Virtual physical therapy can improve outcomes, spending

Photo: Marko Geber/Getty Images

For people with a range of musculoskeletal (MSK) conditions, many virtual physical therapy options can deliver clinically meaningful improvements in pain and function, and reduce overall healthcare spending, according to a new independent evaluation from the Peterson Health Technology Institute.

PHTI's review of scientific literature indicates that many of these options offer clinical benefits to patients that are comparable to in-person physical therapy, and can also increase access, reduce healthcare spending and appeal to consumers due to convenience.

Nearly one in three people in the U.S. have an MSK disorder, which are leading causes of disability and account for nearly 10% of medical spending. These conditions impair patients' daily lives, impact their productivity, limit their ability to work and earn a living, and contribute to mental health challenges, according to the report. 

Since 2010, more than $38 billion has been invested in companies offering MSK options, including mergers and acquisitions.

WHAT'S THE IMPACT?

The report assessed clinical and economic evidence on eight virtual MSK solutions in three categories:

• app-based exercise therapy with limited physical therapist intervention.
• physical therapist-guided solutions that are an alternative to in-person care.
• offerings that supplement in-person physical therapy with virtual care, and are paid for as remote therapeutic monitoring (RTM).

These technologies typically use body-worn motion trackers or cameras to guide patients through exercises and provide tailored feedback. The tech offerings in the evaluation are sold by public and private companies, including DarioHealth, Hinge Health, Kaia Health, Limber Health, Omada Health, RecoveryOne, Sword Health and Vori Health.

The analysis used an evidence-based framework and review of more than 2,000 articles, including 53 submitted to PHTI by companies evaluated in the report. PHTI received input from various experts and individuals, including licensed physical therapists, clinical advisors, MSK patients and other stakeholders.

According to the findings, physical therapist-guided technologies offer the most promise and overall value, as they improve patient outcomes on pain and function comparably to in-person physical therapy, with a net decrease in spending. For many conditions, they may be reasonably substituted for in-person therapy. This category includes Hinge Health, Omada Health, RecoveryOne, Sword Health, and Vori Health.

In terms of the economic impact, the report estimates that if 25% of in-person physical therapy users with low back pain shifted to these platforms at a price of $995 per year, annual savings could total approximately $4.4 million per one million commercially insured individuals.

Among the other findings are that app-based exercise therapies, including tech from DarioHealth and Kaia, can improve pain and function compared to usual care, but are unlikely to be effective as total substitutes for in-person physical therapy. However, they may be effective solutions to provide broad-based virtual care for patients with lower acuity who may experience clinical benefits, and the economic impact will depend on price.

At the same time, while there's a limited evidence base for RTM-augmented PT solutions used between in-person therapy sessions, the findings indicate that this category may deliver better clinical results on pain and functional improvement compared to in-person physical therapy alone. But even after accounting for the health benefits these technologies can facilitate, annual healthcare spending was estimated to increase because the savings from lower utilization don't offset increases in billing.

THE LARGER TREND

While virtual MSK technology companies seek to improve access to PT, their current business models are structured as employee-wellness benefits that are disconnected from medical benefits and spending.

That, PHTI found, makes it more difficult for companies to quickly identify the patients who would benefit the most from care, and approach them with their technology early in the treatment process.

Virtual MSK solutions could deliver even better value by integrating into medical benefits, encouraging earlier referrals to PT, and actively managing other avoidable healthcare utilization, according to the report.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.