Virtual Physical Therapy Is Poised to Take Off

Virtual physical therapy sessions for musculoskeletal (MSK) conditions, such as back, knee and hip pain, are primed to become a major share of all telemedicine visits, health care experts predict. Employers should check that virtual MSK care is covered by their group health plan or is a part of the services provided through their telemedicine vendor.

Blue Cross and Blue Shield of Massachusetts (BCBS/Mass.) has offered virtual MSK visits to its self-insured customers with more than 1,000 employees since 2019. The service is provided through Hinge Health, a digital care firm specializing in back and joint care. BCBS/Mass. is currently analyzing user data to decide whether to cover virtual physical therapy more broadly.

Thomas Hawkins, senior medical director for population health and analytics at BCBS/Mass., said the insurer's analysts are looking at whether reports of less pain from patients enrolled in the 12-week Hinge Health program result in fewer high-cost surgeries.

"We are trying to project what the costs are," Hawkins said. "It's not an inexpensive program, so we want to be certain we can see in our own data that actual surgical costs came down."

A program that specializes in virtual MSK therapy has advantages over other telehealth programs when it comes to providing value for employees, Hawkins said, because patients "are dealing with pain," and "pain is a great motivator, especially for somebody who doesn't necessarily want to go for surgery six months from now."

Supply, Demand and Costs

According to the 2022 Castlight Workforce Health Index, compiled by Castlight Health, a San Francisco-based health care navigation company, surgery and other treatment for MSK conditions routinely account for more than 15 percent of employer medical spending annually, somewhat more than employer spending for cancer care.

Yet, according to the same research, only 11 percent of employers surveyed offer dedicated MSK care—although that 11 percent represented nearly double the percentage that offered MSK care in 2020 (6 percent) and almost triple the 4 percent that offered it in 2019.

"Organizations with larger benefits teams and more resources have started tackling MSK," Hinge Health President Jim Pursley said. "Smaller employers are more dependent on partnerships to help develop solutions."

When deciding between virtual or in-person treatment for MSK conditions, both doctors and patients want options. "There will certainly be times people want to sit down with the physical therapist and go through things," Hawkins said, although "the technology is evolving rapidly" in terms of improving the experience of virtual visits.

Hinge Health's 2022 State of Musculoskeletal Health report states that patients in rural areas, compared to their suburban and urban counterparts, need to drive an average of 10 extra miles, and over 17 additional minutes, to access in-person MSK therapy. Even in major population centers, a drive that's short in distance may be long in time if a patient is stuck in traffic, the report notes, and travel can be expensive once parking costs are taken into account.

Pursley said specialty MSK treatments might play into the decision to cover virtual MSK care. For instance, he said, about 1 in 4 women in the U.S. suffer from a pelvic health disorder that physical therapy could treat, but many of them have limited access to therapists trained for this condition.

In the Omaha, Neb., metro area, with a population of nearly 1 million, there are only 18 physical therapists qualified to treat pelvic disorders, he said.

Factors to Consider

Below are questions benefits managers should keep in mind when selecting MSK virtual care coverage:

• Will there be a co-pay? How much? "Physical therapists often get classified as specialists [by insurers], and co-pays often end up higher" in that case, said Todd Norwood, senior director of clinical services at San Francisco-based Omada Health, a virtual care provider.
  

• Is MSK care easy to access and integrated with other care? Ask how quickly a person can schedule a session with a therapist and how care records between MSK specialists and others, such as primary care physicians, are integrated. With the patient's permission, sharing this information between providers can reduce redundant and unnecessary treatment costs.
  

• Over what devices are therapy sessions held, and are providers staying up with the latest advances? Some virtual MSK providers follow a bring-your-own-device model, while others supply a tablet, for instance. Also, ask how the provider's technology analyzes patients' movements. For example, must the patients attach sensors to themselves or is the vendor using advanced computer-vision algorithms that are built into the app?
  

• Are financial incentives used and are they beneficial? While financial incentives can get people engaged in treatment programs, the comparatively short duration of an MSK program and immediate relief from pain might be incentive enough to keep participants engaged. "We have a high completion rate, around 60 to 70 percent," Hawkins said of BCBS/Mass.'s 12-week program through Hinge Health. "If your pain is being reduced, that keeps people engaged."

Greg Goth is a freelance health and technology writer based in Oakville, Conn.