Remote therapeutic monitoring supports the near-term business case for traditional MSK providers to build a best-in-class hybrid care model now, with much broader long-term applications.
Musculoskeletal (MSK) care continues to be a major area of interest in digital health. And for good reason – with over $400B in annual MSK-related cost, it represents 10-15% of total health expenditures in the U.S. each year. Despite this enormous spend, challenges around access to and standardization of care are well known, negatively impacting patient experience and clinical outcomes. This dynamic (large market, large unmet need) has significantly increased competition in the digital MSK space in recent years, with dozens of new companies launching and several high-profile valuations.
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Traditional MSK providers (defined here as predominantly brick and mortar physical therapy companies, health systems, and orthopedic practices) have taken notice. Between increased consumer demand for digital healthcare services and new competition from digital MSK companies, many traditional providers are now getting serious about their digital MSK strategy. Interestingly, 65-70% of surveyed patients who receive synchronous virtual care do so through their trusted provider. This suggests that a hybrid model of in-person and virtual care delivered by traditional providers is the preferred care model of the future. While incumbents are starting from behind on digital MSK relative to virtual-only players, they can leverage their in-person footprint and brand loyalty with patients to win in the long term.
RTM as an accelerant for providers to invest in digital MSK care
Despite better digital tools and better integration with clinician workflows (e.g., EMR integrations, digital health marketplaces for ‘one click’ prescribing), many traditional providers have been hesitant to launch digital MSK offerings to date. This is at least partially driven by the upfront investment required (both time and money) and a business case that often anchors on ‘soft’ financial (e.g., patient retention, projected volume increases) and clinical (e.g., subjective patient-reported outcomes) ROI metrics.
Remote therapeutic monitoring (RTM) has disrupted this status quo – changing the way traditional MSK providers can think about investing in digital MSK capabilities. A new set of 5 CMS codes introduced for 2022, RTM allows physical therapists and other qualified healthcare professionals to bill for monitoring and managing a patient’s MSK care plan remotely. This model has the potential to significantly strengthen the patient/provider relationship beyond the clinic, simultaneously increasing adherence to both in-clinic visits and a prescribed home exercise plan (HEP). In an industry where only 30% of patients complete their PT episode and HEP noncompliance is estimated at 50% or higher, RTM has the potential to deliver superior clinical outcomes. Given RTM is a complement to clinic-based care, providers can significantly increase per patient revenue (as much as 20-30%) without self-cannibalization of in-clinic volume. As PT clinic volumes continue to recover after initial revenue stagnation during Covid-19, this revenue opportunity is an important tailwind.
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Early trial and error has demonstrated that launching an MSK RTM program is a significant undertaking. In addition to choosing a technology partner, reengineering clinician workflows and hiring staff to oversee the program, providers must also reset patient expectations for treatment in this new hybrid model of care. Even when executed perfectly, there is a high bar for RTM reimbursement as it relates to both patient engagement (minimum 16 / 30 days remote data transmission) and clinician time invested (additional 20-40 minutes per patient per calendar month).
However, when executed well RTM enhances the overall patient experience and collects objective clinical data (e.g., higher adherence, quantified range of motion improvement) to prove superior outcomes. Combined with a clear line of sight to positive near-term financial ROI, traditional providers can now justify the time and resources to build a hybrid model of MSK care.
Broad application of a hybrid MSK care model
In building a hybrid care model to deliver on RTM, traditional providers will be investing in a core competency that offers something that virtual-only MSK players consistently struggle with – deploying the right care, for the right patient, at the right time.
Thoughtful upfront assessment of clinical needs, risks and patient goals can inform a tailored care plan for each patient – a plan delivered by the patient’s trusted provider and one that always puts the patient first. If you consider a hybrid model of care deployed for a young competitive athlete post-ACL tear and a Medicare patient post-knee replacement, there will almost certainly be a different balance of in-person and virtual care. However, for both patients, two things are likely true in 2022 – a virtual-only rehab model is not clinically appropriate and there is a patient preference that some elements of care be delivered virtually.
This is why there is such a large unmet need for a hybrid MSK care model moving forward. Consumers are demanding digital services delivered by their trusted provider and they want it to supplement, not replace, valuable in person interactions. For physical therapy in particular, the value of those in-person interactions cannot be overstated. Those PT providers who build and scale such a model are well positioned to capitalize on additional opportunities which add value for their patients and their business. A few potential opportunities include:
- Direct-to-employer offering: deliver an integrated MSK offering which combines a leading virtual care model with a robust network of brick and mortar clinics. Such a model provides employers an advantage over both traditional providers (e.g., discount on in-person care, better employee experience) and virtual-only providers (e.g., lower downstream costs and better outcomes through smart clinical triage and custom care plans).
- Value-based care: enter into value-based arrangements with payors (and at-risk providers). Offer a fixed price for PT services as part of an orthopedic bundle or a stand-alone arrangement. These services can now be delivered at a lower total cost as some visits shift from in-person to virtual (both synchronous and asynchronous). Prove success of this model with objective data around in-clinic adherence, at-home engagement and better long term outcomes (all muscle that would be built through an RTM program). Note: as mix of in-person vs. virtual care shifts, capture added benefit of freeing up clinical resources for other fee for service activities.
- Consumer wellness and prevention: build longitudinal relationships with patients beyond episodic PT care. Offer long-term MSK wellness solutions (e.g., self-guided injury prevention programs) and virtual check-ups (e.g., joint ROM testing, fall assessment) to spot and treat MSK pathology before acute injury occurs. This could be monetized direct to consumer or as an add on offering to the opportunities above.
As competitive pressures from traditional and virtual-only MSK providers increase and downward pressure on fee-for-service rates persists, the time to invest and build a hybrid model of care is now. The potential for this model to enhance providers’ business performance and empower a lifetime of MSK health for patients is real and tangible. Those providers who act with purpose and focus could build a long-term competitive advantage that lasts for years to come.
Photo: Liubomyr Vorona, Getty Images
Ryan Eder is the Founder and CEO of IncludeHealth. Ryan launched IncludeHealth to empower all people to achieve a lifetime of musculoskeletal health and wellness. Prior to founding IncludeHealth, Ryan spent 15 years designing products and experiences across the healthcare and sporting goods industries. Ryan has received over 40 national and international innovation and design awards, including Gold and Best in Show (twice) in IDSA's International Design Excellence Awards.
Thomas Santo, MD is the Chief Growth & Strategy Officer for IncludeHealth. He is passionate about leveraging digital health tools and services to transform the patient experience in healthcare. Prior to IncludeHealth, Thomas spent 6 years at McKinsey & Co., working closely with payors and providers on virtual-first care model innovation, value-based care and clinical operations transformation. Thomas trained in Radiology at Montefiore health system.
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