Chronic pain is a pervasive issue that presents a significant challenge for health plans, particularly in the Medicaid population. It's a complex problem that intertwines with controlled substance use, frequent emergency room visits, and high utilization of healthcare services. This article explores the intricacies of chronic pain management, the role of health plans, and the potential of digital health solutions in addressing this issue.
The Chronic Pain Landscape Chronic pain is a significant concern for health plans due to its prevalence and the high utilization of healthcare services it necessitates. Patients with chronic pain conditions, such as musculoskeletal pain, fibromyalgia, or rheumatologic pain, are frequent users of services. They often visit the emergency room more than a dozen times a year, leading to substantial healthcare costs.
The issue is particularly prevalent in the Medicaid population, where patients often use the emergency room as their primary care provider. This behavior makes the use of controlled substances and street drugs more apparent, contributing to the complexity of managing chronic pain in this population.
The Cost of Chronic Pain While most controlled substances are relatively inexpensive, other treatment modalities can be costly. These include biofeedback, acupuncture, and chiropractic treatments. Furthermore, when patients become drug-addicted due to pain, they tend to get hospitalized for other issues, leading to even higher costs.
The most significant expense, however, comes from surgeries, particularly for lower back pain, which is a common chronic condition across all segments. It is estimated that two-thirds of the back surgeries performed in the United States are unnecessary, highlighting the need for better management of chronic pain.
The Role of Health Plans Health plans have historically struggled to provide effective solutions for chronic pain. Pain clinics, which are part of most health plans' networks, primarily address musculoskeletal pain. However, their toolbox is limited, often resorting to prescription drugs and interventions such as back pain injections.
The rise of digital healthcare, accelerated by the COVID-19 pandemic, presents a new opportunity for health plans to address chronic pain. Digital apps in the chronic pain space offer various approaches, including biofeedback, mindfulness, and cognitive behavioral therapy. The legalization of medical marijuana, which has been used for decades for chronic pain, also changes the landscape.
The Future of Chronic Pain Management Despite the rise of digital health solutions, health plans are still in the early stages of evaluating their effectiveness. They are looking for clinical utility and return on investment, which many of these new solutions have yet to demonstrate due to their novelty. However, the potential of digital health in chronic pain management is undeniable. As these tools continue to evolve and provide more data on their effectiveness, they could become a vital part of health plans' strategies to manage chronic pain. The challenge lies in identifying the most effective solutions and integrating them into the healthcare system to provide better care for patients with chronic pain.
The Evolution of Digital Musculoskeletal Care One of the larger players in the digital musculoskeletal (MSK) care and physical therapy space, Hinge Health, recently announced its expansion into in-person care with a physical therapy house call service. This service, which will first launch in Chicago before a nationwide rollout, is seen as a complement to virtual care, with the potential to improve patients' digital experiences.
Hinge Health's move reflects the growing trend of integrating digital and in-person care to bridge care gaps and reimagine a healthcare model that works for everyone. This approach is particularly relevant given the challenges of conducting physical assessments from afar, as voiced by rehabilitation practitioners in a recent survey. Hinge Health, founded in 2015, has been a significant player in the digital MSK care space, announcing multiple funding rounds in 2021, including a $300 million Series D, a $400 million Series E, and a $200 million secondary investment.
The company's expansion into in-person care follows the launch of its women's pelvic health program last spring. This move mirrors the trend of other companies in the space, such as Sword Health, which also revealed its own offering around the same time.
Several other companies are also offering virtual physical therapy. For instance, the Hospital for Special Surgery, a New York-based academic medical center focused on musculoskeletal care, raised $21 million in Series A funding to launch its own company, RightMove Powered by HSS. Similarly, Kaia Health announced a partnership with Luna On-Demand Physical Therapy to offer in-person services to complement its digital options.
The digital MSK care space is becoming increasingly crowded, with companies like Upswing Health, RecoveryOne, DarioHealth, and Omada Health also offering their own solutions. As these companies continue to innovate and provide more effective solutions for chronic pain, the future of chronic pain management looks promising.
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