April 28, 2020
The Health Innovations Forum (HIF), a group of leading members of Business Group on Health, is unique in that it not only identifies but also accelerates the adoption of effective and proven innovations in health and well-being. One of many ways HIF members do this is by assessing innovative start-up and mid-stage companies looking to partner with self-insured employers to deliver transformative health benefits. Over the course of 5 years, HIF members have vetted nearly 100 companies, many of which have proceeded to successfully implement their solutions across a number of Business Group members and launch their companies more broadly into the employer market.
Four major themes emerged from the Winter 2020 HIF meeting.
The Elusive Proprietary Algorithm
For health care innovators to create a long-lasting impact with positive disruption, they need to keep quality of care and the consumer experience as their top two concerns. Technology, virtual avenues for care, or artificial intelligence may sound “innovative,” but they are wasted if they’re not improving quality of care or the consumer experience. Employers considering new innovative partners should demand that quality data are transparent, not obscured with non-specific phrases like “proprietary algorithm” and “deep learning” that aren’t further explained.
The Virtual Musculoskeletal (MSK) Vendor Landscape Is Growing
It’s no surprise that the landscape of virtual MSK therapy companies is growing, given that MSK complaints are:
- The number one category cost driver for large employers;
- Responsible for 34% of all lost workdays;
- The third leading cause of disability claims and early retirement in the U.S.;
- Have an extremely high escalation rate to surgery; and
- Lead to significant inappropriate use of opioids.
The cost and inconvenience of treatment are major barriers to fulfilling physical therapy treatment regimens. Virtual MSK solutions can extend the ability of a provider to deliver therapy to patients in their homes or other convenient locations outside of clinical settings, and to do so on demand. Between Physera, Hinge Health, Joint Academy, Virtual Physical Therapists, Reflexion, Kiio, Limber, Simple Therapy, WizeCare, Sword, Kaia, and others that were founded since you started reading this, there are numerous players in this space.
When assessing these options, consider the following:
- What level of clinical certification do you want in a virtual MSK provider? Some providers use health coaches and others use licensed clinical physical therapists. Using licensed clinicians can be more expensive but may give you greater confidence in the results.
- Who is your target population? Some vendors are built to serve post-surgery populations, whereas others focus on a broader group of people with more mild or moderate joint pain.
- How do you want to pay for this service? Some vendors are able to bill through claims like a standard bricks-and-mortar office, whereas others charge a fee directly to the employer.
HIF Presenter: Sword Health is a digital health platform for those suffering from musculoskeletal disorders. Its digital solution for the workforce provides treatments for chronic and post-acute conditions by pairing a licensed physical therapist with clinical teams.
HIF Presenter: Kaia Health makes use of AI technology and human mentors to provide access to multimodal therapy to address MSK issues. Whereas some competitors send devices to the home for monitoring therapy, Kaia runs off a smartphone.
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Personalization and Navigation
Most consumers struggle to understand the basics of health literacy. For example, is a more expensive MRI better? Shopping for your health care needs can be complicated, confusing and opaque. Employers are looking for solutions that make this experience easier and less overwhelming through navigation portals. Virtual platforms move beyond consumer education to provide targeted advice, guiding consumers to quality providers and evidence-based care.
HIF Presenter: Galileo Health has created a platform for delivering virtual primary care, as well as some specialty care, with the ability to steer patients to high- quality clinicians when in-person treatment is required. Traditional telehealth vendors are also entering this market, which looks to create a new “front door” to the health care system.
HIF Presenter: WithMe is a new pharmacy benefit manager (PBM) that seeks to provide personalized medical guidance by matching each employee’s prescription to the lowest-cost pharmacy. The company also bases customizes formularies for individual patients on clinical evidence, rather than a one-size-fits-all model based rebates.
As these innovations show, technology is poised to change the patient experience, from providing primary care virtually to making sure the right drug is given to the right person at the right price.
Addressing High-Cost Claims During Times of Need
Modern medicine often solves problems by applying standardized solutions, but your health is personal. Discovering ways to improve and advance health care outcomes while reducing spending for patients who need complex and costly care requires understanding of their unique personal characteristics. During the HIF meeting, these start-ups presented on how they will support people who fall into this category.
HIF Presenter: MyMee is a digital autoimmune therapy program that rethinks the pharmaceutical-driven paradigm for treatment of conditions like rheumatoid arthritis and multiple sclerosis. The program takes a “food as medicine” approach and has been able to transition patients off of some of the most expensive drugs on the market by helping them identify food triggers that cause debilitating flare-ups.
HIF Presenter: Quit Genius provides a personalized cognitive behavioral therapy program tackling smoking cessation, vaping and opioid use disorder. It is one of several companies that has entered the market recently to rejuvenate the smoking cessation movement and address the opioid epidemic.
HIF Presenter: Carrot is a global, customizable family-building solution for employees, regardless of age, sexual orientation, gender, geography or relationship status. This market has proven to be fertile for new vendors looking to work with employers to improve the family-building experience, which traditionally has relied on IVF, adoption, and surrogacy, all expensive and sometimes frustrating options.
We are at a pivotal and crucial moment in health care history, with a convergence of new medical practice knowledge and emerging technological transformation. In the future, more innovations will merge these advances, bringing precision medicine – care and treatments tailored to the individual —to an increasing number of patients .Interested in learning more or getting involved with the Health Innovations Forum? E-mail firstname.lastname@example.org.