IncludeHealth, a virtual musculoskeletal care and physical therapy provider, has evolved considerably since the company’s early days developing an accessible strength training machine.
In the past five years, the company has leaned heavily into technology to develop a virtual physical therapy practice. Its web-based platform pairs physical therapists with webAI and computer vision to remotely deliver MSK care that precisely monitors patients and tracks outcomes—on par with a physical therapist being physically present in the room. Patients use the remote care platform on their own devices and only need a web browser and a cellular connection—no extra hardware, downloads, sensors or passwords are needed.
CEO Ryan Eder says the company fuses design and technology to make MSK care more accessible and convenient for individuals regardless of their age, geographic location or familiarity with technology. The company's patients range in age from 12 to 99, Eder noted.
The company has been advancing its web-based platform using computer vision and artificial intelligence. It developed a unique AI-generated voice to guide patients through their physical therapy sessions and care plans. “As that voice developed, we realized we needed to personify that voice. We landed on Laina,” Eder said, noting that Laina is an acronym for “live artificial intelligence navigation assistant.”
“Laina is basically the assistant to our PTs to help make that connection stronger, make care more accessible and make care more affordable. We’ve been IncludeHealth for almost two decades, but as we saw this care model and all the technology evolved, we thought this was a bigger inflection point than we've ever seen. We've got more validation in the model, within the technology, than what we've ever had before, and we felt it made sense to create a new chapter for us and rebrand to LainaHealth,” Eder said in an exclusive interview to talk about the company’s rebrand.
The company has been developing computer vision for MSK care for the past six years. Starting in 2019, it collaborated with Cincinnati Children’s Hospital Medical Center, the U.S. Air Force, Google and ProMedica to build an MSK operating system to be web-based and accessible on any device. Through that work, particularly with Google, it trained its computer vision models for clinical accuracy.
Up until a few years ago, LainaHealth (formerly IncludeHealth) was partnering with MSK care providers to offer hybrid services to their patients under remote therapeutic monitoring and value-based care.
But, the company ran into challenges operationalizing that model at scale, Eder noted.
Instead, it pivoted and began treating patients directly as a virtual provider. LainaHealth is quickly building out its business with commercial payers, employers and government entities. The company’s aim is to make MSK care more accessible to patients, improve outcomes and deliver cost savings, Eder noted.
“I’m a firm believer that if you can make care more convenient, you’re going to get better adherence, and if you get better adherence, you’re likely to get better outcomes and the only way to know that is to quantify those outcomes,” he said.
LainaHealth has the data to back up the clinical and economic impacts of its PT-guided virtual solution, Eder claims. The company’s platform can collect data from every patient PT session—adherence to the care plan, range of motion, functional tests and patient-reported outcomes measures.
LainaHealth’s solution cuts physical therapy costs in half, according to an analysis of 2024 data from more than 1,000 patient referrals across commercial payers, employers and government organizations the company works with. Results from that analysis demonstrate average direct savings of $634 per episode of care, while patients engaged in more than twice as many sessions as traditional care, according to the case study.
Savings per episode varied from 59% for a commercial health plan to 78% for self-funded employers, the company's 2024 data showed.
MSK conditions are a real pain point for employers, driving up medical spend.
Digital physical therapy company Hinge Health, which filed an initial public offering in March, cites a market analysis it commissioned from Health Advances that found MSK medical costs in the U.S. totaled nearly $1.3 trillion in 2023, when calculating both direct and indirect costs, like lost worker productivity. MSK conditions are one of the top drivers of healthcare spending in the U.S. and accounted for nearly 1 in 7 dollars spent on healthcare expenses in 2023, according to Hinge Health's S-1 filing.
Hinge Health also estimated that it is currently tapping into only about 5% of the total addressable market for MSK care, which leaves plenty of room for other players.
Virtual MSK care is a hot market, and, with Hinge Health's upcoming IPO, investors and health tech players are watching the industry closely.
LainaHealth has a different approach that many of the companies in the first wave of MSK care, Eder said, pointing to Hinge Health, Sword Health and Omada Health.
“I think they've educated the entire market about the cost associated with musculoskeletal care. If you read Hinge’s S-1, you'll also see that they have a fraction of the market, and there's a lot of opportunity for different approaches to help address this. That’s where I'm excited about our approach to it that's different from them, but obviously we’re playing in the same musculoskeletal sandbox but doing it in a different integrated way,” he said.
“Even with traditional PT, stats are showing that 65% of those prescribed PT don't go and it's due to time, distance and cost. If you can just break down those barriers, that's the trifecta,” he added.
LainaHealth is tackling those barriers, he noted. An individual can complete a virtual PT-guided session at home in the time it takes to get dressed to leave the house and drive to an in-person PT appointment, he said.
A key point of differentiation with LainaHealth’s model is that the company focuses on medical episode optimization versus only the avoidance of surgery or other high-cost interventions, Eder stressed. The company integrates with existing provider networks.
“We're not going to an employer base or member base and having people self-enroll regardless of medical necessity to avoid a surgery; that's not our approach. We’re integrated, and these patients have been diagnosed and prescribed PT from their physician. Our goal is to offer care that's more accessible and convenient at a direct cost savings. We get referrals from PCPs, orthopedic specialists and care navigators. We work with third-party administrators and health plans directly, and so they're sending us patients with referrals like you would a traditional [PT] practice,” he noted.
He added, “We have a model that can directly save on PT costs. There’s a lot of talk about surgery avoidance, but for some of our partners, physical therapy is their number three cost. There's no one saying, ‘How can I effectively offer more access but save on cost per episode?’"
LainaHealth has a team of PTs on staff, full-time employed, and each patient has a 45-minute initial evaluation with a PT. “This is a pure medical model,” Eder said.
PTs develop personalized care plans based on what the patient needs. “We can also collaborate with our referring partners if there's certain outcomes measures we want to collect, or a certain care plan structure. This is not a templated approach,” he said.
Patients perform the care plan, typically about 20 sessions, on their own time using their own devices—the solution, which is HIPAA-compliant, works on smartphones, tablets or laptop computers without any downloads required.
The system’s automated monitoring and computer vision tracks a range of data, including adherence to the care plan (whether they did the all the reps), motion quality, range of motion and sit-to-stand functional assessments, and reports those data back to the physical therapist.
The system also captures patient-reported outcome measures.
“It will report if there's a pain spike or low adherence, or low motion quality, or even a drop in NPS. That goes out to the PT, and that PT will proactively reach out to that patient and make sure everything's OK and update the care plans,” Eder said. “Meanwhile, the patient has secure messaging with their PT through their entire episode. Our patients say they feel more connected to their PT, because they're able to message them more continuously than just limited to when they can get into the clinic.”
The company uses AI as a tool to bolster the PT and patient connection, he added. “I’m a big believer that someone's recovery is really tied to knowing there's another trained clinical human that cares, understands your case and is managing you through and so we just think the AI is a way to make the care more convenient and efficient,” he said.
LainaHealth’s webAI computer vision platform offers opportunities beyond direct patient care as the company collects outcomes measures for other organizations. “We’re working with device implant manufacturers, one of the Blues plans, some COEs [centers of excellence], where they've got a provider network out there but it's really hard to quantify clinical outcomes,” he said.
One device manufacturer previously used an app to try to collect these data but only reached a 10% engagement rate. “Our goal was to double that, and we got in the mid-40s. We’re able to just quantify how these patients are recovering their entire journey just by using one-click secure links,” he added.
The Peterson Health Technology Institute evaluated eight virtual MSK solutions and concluded that PT–guided solutions can be an effective alternative to in-person PT and have the potential to reduce healthcare spending. According to the institute's analysis, if 25% of in-person PT users with low back pain shifted to these MSK platforms at a price of $995 per year, it would save an estimated $4.4 million per 1 million commercially insured individuals.
In 2023, LainaHealth raised $11 million in a financing round led by CincyTech, with participation from Tamarind Hill and other investors.
The company is now focused on scaling access to its solutions through partnerships.
“We’re expected to be at least five times the size of this a year from now. Things are really ramping up,” Eder said.
He touts LainaHealth's ongoing evolution as a strength, because it adjusts its product and business as the healthcare landscape changes.
“A lot of times, founders fall in love with their idea or their products kind of blindly and aren't willing to take a look at the environment, listen to the feedback they're getting and evolve. That evolution is what kept us going and is what now has us in this position that we're in," he said.