Remote therapy monitoring supports the near-term business case of traditional MSK providers to establish a best-in-class hybrid care model with broader long-term application.
Musculoskeletal (MSK) care remains a major focus area for digital health.and for good reason – more than $400B Of the annual costs associated with MSK, it accounts for 10-15% of total annual U.S. health spending. Despite the enormous cost, the challenges surrounding access and standardization of care are well known, negatively impacting patient experience and clinical outcomes. This dynamic (large market, massive unmet demand) has significantly intensified competition in the digital MSK space in recent years, with dozens of new companies launching and garnering high-profile valuations.
Traditional MSK providers (defined here as primarily brick-and-mortar physical therapy companies, health systems, and orthopaedic practices) have taken notice.between Increased consumer demand for digital health services As well as new competition from digital MSK companies, many legacy vendors are now taking their digital MSK strategies seriously. Interestingly, 65-70% of surveyed patients receiving synchronous virtual care did so through their trusted provider. This suggests that a hybrid model of in-person and virtual care provided by traditional providers is the preferred mode of care in the future. While incumbents are starting to lag relative to virtual-only players in digital MSK, they can leverage their physical footprint and brand loyalty among patients to win long-term.
RTM as facilitator for providers to invest in digital MSK care
Despite better digital tools and better integration with clinician workflows (e.g., EMR integration, digital health marketplace for “one-click” prescriptions), many legacy vendors have so far been reluctant to launch digital MSK offerings . This is driven, at least in part, by the up-front investment required (time and money) and the business case often based on “soft” financial (eg, patient retention, projected volume increases) and clinical (eg, subjective patient-reported outcomes) ROI metrics.
Remote Therapy Monitoring (RTM) disrupts this status quo – changing the way traditional MSK providers think about investing in digital MSK capabilities. RTM introduced a new set of 5 CMS codes in 2022 that will allow physical therapists and other qualified healthcare professionals to bill MSK care plans for remote monitoring and management of patients. This model has the potential to significantly strengthen the patient/provider relationship outside the clinic, while improving adherence to clinic visits and prescribed home exercise programs (HEPs).in a only 30% of patients completing PT episodes and HEP nonadherence was estimated to be 50% or higher, RTM has the potential to provide superior clinical outcomes. Given that RTM is complementary to clinical-based care, providers can significantly increase revenue per patient (up to 20-30%) without self-cannibalizing clinical volumes.As the number of PT clinics continues to recover thereafter Initial income stagnated during Covid-19this revenue opportunity is a significant tailwind.
Early trial and error showed that launching the MSK RTM program was a major undertaking. In addition to selecting technology partners, redesigning clinician workflows and hiring people to oversee the program, providers must also reset patient expectations for treatment with this new hybrid care model. Even well executed, RTM reimbursement has a high bar as it relates to patient engagement (minimum 16/30 days of remote data transfer) and time invested by clinicians (additional 20-40 minutes per patient per calendar month) .
However, when executed properly, RTM can enhance the overall patient experience and collect objective clinical data (eg, higher adherence, quantified range of motion improvement) to demonstrate superior outcomes. Combined with a clear outlook for a positive near-term financial ROI, traditional providers can now justify the time and resources to build a hybrid model of MSK care.
Widespread use of the MSK hybrid care model
When building a hybrid care model to deliver RTM, traditional providers will invest in a core competency that provides a problem that virtual MSK-only participants have struggled with – deploying the right care to the right patient at the right time .
A thoughtful, up-front assessment of clinical needs, risks, and patient goals enables the development of a tailored care plan for each patient—delivered by a patient’s trusted provider who always puts the patient first. If you consider the hybrid model of care deployed for young competitive athletes following ACL tears and Medicare patients following knee replacements, there will almost certainly be a different balance between in-person and virtual care. For these two patients, however, two things may be true in 2022—virtual-only rehabilitation models are not clinically appropriate, and patients tend to provide certain elements of care virtually.
This is why there is such a huge unmet need for a hybrid MSK care model in the future. Consumers are demanding digital services from providers they trust, and they want it to complement rather than replace valuable face-to-face interactions. For physical therapy in particular, the value of these face-to-face interactions cannot be overemphasized. Those PT providers who build and expand this model are well positioned to capitalize on additional opportunities to add value to their patients and their businesses. Some potential opportunities include:
- Provide directly to employers: Offers integrated MSK products that combine a leading virtual care model with a robust network of brick-and-mortar clinics. This model offers employers advantages over traditional providers (eg, in-person care discounts, better employee experience) and virtual-only providers (eg, lower downstream costs and better outcomes through smart clinical triage and customized care plans) The advantages.
- Value-Based Care: Enter into value-based arrangements with payers (and risky providers). Fixed price for PT services as part of an orthopaedic bundle or stand-alone arrangement. With some visits moving from in-person to virtual (synchronous and asynchronous), these services can now be offered at a lower overall cost. The success of this model is demonstrated with objective data on clinical adherence, family involvement, and better long-term outcomes (all muscles will be built through the RTM program). NOTE: As a combination of in-person versus virtual care transitions, the added benefit of freeing up clinical resources for the cost of other service activities can be obtained.
- Consumer Health and Prevention: Longitudinal relationships with patients outside the care of incidental PT. Provides long-term MSK health solutions (eg, self-directed injury prevention programs) and virtual exams (eg, joint ROM testing, fall assessment) to detect and treat MSK pathology before acute injury occurs. This can be monetized directly to consumers or as a complement to the opportunities mentioned above.
With increasing competitive pressure from traditional and virtual-only MSK providers and continued downward pressure on fee-for-service, now is the time to invest in and build a hybrid care model. This model can improve provider business performance and provide patients with a lifetime of MSK Sloan Health services, which is practical. Those suppliers who are purposeful and focused can build long-term competitive advantages that last for many years.
Photo: Liubomir Worona, Getty Images
