Analyzing Innovations in Musculoskeletal Care to Improve Patient Outcomes, Cost Savings

With musculoskeletal care representing one of the leading cost drivers in health care spending for self-insured employers and health plans, a transition to preventive care characterized by both digital and in-person care solutions can lead to improved patient outcomes and cost savings, said Jeff Krauss, MD, chief medical officer at Hinge Health.

Transcript

AJMC®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences’ Medical World News, The American Journal of Managed Care^® is pleased to welcome Dr Jeff Krauss, chief medical officer (CMO) at Hinge Health.

Great to have you on, Jeff, can you just introduce yourself and tell us a little bit about your work?

Krauss: Yeah, sure. Great to be here. My name is Jeff Krauss, I'm the CMO at Hinge Health. I'm a board-certified physiatrist, I'm also board-certified in lifestyle medicine as well. I've been at Hinge for about 2 and a half years now. I'm full time at the company, although I do continue to practice part time. I do that out of the VA hospital. And then I'm also a clinical assistant professor in the Department of Orthopedics at Stanford University.

Before medicine, I actually was more of a tech guy. I did computer science and spent about 8 years as product manager for Oracle and then at eBay, before going into medicine. At Hinge Health, I focus on our clinical processes, research, product, the clinical input onto our product, and then help out with a lot of commercial work as well.

AJMC®: In the past year, Hinge Health has significantly expanded its clinical and technical musculoskeletal (MSK) capabilities to now cover the full continuum of MSK care. Can you speak on the implications of this growth in the employer space and for patients seeking this type of care?

Krauss: Yeah, so Hinge started with our chronic program—that's addressing people who have chronic MSK pain, because that's the biggest area of both need and also cost in terms of what self-insured employers and health plans are spending on care. But we've expanded that to be our full digital MSK clinic, we call it, which is including the sort of broader continuum going from acute care or prevention to acute, sort of episodic care as needed, chronic care, perioperative pre- and postsurgery care, and then also an expert medical opinion service.

So, we're really trying to encompass a lot more of the needs within MSK, given that people have such broad needs in any given population and MSK is such a broad field. I'd say, bigger picture, really, we're trying to overcome the 2 biggest barriers [which] would be sort of giving people better access to care and I think it can also improve the quality of care.

When it comes to the access to care, there are a lot of cost barriers that people have, and our programs are offered for free to members through the employer or the health plan. And then that's also a lot more convenient, in the sense that people don't have to go in to see somebody which obviously is a problem, especially during the COVID-19 period.

Then, I'd say from a quality perspective, we are seeing really strong outcomes in our programs. We published a paper with the first 10,000 users that went through our program and we had about 68.5% pain reduction that we saw and that was spread broadly across the population, as well as significant reductions in depression and anxiety scores using the PHQ-9 and GAD-7 surveys.

So, I think we're seeing really good quality as well, and then the big goal with a lot of this is avoiding unnecessary surgeries. And the data that we have so far based on both patients’ self-report and claims data show that we really seem to be preventing surgeries. As many people know, in MSK there are a lot of unnecessary surgeries that are obviously costly, and in many cases don't help people to recover. So, I think overall what we're seeing is really good for patients, and I think it overall is adding value to MSK care as a whole.

AJMC®: Recently, Hinge Health announced substantial increases in their funding amid revenue growth and a growing customer base. How will this funding be utilized and what patient populations may benefit from this?

Krauss: The number of employers using a digital MSK solution is expected to pretty much triple in the next couple of years. So, a lot of this additional funding is going to help us to expand our organization to support that. For example, we're growing our clinical team by about 3 times, which is full-time physical therapists (PTs), physicians, nurse practitioners, etc.

Also going to be focusing a lot more on our research, increasing the number of peer-reviewed studies that we have—we have 4 out today with another submitted now, but have a lot more that we would like to research both in terms of clinical outcomes and in terms of cost outcomes.

I'd say though, our overall goal here is to go really deep in MSK. So, we're truly adding value and including both outcomes and reduced costs. And this space is huge. so it's not really enough to just provide sort of superficial solutions, just simply providing like digital, physical therapy is a start, but we really want to make a bigger difference and so we really need to go deeper there.

So, there's lots of things that we're exploring and happy to talk more about, but ranging from better prevention to better surgical care that I think we can use the funding for.

As for patient populations, we are continuing to serve the employer markets. We already have quite a diversity of patients through the employer market. We're also working more and more with health plans so that we can expand even further and now we're expanding into Medicare as well. We've had good results with our elderly population on the Hinge platform to date, but this is another big area of growth for us to get into the Medicare market.

AJMC®: As the market leader in digital musculoskeletal care, what are the next steps for Hinge Health to continue in improving and optimizing how MSK issues are addressed by employers and health plans? Are any unmet needs persisting?

Krauss: Yeah, I would say there's lots of unmet needs. I think we've really only scratched the surface of what we can do to improve MSK care. As I mentioned before, we're adding a lot more clinical care into our programs, including doctors, PTs, nurse practitioners, etc. Also investing heavily in research and improving the ROI [return on investment] of our programs.

Other areas, though, to expand into, there's a lot of great home-based technologies for patients that we can also start to make available through our programs to users that we've only sort of scratched the surface on. I think we can also go really deep in helping people who are considering surgery to find better places to have that surgery that are really high quality, and also in many cases, lower cost. And I think then we're also really always looking for ways to improve our existing programs, meaning everything ranging from prevention to our surgery program and our expert medical opinion service.

We can do that through better technology, adding better education into our programs, improving the quality of our coaching and behavior change techniques. So, really, I think we're only scratching the surface so far, and there's a lot more that we sort of have coming down the road in the next year or 2.

AJMC®: Lastly, do you have any other concluding thoughts?

Krauss: Well, I would just say I think it's really exciting what's happening with the ability for digital health to improve many areas of health care, but I think in particular with MSK it's really exciting.

As I mentioned before, I continue to practice and when I see patients for just one visit, there's a limited amount that I feel in many cases I can do for their MSK conditions. I can educate them, I can maybe do an injection, but it's not really solving a lot of the core needs. I can prescribe PT, but we all know that one of the big issues is adherence and a lot of people just don't do that.

So, I think that this model of digital MSK care is really effective for patients in that we can provide them with exercises to do at home really conveniently on an ongoing basis and that adherence to the exercise is so important in terms of getting good outcomes. And we can do education that really we can give little doses of it that sink in over time so that it's a lot more effective.

So, I would just say that I think, ultimately, I see this as being sort of a great complement between the clinical care that's provided in clinic, but that these digital health solutions for MSK I think can really add value to MSK treatment both in terms of really improving the outcomes for patients and lowering the costs, which is so important given that MSK is is the number one cost driver or at least in the top 3 for most of the self-insured employers and health plans that we're working with now.

AJMC®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!