In Q4, 2016, VenAdvisory®, a digital health commercialization firm, evaluated the product-market fit for an innovative, first-to-market wearable mobile solution for patients recovering from total-knee and total-hip replacement surgeries.
The solution called Breg Flex is designed to accelerate patient recovery anywhere, anytime for total joint replacements. Flex supports conservative therapy before surgery and recovery from sports injuries. Unique to Flex is the use of visual coaching and gamification. The visual coaching relies on a real-time avatar; a likeness of the patient performing exercises that are displayed on a mobile tablet. Under watchful observation, patients are motivated to perform their daily exercises. Outcome results are captured automatically and reported to a patient panel progress dashboard for care team review.
VenAdvisory interviewed over 50 organizations, key opinion leaders, physicians, physical therapists, and patients to determine the proof points for this innovative, wearable recovery solution. We reviewed over 100 peer-reviewed publications for strategies to reduce Total Joint Replacements (“TJR”) costs while improving outcomes. We identified that Flex can reduce post-acute care costs. These costs account for approximately 40 percent of all total knee (TKA) and hip replacement (THA) spending during the 90-day episode period.1
The VenAdvisory study found that approximately $1,500 to $2,000 can be saved on average, with Flex for each $20,000 THA and TKA Medicare patient (i.e., Comprehensive Care for Joint Replacement (“CJR”).2,3 The interview results also identified that Flex addresses remote patient monitoring needs, particularly patient adherence to prescribed home therapy treatments, management of pain and avoidance of potential complications that leads to emergency department (ED) visits and readmissions. The study was sponsored by Breg.
POST-ACUTE CARE SAVINGS OPPORTUNITIES
Medicare’s Bundled Payments for Care Improvement (“BPCI”) and CJR programs have made significant progress in reducing implant costs and the average length of stay. Similarly, commercial payer payment models for TJR have incentivized providers to shift patients (under age 65) away from inpatient surgeries to 24-hour ambulatory surgeries and discharge.4
Still in 2017, significant opportunities remain to save further cost and optimize outcomes in post-acute care (“PAC”) discharge services. How then, can these PAC costs be further reduced? How can patients benefit from accelerated patient recovery in the comfort of their home while provider confidence in patient adherence is addressed in near real-time?
As episode of care reimbursement and incentive models evolve and clinical pathways change quickly in response, what emerges is a delicate balance that must weigh patient risk factors.5 How to safely balance - reductions in length of stay, steerage to ambulatory surgery, shifts in discharges away from skilled nursing facilities to home and reductions in home health and physical therapy visit costs without spikes in ED visits and readmissions.
Reducing Post-Acute Care Blind Spots With Smart Wearables For Total Joint Replacement Surgeries
Clayton Christensen talks about disruptive innovation in healthcare when technology shifts care outward; when care is decentralized, scalable, evidence-based and personalized. VenAdvisory evaluated one such disruptive innovation for orthopedic episodes of care. The firm found that while a variety of wearable sensors, such as watches, devices, patches, and monitors, have been adopted by individuals, their use to support personalized rehabilitation treatments by providers has been much more limited. The firm sought to validate the product-market fit potential for Flex, a new wearable sensor technology for orthopedic episodes that combines a mobile application, gamification, behavior change, telehealth, care coordination and augmented reality with current orthopedic episode pathways. VenAdvisory sought to validate proof points and test go-to-market assumptions. These assumptions included whether Flex and its business and clinical process models could:
Simplify patient transitions to the home
Work within existing provider workflows, including EMR usage
Accelerate patient recoveries while also improving outcomes and avoiding readmissions and ED visits
“Sensor technology is the wave of the future"
—SVP, Academic Medical Center
Equally important is the patient perspective. Can the patient experience be improved by reducing the out of pocket expense, time and commute to outpatient therapy?
At three independent sites, orthopedic surgery practices prescribed a prototype (wearable device and mobile application) to 25 patients undergoing either a hip or knee replacement surgery. Detailed patient interview feedback was collected in 2016 and early 2017 regarding their recovery experience using Breg Flex.
Higher high functional improvement
Patients had 20% higher high functional improvement scores at discharge compared to the national average 6
Physical therapy visits
Wearable device wearing patients resulted in 25% fewer physical therapy visits 6
Patients compliant with home exercise
75% vs. 30%
75% of wearable patients were compliant with home exercise programs, compared to 30% for non-wearable patients 6
To better understand patient motivations and preferences, we also uncovered the following findings for patients from survey, interview and published data:
Guided Home Exercise
Flexibility in Exercise Programs (e.g., pause, restart, skip)
Would suggest wearable to a friend
100% of patients with wearable devices would suggest the solution to a friend
95% of wearable users found the solution increased their motivation
75% of wearable patients identified speed of recovery as their top priority
Keswani, A., et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. Journal of Arthroplasty. June 2016. Volume 31, Issue 6, Pages 1155–1162.
Centers for Medicare & Medicaid Services. Comprehensive Care for Joint Replacement Model. Web. Accessed 1 February 2017.
Alliance for Home Health Quality Innovation, “Distribution of Post-Acute Care under CJR Mode of Lower Extremity Joint Replacements for MS-DRG 470”. 2011-2014 Standard Analytical Files (SAF) Limited Data Set (LDS); 5% and 100% sample of Medicare beneficiaries, All Part A and Part B Care Settings.
Harris Meyer, Replacing joints faster, cheaper and better? Modern Healthcare, June 4, 2016
Yao, Dong-han, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Post discharge Complication Timing and Risk Factor Analysis. Journal of Arthroplasty. February 2017 Volume 32, Issue 2, Pages 375–380.
Breg. Breg Flex: Mobile Patient Therapy Monitoring for Value Based Care. Results of observational studies of patients. Carlsbad: Breg, 2017. Print.
Wang, Li., et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2016 Feb 2;6(2): e00985.
D. Santa Mina, et al. analysis. Physiotherapy 100 (2014) 196–207.
Brown K., et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.
Snow R., et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 2014 Oct 1;96(19): e165. Web. Accessed 12 Feb. 2017.
To be continued: This insight is Part 1 in a series of four parts.
A full download of the article will be available at the end of the series.