Digital physical therapy solutions can improve patient outcomes, reduce healthcare spending, report finds

Two months after it released a scathing report on digital diabetes management solutions, the Peterson Health Technology Institute (PHTI) gave high marks to virtual physical therapy services for improving patient outcomes and cutting healthcare costs.

The organization's analysis evaluated eight virtual musculoskeletal solutions that focus on common MSK disorders, such as those that arise from acute injuries, repetitive motion or strain, or osteoarthritis.

"We were excited to see all the positive outcomes both clinically and economically," said Caroline Pearson, executive director of the PHTI, in an interview. "We looked at virtual musculoskeletal solutions that deliver virtual physical therapy, and we found that all of those solutions deliver clinically meaningful improvements in both pain and functional status. For many of the solutions, we also found that they perform as well as in-person physical therapy, which means that, for some patients, they may be able to substitute them if they find virtual PT to be more convenient or more accessible."

These tools could potentially improve access to therapy, reduce healthcare spending and offer greater convenience compared to in-person physical therapy, according to the researchers who conducted the analysis.

PHTI’s report assessed clinical and economic evidence on eight virtual MSK solutions in three categories—app-based exercise therapy with limited physical therapist intervention; physical therapist-guided solutions that are an alternative to in-person care; and solutions that supplement in-person physical therapy with virtual care and are paid for as remote therapeutic monitoring.

"We found that for the physical therapist-guided solutions, there is the potential to reduce healthcare spending, both because those solutions can be delivered more cost-efficiently than in-person PT and because they can improve outcomes that help avoid other unnecessary care, like surgery, injections and imaging," Pearson said.

Nearly 1 in 3 people in the U.S. have an MSK disorder, which are the leading causes of disability and account for nearly 10% of medical spending in the U.S. Since 2010, more than $38 billion has been invested in companies offering MSK solutions, including mergers and acquisitions.

PHTI's analysis looked at solutions offered by DarioHealth, Hinge Health, Kaia Health, Limber Health, Omada Health, RecoveryOne, Sword Health and Vori Health. 

It's the organization's second analysis since launching in July 2023 as an independent evaluator of digital health technologies. The Peterson Center on Healthcare launched the PHTI, with a commitment of $50 million, to assess the clinical benefits and economic impact of digital health solutions along with the offerings' effects on health equity, privacy and security. 

Pearson stressed that PHTI used the same evidence-based framework that it used to evaluate digital diabetes management solutions, a report that drew quick backlash from vendors when it was released in March.

For the digital MSK solutions analysis, PHTI reviewed more than 2,000 articles, including 53 submitted by companies evaluated in the report. PHTI says it received input from various experts and individuals including licensed physical therapists, clinical advisers, MSK patients and other stakeholders.

"Our findings indicate that virtual solutions represent effective treatment options that can expand the number of patients who both start and stick with physical therapy,” Pearson said “These solutions leverage technology to efficiently and conveniently deliver services that help patients recover and avoid high-cost care, thereby reducing overall spending."

PHTI's blistering report released back in March concluded that diabetes monitoring apps "do not deliver meaningful clinical benefits, and result in increased healthcare spending." 

Pearson said the positive assessment of digital MSK solutions can be attributed, in part, to the fact that virtual PT solutions have the potential to replace other care by either substituting for in-person PT or avoiding other unnecessary care.

"That makes the economic value proposition much stronger. Whereas, the diabetes solutions, because they were focused on self-management, they were always going to be cost-additive. It's a higher bar for meeting that economic impact assessment criteria," she said. "The second reason is really about the clinical area. The interesting thing about musculoskeletal care is that we deliver a lot of suboptimal musculoskeletal care in this country. We know that PT is incredibly effective and reduces healthcare spending. These tools are building on a strong base of clinical evidence around PT as a very cost-effective solution for patients and driving more patients into PT."

"Unfortunately, in diabetes, we don't have a lot of wonderful clinical options. Managing diabetes continues to be challenging, whether you're seeing a provider in-person or in a virtual environment. So, it's not surprising that the clinical outcomes were more limited in that area," Pearson said.

According to the findings, physical-therapist-guided solutions offer the most promise and overall value, as they improve patient outcomes on pain and function comparably to in-person physical therapy, with a net decrease in spending. For many conditions, they may be reasonably substituted for in-person therapy.

The report estimates that if 25% of in-person physical therapy users with low back pain shifted to these platforms at a price of $995 per year, annual savings could total approximately $4.4 million per 1 million commercially insured individuals.

App-based exercise therapies, including solutions from DarioHealth and Kaia, can improve pain and function compared to usual care but are unlikely to be effective as total substitutes for in-person physical therapy, the report concluded. However, they may be effective solutions to provide broad-based virtual care for patients with lower acuity who may experience clinical benefits.

The American Physical Therapy Association (APTA) cheered the report, saying it "validates the idea that early access to and use of physical therapy has the potential to lower costs and improve patient outcomes by engaging the expertise of physical therapists earlier in the episode of care."

"Virtual musculoskeletal solutions guided by PTs can help reduce overall health care costs, ease administrative burdens on physical therapists, close an access gap for millions and deliver improved clinical outcomes for the patients under our care," APTA President Roger Herr said in a statement.

APTA views this report as a "call to action" for payers and policymakers to enhance policies that harness the power of physical therapy through digital platforms, traditional in-person methods and hybrid approaches, the organization said.

In a statement, Sword Health said, "The PHTI report is yet more confirmation of the previous studies that show that Sword delivers transformative clinical outcomes for our members and high ROI for our clients."

Carolyn Jasik, M.D., Omada's chief medical officer, said the latest PHTI report is an improvement from prior efforts in terms of methodology and scope. "We are encouraged to see PHTI compare virtual options to usual care, which aligns with our previous feedback," she said in a statement. "That said, we’re left wondering why existing standards of care were not considered in past reports on other conditions."

Jasik also said the organization's analysis of digital MSK solutions "over-simplifies" the categorization of PT-guided solutions and, in particular, overlooks the substantial differences between physical-therapy-only vs. physical-therapy-guided care throughout a member’s treatment.

The report put companies like Omada that offer exclusively physical-therapist-provided care in the same category as companies that offer health-coach-directed care, according to the company.

Omada had criticized PHTI's diabetes management analysis for not offering a comprehensive look at the company's service offerings but rather looking at "one disease outcome in one disease state."

Hinge Health said it "stands behind the report’s conclusion that virtual MSK care provides 'clinically-meaningful improvements in pain and function' compared to status quo care."

PHTI's digital MSK report offered a number of recommendations for healthcare stakeholders. Digital MSK solutions should be more closely integrated into mainstream medical care and insurance medical benefits, Pearson noted.

"Right now, most of these solutions are being filtered through the wellness benefit which means that it is harder for them to identify patients that might benefit from virtual PT. It is hard for physicians to both recommend and refer to virtual PT, and it's hard for patients to even know that virtual PT is available to them," she said. "If we had tools that were part of typical medical insurance benefits, you could more effectively realize the value that they have proven they can deliver."

As many of these solution providers have proven their value proposition to help avoid unnecessary care, employers and health plans should ramp up their focus on value-based contracts, she noted. "As far as we know, Sword Health is the only company that is offering financial performance guarantees," she said.

In the coming months, PHTI plans to evaluate digital solutions for hypertension and then tools for mental health conditions including depression and anxiety.