In this digital, post-pandemic world, the role of the patient has shifted. This, in turn, has led to rapid changes in the demands on rehab therapists and their overall operations.
No longer largely reactive participants in their wellness journeys, traditional rehab therapy patients have evolved into consumers – powerful influencers within the healthcare industry whose evolving needs and expectations are ushering in a new era in physical therapy care.
These consumers demand convenience, accessibility, and equitable care. They expect transparency in the sharing of information related to their personal health. And, they want a healthcare experience that’s active, ongoing, and engaging both during and between visits.1
Armed with smartphones, smartwatches, fitness trackers, and other common devices which permeate nearly all other aspects of their lives, a larger number of consumers also want more digitally accessible healthcare services.
In rehab therapy, this demand has led to the emergence and growth of digital musculoskeletal care, or digital MSK.
According to Andrew (Drew) Contreras, PT, DPT, Vice President of Clinical Integration and Innovation with the American Physical Therapy Association (APTA), the expansion of digital connectivity into healthcare is a natural progression that should be thoughtfully and intentionally embraced.
“Digital MSK is an opportunity,” Contreras said. “It has the potential to transform healthcare delivery. In the right applications, these tools can advance quality of care, provide clinician support, speed access to services, increase patient engagement, and reduce overall spending.”
And it’s also here to stay, says Tannus Quatre, PT, MBA, a physical therapy operations consultant with Net Health.
“The speed at which we’re able to adopt digital MSK successfully and start to create value for the consumer will map to our ability as a rehab therapy profession to continue to grow,” he said. “It will certainly factor into our ability to encourage a greater base of customers to choose rehab therapy versus the many other alternatives that exist in the market.”
What is Digital MSK?
Digital MSK is a model for rehab therapy-based care delivery that leverages digital technologies and tools for the benefit of those experiencing musculoskeletal ailments. This includes the use of smartphones, tablets, apps, wearable technologies, and various other software solutions for the betterment of rehab therapy patients.
The goal of these technologies and solutions is to build a more robust, inclusive, and accessible bridge between patients (and their consumer-based expectations) and the rehab therapy professionals who can best help them.
Once built, these digital connections can enhance engagement, secure better patient compliance and outcomes, and provide a more optimal patient experience. It can also result in increased market share and overall revenue potential for a rehab clinic or operation.
Telehealth is often one of the first of these services that comes to mind when considering digital MSK, mainly due to its surge in use during the COVID-19 pandemic.2 An increasing number of rehab therapists across the country, however, have implemented other aspects of digital MSK as part of their operations.
Services and programs included under the digital MSK umbrella include:
- Telehealth and Telerehab
- Digital Home Exercise Programs (HEP)
- Patient Portals
- Remote Therapeutic Monitoring (RTM)
- Remote Patient Monitoring (RPM)
- Online Scheduling Tools
- Appointment Reminders
- Direct Patient Messaging
- Patient-Reported Outcome Surveys
- Net Promoter Scores
Of course, the implementation of a digital MSK program is not an all-or-nothing decision. Depending on the needs and goals of clinicians, administration, and ownership, digital MSK technologies and tools can play a significant role in operations, and they offer complementary benefits as part of a hybrid solution.
Digital Solutions Offer Patient-Centered Flexibility
Like treatment options, the level of benefit offered by clinicians through digital means will largely be determined by patients – their needs both individually as well as part of wider population pools.
“Some patients will only be appropriate for in-person care [while] some patients can benefit from fully remote care,” Contreras said. “Most patients will be somewhere in the middle, requiring in-person care at times and virtual care at other times.”
The advancement of technologies in areas such as predictive analytics, artificial intelligence, machine learning, and so on will also continually play a factor in the adoption, implementation, and use of digital MSK solutions, according to Quatre.
“At this point, as technology continues to evolve and innovators in the rehab therapy space uncover new ways to apply these technologies, digital MSK really doesn’t have one definition, shape, or form,” he said. “It’s actually still evolving in real time to better serve patients.”
And as technology evolves, so will research that guides rehab therapists toward best uses and best practices when applying tools related to digital communication, engagement, and treatments.
“We have sound studies available to use, but the evidence will change as the field continues to change, which it is doing rapidly,” Contreras said. “It is our job as clinicians to try and stay up to date with the evidence and adjust accordingly. APTA can help provide tools and help clinicians assess the safety and effectiveness of digital tools.”
A Perfect Digital Storm
Though the pandemic played the most outsized role in nudging digital MSK tools, like telehealth, toward the forefront of rehab therapy, it remains just one aspect of what makes the industry’s digital transformation part of a larger narrative – a perfect storm of conditions, if you will, that is forever changing the profession.
Factors making digital MSK ripe for today’s market include:
The COVID-19 Pandemic
There it is again. It’s impossible to talk about the emergence of digital MSK without mentioning the role the pandemic played in forcing the early adoption of telehealth and other technologies. In fact, telehealth and virtual appointments increased 38-fold just one year into the pandemic, according to one study.3 These services offered patients a bridge to care during an era of social distancing.
Digital Transformation
Thanks to the evolution of technology and the vision of innovators within the healthcare space, the foundation for many of the digital tools embraced during the pandemic existed prior to 2020. The pandemic simply forced rehab therapists to shed their skepticism and reluctance around these digital tools for the sake of helping them stay connected with patients.
The Rise of Healthcare Consumerism
Healthcare consumerism is defined as proactively using trustworthy and relevant information, along with appropriate technologies, to make better-informed decisions about one’s health.4 As addressed previously, consumers have simply grown accustomed to in-hand, on-demand solutions that meet their current needs, and healthcare is no different.
The Emergence of Value-Based Care
As payers, such as Medicare, continue to transition toward value-based care reimbursement models, clinicians are finding the use of digital tools that enhance engagement – digital HEPs, patient portals, remote therapeutic monitoring, and patient reported outcomes surveys, for example – help patients achieve better outcomes. This perfectly aligns with the goals of value-based care, which provides incentives for improved outcomes.
Impactful Regulatory Changes
The wider adoption of digital MSK throughout the rehab therapy market during the pandemic led the Centers for Medicare and Medicaid Services (CMS) to expand its repertoire of reimbursable codes to include telehealth services as well as remote therapeutic monitoring (RTM). This provides the opportunity for new revenue streams to rehab therapy clinics and operations.
Investment in Digital MSK is Surging
Right now, investment in digital health and virtual care is skyrocketing. This indicates the rapid pace of innovation in healthcare is not likely to slow anytime soon.
This surge, according to McKinsey & Company, is being fueled by private equity and venture capital investments that are focusing primarily on healthcare technology and consumerism.
One recent analysis stated there were “more than six-times as many tech-focused healthcare deals in 2021 as in 2014.”5 Another study projected that the investment in digital therapeutics, estimated at $4.5 billion in 2023, will exceed $17 billion by 2027.6
The main driver of all this? Opportunity.
After having experienced telehealth during the pandemic, 76% of those surveyed showed an interest in using digital healthcare at some point in the future.7 Findings from another study determined more than half of adults would prefer a healthcare plan that included virtual benefits, citing convenience and safety as their biggest drivers.8
Narrowing a Gap in Rehab Therapy Care
Investors in digital MSK specifically also see the wide gap that exists between those who can benefit most from rehab therapy and those who ultimately choose PT as the solution to their musculoskeletal ailments. The numbers are difficult to ignore:
- One-half of all American adults suffer from musculoskeletal pain or injury.9
- Only 10% to 20% seek physical therapy as their solution despite it being one of the most effective avenues for the treatment and prevention of MSK ailments.10
By making musculoskeletal care more accessible, convenient, and cost-effective through digital MSK solutions, investors in brands like Hinge and Sword are betting they can close this gap while making a significant difference in patients’ and consumers’ lives.
With such force behind their efforts, these and other digital therapy companies will most certainly serve as a disruptive force within the rehab therapy market. How much of a threat? It all depends on how well we adapt to this new digital movement.
“It’s not optional for a rehab therapy practice or operation to turn a blind eye to what’s happening digitally,” Quatre said. “The customer is always going to trend toward where the value is to be found. If digital MSK is creating value, which it is, we feel patients can find even greater value in engaging with practitioners within their own communities – people they know, and who know them – which can provide a hybrid approach that includes a mix of in-person and virtual care.”
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1 McKinsey & Company, “Driving growth through consumer centricity in healthcare,” March 14, 2023
2 U.S. Government Accountability Office, “Telehealth in the Pandemic – How Has It Changed Healthcare Delivery in Medicaid and Medicare?” Sept. 29, 2022
3 McKinsey & Company, “Telehealth: A quarter-trilling-dollar post-COVID-19 reality?” July 9, 2021
4 Health Affairs, “The ‘New’ Health Care Consumerism,” March 5, 2019
5 McKinsey & Company, “Driving growth through consumer centricity in healthcare,” March 14, 2023
6 MedCity News, “The Drive to Adopt Digital Therapeutics: Where do we stand?” March 3, 2023
7 MedCity News, “Unlocking digital MSK for providers,” Nov. 22, 2021
8 McKinsey & Company, “Consumer Health Insights: How respondents are adapting to the ‘new normal” March 25, 2023
9 Bone and Joint Initiative USA, “The Burden of Musculoskeletal Diseases in the United States,” 2015
10 Centers for Disease Control and Prevention, “Physical, Speech, Rehabilitative, or Occupational Therapy Use Among Adults Aged 25-64, by Veteran Status,” August 2022
11 Medical History, National Institutes of Health, “The Lancet on the Telephone 1876-1975,” 1977
12 Medical History, National Institutes of Health, “The Lancet on the Telephone 1876-1975,” 1977
“It has the potential to transform healthcare delivery.”
Advantages of Digital MSK Care
Patient Advantages
- Better accessibility
- Stronger patient engagement
- Greater patient compliance
- Improved access / patient empowerment
Rehab Therapist Advantages
- Enhanced quality of care
- Flexibility in care delivery and patient engagement
- Ability to reach new populations of people
- Increased growth and revenue potential
‘Lift the Child to the Telephone’
A Historic Perspective on Telehealth Care (1879)
While the foundation for digital health as we know it today harkens back to the early 1990s, when the internet became publicly accessible, innovations in telecommunications have long inspired medical practitioners and their desire to better connect with and treat patients.
Just months after Alexander Graham Bell first transmitted speech electronically in 1876, for example, medical journals from the era published articles, dispatches, and letters that openly reflected on the telephone’s application in improving patient access and engagement.
Two early letters, which appeared in an 1878 edition of The Lancet, considered ways the telephone could be used to transmit physiological data – signals like heart, lung, and other muscle sounds – from the patient to a doctor.11 Today, we know this as remote patient monitoring (RPM).
In another dispatch published in 1879, an anonymous contributor wrote about how the telephone could improve access for patients too far away for face-to-face doctor visits.12
It told the story of one doctor who asked a mother to hold her baby up to the phone so he could better hear its cough. “That’s not the croup,” the doctor concluded, putting the mother at ease and saving him a late-night trip to the child’s home.
This moment – perhaps one of history’s first telehealth sessions – served as an early step along a winding path which led to our current digital landscape. It’s a landscape that continues to inspire innovation that improves accessibility, engagement, and peace of mind.