Hundreds of millions of Americans live with musculoskeletal conditions, experiencing persistent pain in their joints, bones and muscles, limiting their ability to not only work but live fully and comfortably. Yet, many with MSK struggle to get early and
The World Health Organization estimates that 1.7 billion people have MSK conditions, with one in two Americans affected by these conditions, according to the United States Bone and Joint Initiative. In the past decade, spending to treat MSK conditions has doubled to $20 billion in the U.S., but there have not been improved patient outcomes, as noted by Hinge Health’s State of MSK Report. With MSK spending so high, why are people not getting better?
Dr. Marc Gruner, co-founder and chief medical officer at MSK digital treatment platform Limber Health, says that many patients have not had the tools to consistently care for themselves at home, where a majority of recovery often takes place.
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“Patients should try the least invasive, most conservative approach to treatment first, and then work their way to more aggressive treatments,” says Dr. Gruner. “And that conservative approach means physical therapy, exercise and even mental health help.”
But conservative care involves daily lifestyle changes and exercises that go beyond the doctor’s office. Dr. Gruner believes that one of the biggest challenges MSK patients face is getting physical therapy early enough, which can reduce healthcare spend and improve outcomes. Workers Compensation Research Institute found that when physical therapy is started more than 30 days post-injury, patients are 46% more likely to receive an opioid prescription, 47% more likely to receive an MRI and 89% more likely to get lower back surgeries than patients who started physical therapy within three days of their injury. Additionally, the medical cost claim for workers who waited more than 30 days to get physical therapy was 24% higher.
“We considered how we could get people to therapy early and work with healthcare providers to improve adherence to therapy,” says Dr. Gruner. “If we provide the right tools, which includes both in-person and digital care, there’s a better chance of success in a conservative treatment pathway.”
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Limber partners with in-clinic providers to deliver hybrid care by offering digital tools such as a library of at-home exercises, progress tracking and data analytics to ensure patients stay on track and see positive outcomes, explains Dr. Gruner. In addition, patients get access to a national network of in-person physical therapists as well as emotional health coaches.
“Normal brick-and-mortar clinics do not have digital offerings for musculoskeletal care,” says Dr. Gruner. “Sometimes you get a paper printout of exercises and steps you should take, but your condition is not explained.”
Dr. Gruner stresses that Limber’s provider care team model — which could be a combination of physical therapists, physicians and mental health care providers depending on the patient — means people not only get holistic care, but holistic knowledge of what they are struggling with. For example, many may not realize that MSK does not begin and end with physical pain. According to Hinge Health, 65% of people with depression also reported chronic MSK pain. MSK can increase risk of depression, which can increase the intensity of pain. This negative feedback loop has to be recognized by both providers and patients, explains Dr. Gruner.
Limber’s care model is working. In a randomized, controlled trial conducted by Mayo Clinic, patients with knee pain who used Limber showed better function and pain improvement than those who only had in-person physical therapy.
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Beyond providers, Limber also partners with employers who want to offer their platform as a benefit to employees — something Limber claims is good for health and bottom lines. The company reports that 77% of users have voided surgery or further treatment after completing a Limber program, equating to lower employer medical spend and reduced absenteeism.
Notably, Limber’s work goes further than the treatment space. The company helped pioneer Remote Therapeutic Monitoring billing codes with the American Medical Association so providers can be reimbursed for their virtual care, starting from the initial setup and patient education to remote monitoring. Now, Limber is looking to Medicare.
“We are excited to endorse new current procedural terminology, or CPT, codes in Medicare,” Dr. Gruner says. “This means patients over 65 could use Limber as an augmentation of their therapy experience.”
CPT codes are used to report medical, surgical and diagnostic procedures and services to physicians and health insurance companies. In other words, to receive coverage, that procedure or service needs to be recognized as a CPT code. Limber is pushing for MSK hybrid care to become a normalized option for treatment.
“We want to provide the technology and digital tools to empower providers and insurers for the next generation of healthcare,” says Dr. Gruner. “People should be able to get individualized care when they need it.”
