Jeff Krauss, MD: COVID-19 Accelerating Digital Platforms

While the coronavirus disease 2019 (COVID-19) has forced many specialties to implement telemedicine, some companies were preparing for a bigger digital footprint prior to the pandemic.

Hinge Health has recently made the expanded version Digital Musculoskeletal Clinic (MSK) available, adding clinical & technical capabilities to cover the full continuum of care.

The digital platform currently tailors each user to job-specific prevention measures with the option of personal virtual sessions with physical therapists, as well as advice for pre- and post-rehabilitation following surgery.

In an interview with HCPLive®, Jeff Krauss, MD, Chief Medical Officer of Hinge Health, explained how the company has expanded their platform to address some of the demand linked to the ongoing pandemic.

HCPLive: Can you describe this new platform and how it works?

Krauss: So, the new digital platform that we're introducing is a virtual digital musculoskeletal clinic and the what makes this unique is that our prior program, and most programs have focused on chronic musculoskeletal conditions.

That by definition is conditions that have existed for 12 weeks or more and that is a reasonable place to start with covering MSK because roughly three quarters of the costs come from those chronic conditions.

But there are also a lot of other really important areas to address along the musculoskeletal continuum of care.

And that's what we're also trying to include in this digital clinic and those include first prevention, trying to prevent problems before they arise and then acute condition, conditions that are that needs to be treated in a period of days to maybe a few months.

That deals with those inevitable injuries that are going to arise just from people's work or from people's lives.

Then we have the chronic program, which for Hinge has been our flagship program and is really focused is much more behavioral to try and encourage healthy lifestyle and to encourage healthy habit formation. And the real goal there is to drive down these elective, but very expensive surgeries that often are not really effective for chronic pain.

And then the last piece of the continuum would be the perisurgical care, which would be both what is now called prehab or pre-rehabilitation, which the goal is to make somebody as strong and flexible as possible before the surgery and post-operative rehabilitation.

So that in the physical therapy, exercises and movements and mobilization requires a following the surgery in order to maximize outcomes for the best recovery.

Then one other big thing that we've included in the clinic is an expert medical opinion service and that is for those people who are seriously considering surgery, which is obviously a big step for the patient and a very costly thing for the payer.

We are providing a service led by specialists who review the patient's notes and imaging and then can provide a recommendation on what they believe the appropriate next step is.

HCPLive: Do you believe this could be implemented by large organizations such as for example college athletic departments?

Krauss: I think that there would be a lot of benefit for athletes to have access to this kind of a program in prevention or trying to get them to follow certain healthy behaviors that would prevent them from getting injured in the first place.

Certainly, they have lots of acute injuries and I think they have a lot of in person resources on a big team, but they certainly there are people that would prefer to have somebody just available to them from home and not have to go in to see somebody.

And that's where our acute program can come in and they can set up a in person virtual physical therapy session with one of our physical therapists, and they help them to design a plan of care.

HCPLive: How important is it for more digital tools to emerge now that there is more of a push for telehealth due to COVID-19?

Krauss: I believe it’s really important. This is a trend that started well before COVID where people were finding that they benefited quite a bit from digital solutions for a variety of reasons.

One is obviously convenience of not having to go in person and 2 is that digital solutions can be more effective because they can touch a patient on an on a near daily basis with reminders and education, which just isn’t possible in that traditional clinical setting.

The trend was already starting for generally remote delivery of care, but with COVID-19, there's obviously been a big acceleration here.

We've seen a lot of demand during COVID and we've had to it as part of our calculations and dramatically expanding our capabilities and our staffing, physical therapists and we're now hiring more physicians as well, to accommodate this increased demand for remote care.

HCPLive: Does telemedicine level the playing field for people who don’t live in big cities have access to top doctors?

Krauss: It really makes geography much less important. Somebody living in a rural area can get the same care as somebody who's living in an urban area. So, I think it's a real equalizer in that way.

HCPLive: Do you think tools like this can reduce some of the burnout issues?

Krauss: I think it could help. I think the burnout issues are broader and there are there are many reasons for those. But I continue to practice part time at the VA in Palo Alto and I continue to do a musculoskeletal clinic there.

I often think that the kind of remote solution that Hinge offers would be a perfect complement to any care that I deliver. And it certainly is a cause of frustration and it can be demoralizing when I see my patients that I don't have the tools to help them recover from a lot of their injuries or pain conditions.

HCPLive: Are there any technological gaps you would like to see closed that would improve the status of the Hinge platform?

Krauss: There's lots of room to continue growing here and in a lot of ways, I feel like we're early in the process.

I see a few areas of growth here. So, one of them is the integration within person care. There are, of course, situations which require in person care and that happens everywhere throughout the continuum from an acute, you know, ankle sprain or other injury through people who need to get imaging through procedures, such as injection, all the way through the surgeries themselves.

I think the integration between the digital pieces and the in-person pieces are really a critical component. And there are lots of ways that we're thinking about that that can be done, but I would say that that's the biggest gap that remains right now.