Virtual physiotherapy is about to make a breakthrough

Virtual physical therapy sessions for musculoskeletal disorders (MSK), such as back, knee and hip pain, are expected to account for a majority of all telemedicine visits, health experts predict. Employers should check whether virtual MSK care is covered by their group health insurance plan or is part of the services provided by their telemedicine provider.

Blue Cross and Blue Shield of Massachusetts (BCBS/Mass.) have been offering virtual MSK visits to their self-insured clients with more than 1,000 employees since 2019. The service is provided by Hinge Health, a digital care company specializing in back and joint care. BCBS/Mass. is currently analyzing user data to decide whether to broaden coverage of virtual physical therapy.

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 participating in the 12-week Hinge Health program translate into less expensive surgeries.

“We’re trying to extrapolate the costs,” Hawkins said. “It’s not a cheap program, so we want to be sure that we can see in our own data that actual surgical costs have come down.”

A program that specializes in virtual MSK therapy has advantages over other telehealth programs when it comes to delivering value to staff, Hawkins said, because patients “are dealing with pain” and “pain is a big motivator, especially for someone who doesn’t want to have surgery in six months.”

Supply, Demand and Cost

According to the 2022 Castlight Workforce Health Index, compiled by Castlight Health, a San Francisco-based health navigation company, surgeries and other treatments for MSK disorders routinely account for more than 15 percent of employer annual medical expenses, slightly more than employer spending cancer treatment.

Still, according to the same study, only 11 percent of employers surveyed offered specific MSK care—although that 11 percent accounted for nearly double the percentage offering MSK care in 2020 (6 percent), and almost triple the 4th percent they offered in 2019.

“Organizations with larger social performance teams and more resources have started to address MSK,” said Jim Pursley, president of Hinge Health. “Smaller employers rely more on partnerships to develop solutions.”

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

joint health
2022 Health status of the musculoskeletal system The report says patients in rural areas have to drive an average of 10 extra miles and over 17 extra minutes to access in-person MSK therapy compared to their suburban and urban counterparts. Even in large metropolitan areas, a short journey can be a long one when a patient is stuck in traffic, and trips can be expensive when parking costs are factored in, the report notes.

Pursley said specific MSK treatments could play a role in the decision to cover virtual MSK care. For example, he said, about one in four women in the US has a pelvic disorder that could be treated through physical therapy, but many of them have limited access to therapists trained for the condition.

In the Omaha, Neb., metropolitan 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 for benefit administrators to consider when selecting coverage for MSK virtual care.

  • Will there be a co-payment? How much? “Physiotherapists are often classified as specialists [by insurers]and co-payments are often higher when they do,” said Todd Norwood, senior director of clinical services at San Francisco-based Omada Health, a virtual care provider.

  • Is MSK care easily accessible and integrated with other care? Ask how quickly a person can schedule a session with a therapist and how treatment records are shared between MSK specialists and others, such as B. general practitioners are integrated. With patient consent, sharing this information between providers can reduce redundant and unnecessary treatment costs.

  • Which devices are used to hold therapy sessions, and keep vendors up to date with the latest advances? Some virtual MSK providers follow a bring-your-own-device model, while others offer a tablet, for example. Also, ask how the vendor’s technology analyzes patient movements. For example, do patients need to attach sensors to themselves, or does the provider use advanced computer vision algorithms built into the app?

  • Are financial incentives used and do they make sense? While financial incentives can lure people into participating in treatment programs, the comparatively short duration of an MSK program and the immediate relief from pain might be enough incentive to engage participants. “We have a high completion rate of about 60-70 percent,” Hawkins said of BCBS/Mass’s 12-week program. by Hinge Health. “When your pain is relieved, it keeps people engaged.”

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

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