Industry Voices—To see where digital therapeutics is heading, look to MSK care

Sometimes investing gets personal. When I started looking at virtual, digital healthcare platforms for musculoskeletal conditions, it hit close to the bone, specifically the knees.

I shot mine hanging over the side of a Star-class sailboat across three Olympic campaigns. I had both knees scoped, ignored my orthopedist’s recommendation of preventive physical therapy (PT) and eventually was forced to have two knee replacements, after which I became a PT convert.

I’m more mobile than I was 20 years ago, but had my injuries occurred more recently, and I’d made better choices, the approach to repair and recovery could have been very different.

In the last five years, with the evolution of telehealth and wearable devices, a number of digital platforms emerged to go after MSK care. As part of my investor’s due diligence, I recreated all the therapy and exercises I went through during my actual knee replacement rehab and discovered that if these innovations were available when I had my surgeries, I could have done the entire rehab program at home, on my time, and probably more rigorously.

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The impact of digital health

According to the World Health Organization, 1.7 billion people worldwide suffer from an MSK condition affecting joints, bones, muscles, the spine, connective tissue and body systems, with more than half a billion alone bothered by lower back pain.

The impact of chronic MSK conditions is both individual and societal: It is the leading cause of disability, limiting mobility and dexterity, and contributing to early retirement, absenteeism, reduced productivity, and increased healthcare needs and costs.

In a 2020 survey, the Business Group on Health found that 44% of employers ranked MSK-pain-severe-enough-to-warrant-surgery as the top condition impacting their healthcare costs. Unfortunately, the numbers are on the rise, due to population growth and aging, reflected in a U.S. digital MSK disease-treatment market projected to grow to $5.7 billion by 2025

Aside from the historic development of the COVID-19 vaccines, the delivery—and consumption—of care has been the breakthrough of our pandemic year.

Telemedicine grew by more than 40% in the past year, with most usage coming from first-time patients. Digital health closed the first quarter of 2021 with $6.7 billion in U.S. funding, the most funded quarter in its history, and for the first time, digital MSK companies were among the top six funded clinical indications. 

Clearly, investors, employers and health plans have been motivated by the transformation of the patient experience through 24/7 remote access that has increased utilization and reduced the cost of care.

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Doing more by reaching more

Despite the enormous need for MSK treatment, the market is largely underserved. PT and occupational therapy (OT) are the essential nonsurgical or post-surgical interventions for prevention and recovery, yet more than half the people who need them don’t receive them due to poor access and the cumbersome logistics of a system frozen in the past.

Though the development of imaging technology has vastly improved the diagnosis of MSK conditions, the method of delivering PT/OT is largely unchanged from 75 years ago, the same that I experienced following my knee replacements. The standard referral is for 15 to 20 in-person visits at a medical clinic. That has proven to be a formidable obstacle to treatment, especially for people whose mobility is compromised. Expecting people who have trouble walking to get themselves to a clinic is absurd. We need a better method.

Combining the expertise of licensed therapists with DTx (digital therapeutics), advantages for access and engagement are beginning to transform MSK care. By studying where DTx has been effective in other disease categories such as patient monitoring and mental health, DTx for MSK clearly can have a market-changing impact.

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However, for the market to continue to mature and evolve, the virtual MSK treatment companies need to continue to focus on the following areas:

  • Objective, peer-reviewed evidence of clinical outcomes is essential to long-term success. Consumers will expect it. Employers will demand it for consideration. Health plans will require it for reimbursement.
  • The clinical approach has to be a mix of technology and clinically credentialed experts. An app alone doesn’t address the therapeutic needs of MSK pain, and the use of licensed physical therapists ensures appropriate therapy.
  • Beyond the immediate opportunity for synchronous virtual PT/OT with wellness intervention, technology sensors can make therapy smarter and more efficient for the patient and the provider.
  • Modalities of service must address both preventive and recovery solutions across a broad set of MSK indications including not only the usual suspects of hip, knee and back pain but also addressing pain points around shoulder, wrist and other problem areas. While prevention is an appealing and cost-effective approach for reducing the impact of MSK, the reality is that the majority of the population will seek intervention only when the offered therapies are convenient.
  • And, finally, integrating longitudinal MSK therapy with health plans, employee benefits plans, primary care physician recommendation and virtual care will be adopted more quickly with an outcomes-based, value-driven pricing model focused on positive results at lower cost.

We’re in a time of historic shifts in healthcare. I know this as a patient and investor. Digital technology is enabling new approaches to solving old problems, and nothing is older in medicine than MSK pain. Now is the time to take advantage of the opportunity before us.

Todd Cozzens is managing partner of Transformation Capital.