way forward for distant MSK
Digital firms do not see in-person care going away – notably for higher-need sufferers – however know-how and synthetic intelligence may complement a bodily therapist’s work.
Rick Anderson, president and normal supervisor, North America at DarioHealth, thinks AI fashions may deal with lower-acuity issues on their very own ultimately, however a bodily therapist’s oversight is critical right now. Final month, Dario entered into an agreement to acquire Physimax, which presents AI-enabled motion evaluation and harm prevention.
“From a medical effectiveness perspective, enter and oversight, no less than proper now, is essential,” Anderson stated. “Sooner or later, I believe that AI-based fashions and laptop imaginative and prescient are getting higher and higher, … however what that basically permits is the power for PTs to essentially concentrate on the more difficult instances.”
In the meantime, tele-rehabilitation is rising on bodily therapists. Although the American Bodily Remedy Affiliation would not take a stance on digital MSK firms, because the platforms are evolving and fluctuate, the group is supportive of telehealth and legislation that would expand access.
A latest examine published in JMIR discovered practitioners within the U.Okay. typically considered tele-rehabilitation positively, noting advantages like diminished journey time, attending to see sufferers of their house atmosphere and permitting senior workers to help lower-level staff.
However there have been downsides, like issues about conducting efficient bodily assessments and security if a affected person had been alone and unsteady on their toes. Know-how is also a problem, as web connections weren’t at all times secure and a few sufferers struggled to make use of the platforms.
Examine authors Sarah Buckingham, analysis fellow, and Jenny Freeman, professor of physiotherapy and rehabilitation, each from the varsity of well being professions on the College of Plymouth, stated superior know-how may assist with a few of these issues, however they should be vetted totally.
“Know-how strikes rapidly, and there are a selection of attainable software program applications and instruments that might probably be of nice profit for distant bodily assessments. New applied sciences must be rigorously examined (together with an analysis of their value and acceptability to the tip person) earlier than they’re adopted by well being providers, and it must be confused that know-how can’t change a clinician’s experience,” they wrote in an e-mail to MobiHealthNews.
So, what’s subsequent for these firms after this yr of fast progress? As firms mature, some will probably go public, and the market may see extra mergers and acquisitions, together with from aggregators that can attempt to bundle quite a lot of digital well being options to promote to employers.
Those that take the general public route may have entry to capital, however they’re going to be beneath elevated scrutiny to indicate return on funding, stated Peter Micca, audit and assurance accomplice, and nationwide well being tech chief at Deloitte & Touche LLP.
“The 2 wildcards in any type of enlargement are the buyer, the affected person, and the way rapidly they undertake instruments. … The second is the regulatory atmosphere,” he stated. “To a big diploma, this business shouldn’t be regulated. Their clients are, however the business is not regulated. The FDA did come out not too long ago and proposed a certain set of regulations round well being know-how and medical trials. And so can we see CMS, HHS and all of the alphabets take into consideration wanting to manage this in a roundabout way? I believe all of the capital that the sector has acquired within the final yr is beginning to get plenty of consideration.”
Deloitte’s Kheyn-Kheyfets stated some firms will transfer to utilizing extra superior applied sciences like AI, hiring fewer bodily therapists and enhancing their margins. However that might come down to a different large consider healthcare: what will get paid for.
“On the finish of the day, it is going to come all the way down to reimbursement, like no matter new line incentives, no matter will get reimbursed, is what will get carried out,” Micca stated. “So I believe therein lies the affect of employers and well being plans to type of steer these capabilities to rising applied sciences by a monetary nudge.”
