Health benefits industry veteran Jason Dixon was doubtful about the prospects for virtual physical therapy (PT) for patients recovering from joint replacement surgery. But he changed his mind when his employer, captive insurance firm BevCap Management in McKinney, Texas, began offering its clients Reflexion Health's Virtual Exercise Rehabilitation Assistant (VERA) in August 2018.
VERA is an avatar-and-sensor technology platform that combines 3-D motion-capture technology with telehealth visits so patients can complete their post-joint-replacement therapy program from home, monitored and guided by licensed physical therapists.
When Dixon learned that 36 of his clients had taken VERA therapy, he became a convert.
"I was very skeptical," Dixon said. "But our statistics and member satisfaction are through the roof."
Dr. Mary O'Connor, director of the Center for Musculoskeletal Care at Yale School of Medicine and an orthopedic surgeon at Yale New Haven Hospital, says VERA is a revolutionary approach to post-surgery rehab.
"In real life, people don't always do what they are supposed to do to help [themselves] get better," O'Connor said. "With VERA, we know if the patient logged in, and we know if they did exercises. VERA allows us to identify if a patient is struggling. If you miss two days of therapy, you'll get a call on the third day."
Convenience, Control and Cost Addressed
Reflexion Health CEO Joe Smith, M.D., said advances in technology, such as the Microsoft Kinect 3-D sensor, made clinically valid at-home therapy possible.
"It doesn't make any sense to make the injured or hobbled or hurting person get in a car or otherwise find their way to a therapist's office or doctor's office or clinic," Smith said. "The best way, the patient-centered way, was to bring as much of that knowledge, guidance, measurement and monitoring to the patient."
For benefits managers contemplating putting a virtual therapy module in place, Smith, Dixon and O'Connor offered a few observations:
- Neither BevCap nor Yale charges patients for virtual post-surgical rehabilitation. O'Connor noted that treating follow-up PT as discrete care, with out-of-pocket costs for patients, often leads to a Catch-22: "They do two, three or four of their sessions with a $20 or a $50 co-pay or more, and then they stop because they feel a little better. Then, two months later, they are re-injured, and they're back because they never got well enough in the first place. This is not how we want to provide care."
- Virtual rehab is not for every patient. Dixon said patients need to feel they are in control of the choice of therapy, and 70 percent to 75 percent will choose virtual rehab. "They can do virtual Skype visits through the machine, [but] it's not for every patient. We screen our patients, and some just aren't interested."
In the 2020 Large Employers' Health Care Strategy and Plan Design survey report, the nonprofit National Business Group on Health's annual barometer of where large employers are expected to spend employee benefits funds, 44 percent of employers ranked musculoskeletal issues—such as knee, hip and back pain severe enough to warrant surgery—as the top condition impacting their costs while 85 percent ranked it among the top three conditions.
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A Growing Market
Patients with some musculoskeletal conditions are not candidates for surgery, but the market for remote therapy is growing for those types of back or joint pain caused by conditions for which surgery may not be an option. For example, in early November, Reflexion Health introduced HelloPT, its virtual platform for less-critical musculoskeletal issues.
Competing products include Kaia Health, Kiio, Hinge Health and Sword Health, which also employ at-home sensor and camera or tablet technologies to instruct and monitor a patient's progress.
These virtual PT platforms and apps are in the vanguard of what could be a wide and rapid take-up of virtual musculoskeletal care. In the National Business Group on Health's survey, virtual care for musculoskeletal management showed the greatest potential for growth among virtual health care services. Nearly all large employers polled will offer telehealth services for minor, acute services next year, and in addition:
- 23 percent of employers will offer musculoskeletal management virtual services.
- 38 percent are considering doing so by 2022.
"A tiny minority of people who need physical therapy actually get it," often due to a shortage of therapists, Smith said.
Opportunities for Independent Therapists
A growing number of independent physical therapists with established practices also see the potential in telehealth PT. Damien Howell, a therapist in Richmond, Va., who offers online PT through a partnership with telehealth vendor American Well, noted that there are some obstacles to going online for established independent therapists.
For example, he said, his clients can upload photos but not videos through the American Well platform, which limits the amount of evaluation he can do. In addition, single-state licensing limits the market potential for independent therapists.
The multistate Physical Therapy Compact, however, which allows member therapists to practice in all participating states, should allow greater flexibility and opportunity, he said, especially if insurers and benefits managers see cost savings from teletherapy.
Even when therapy starts with one or more in-person sessions, patients may choose to follow up with online PT so their therapists can ensure they're continuing to do their prescribed stretches and exercises—and doing them correctly.
"There is a lot of physical therapy where you don't need hands on, where we do education and engaging, and that can easily be done over the Internet," Howell said. "It's the way of the future."
Greg Goth is a freelance health and technology writer based in Oakville, Conn.
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