Mobihealthnews: Seniors Aren’t Tech-Averse. We’re Just Not Designing for Their Needs.

By Mark Luck Olson

Seniors are certainly less tech-savvy than younger generations who grew up with it. My parents are from the World War II generation, long before there was the personal computer, let alone the internet. Trying to help my aging mother with email is a challenge. But just because some may not know how to use TikTok, what a nonfungible token is or how to make the WiFi work doesn’t mean they are technology averse.

MedCityNews: Have back, hip or knee pain? What to consider before seeing an orthopedic surgeon

MedCityNews | By Dr. Alan Daniels, April 6th, 2022

As an orthopedic spine surgeon who performs approximately 500 surgeries a year, my favorite type of patient is the one I never have to see—not even once. The reason for this is that means their musculoskeletal (MSK) issues—any condition or injury affecting joint, bone, tendon or muscle—haven’t progressed to the point where they need to consult with a surgeon.

To put it bluntly, surgery is not always the best answer. Surgery is invasive, expensive and sometimes risky. Often behavior modifications that help with losing weight and increasing mobility, such as exercise, stretching and eating healthily or physical therapy, can successfully address many MSK issues, while at the same time reducing healthcare spending. For example, when physical therapy is the first line of treatment, according to a systematic review in the Physical Therapy & Rehabilitation Journal, it results in lower overall healthcare costs, fewer visits to the doctor and better patient mobility.

Mobi Health News: Digital musculoskeletal care is booming. Where does the market go from here?

Mobi Health News | By Emily Olsen, February 04, 2022

Musculoskeletal care is a big problem for the U.S. healthcare system, digital health companies say. Disorders are common and expensive to treat, but care that could cut down those high costs is inaccessible to many who need it.

That message is resonating with investors. Over the past year, they’ve poured hundreds of millions of dollars into the digital MSK space. Unicorns Hinge Health and SWORD health both closed multiple rounds of funding in 2021, some worth nine figures

But they weren’t the only companies competing for venture dollars: Kaia HealthRecoveryOne and SpineZone also raked in millions of dollars in deals last year. Meanwhile, DarioHealth, which also offers tools for managing chronic conditions like hypertension and diabetes, bought its way into the space by acquiring Upright Technologies. It announced the launch of its MSK platform, called Dario Move, in October. 

RecoveryOne stakes claim in Medicare Advantage: Providing access for Seniors most in need of virtual MSK solutions

If you scan the digital health scene for companies that deliver virtual physical therapies for musculoskeletal (MSK) conditions to the senior population, you likely won’t find any. Yet, if you look at the sheer number of people with MSK problems, half of them are on a Medicare plan.

What’s the disconnect? The simple answer, partnering with a health plan serving Medicare customers is time-consuming and difficult. It’s not as easy as signing up a self-insured commercial customer, which is what other digital MSK health companies target.

That’s why we have expanded our partnership with Cigna to offer virtual physical therapy and a broad MSK solution to Medicare Advantage customers. It’s a strategic collaboration that has allowed us to make a real stake in Medicare by offering RecoveryOne’s solution to treat MSK conditions and injuries as an in-network benefit.

Our platform is currently available to Cigna Medicare Advantage customers within the Tennessee market, which includes plans in North Mississippi, Virginia and North Georgia, with the intention to expand to many other markets.

At RecoveryOne, we don’t shy away from challenges or hard sells. We are invested in our customers and make every effort to ensure all of their members have access to our MSK platform. In fact, RecoveryOne was founded originally to support total hip and total knee populations. It was our bread and butter in the early days and a meaningful proportion of those customers was in the 65 and older crowd. While we have improved our offering since then to be a comprehensive solution for all back and joint problems, we haven’t forgotten our roots and continue to support seniors.

The need for MSK solutions aimed at the senior population
Nearly three out of four people age 65 and over in the United States are affected by MSK ailments, most commonly damage caused by osteoarthritis and fall-related injuries. Yet, the MSK digital health industry is focused on self-insured employers, not Medicare-managed health plans, which cuts out a huge swath of the senior population, the ones who would benefit most from it. In some instances, digital health companies who contract with self-insured employers end up with older customers through the company retirement benefits program. But that’s almost by accident and makes up a marginal slice of the Medicare pie. We purposefully aim to help and support seniors.

RecoveryOne saw a need to expand digital programming to a vulnerable population. With Covid, it is even more important to offer virtual service so seniors don’t have to venture out into the pandemic and risk exposure. 

From the comforts of their home, seniors meet virtually with a physical therapist for an initial assessment. The appointment is with a real person, not a bot. Based on the unique factors for the individual, the therapist chooses one of our 200 clinically proven pathways that includes exercises to reduce pain and improve recovery. Every customer also receives a personal health coach who connects with them regularly to motivate and answer questions via messaging. To keep it simple, we don’t bother with sensors, they are bulky and annoying to wear during exercises.


Historically, most people don’t finish their in-person physical therapy, mainly because it’s a hassle. With RecoveryOne, it’s not a chore. It’s simply convenient and effective. And our health coaches are there to support seniors along the way.

 

Debunking the Myth Old People are Tech-Averse
The question I most often get asked about serving the Medicare population is “Aren’t seniors tech-averse?” I mistakenly assumed the same years ago. I’m relieved to know I was wrong.  So, let’s debunk it.

The vast majority of older people have smartphones. Grandparents today regularly use their phones to video chat with their grandchildren and post on Facebook. Today, smartphone adoption is 86% for 50 to 59 and 81% for those 60 to 69, with 62% of those 70 and older using smartphones. And that’s all you need to access our MSK solution.

On our platform, I’ve been pleasantly educated to see a senior population’s high level of comfort with our technology. Seniors surely aren’t as tech-savvy as the Gen Z population, but they are more than capable of accessing and navigating RecoveryOne. And just because they aren’t digital natives doesn’t mean they shouldn’t get access to digital health solutions.

A Scalable Solution for Seniors that Saves Money

Working with Cigna’s Medicare Advantage customers is a scalable, cost-effective solution for helping heal seniors with MSK injuries. 

Because Medicare Advantage customers don’t have to leave their homes or wait weeks for an available in-person appointment, they save money, time and energy not having to travel or pay for expensive gym memberships.

RecoveryOne saves health plans money. Based on national claims data from more than 350,000 members, RecoveryOne reduced the total medical cost by $751 per member per month for MSK-related diagnoses and reduced costs by nearly 77% for low back pain and 84% for rotator cuff tears.

So while the MSK digital health industry may appear crowded, it actually fails to address the senior consumer population. That’s a massive missed opportunity. Let’s help those who need virtual care most heal from their injuries or surgeries. Now that RecoveryOne’s solution is available to Medicare Advantage customers, there is work to be done to expand even further and improve our product even more.

Putting ACT into ACTion

Pain can take up a lot of space in your brain. Sometimes, you might even feel like the struggle to avoid pain takes over your life. If so, acceptance and commitment (ACT) might be a good approach for you. With ACT, you can learn to accept that you have pain, but that you don’t have to put your life on pause to manage it.

Here’s an ACT exercise that can help you observe your pain without letting it take over. Close your eyes and take a deep breath. Notice any physical sensations. You might notice pain or tightness, the fabric of your clothing on your skin, or maybe even a feeling of calm. Next, notice what you hear around you. Finally, notice your thoughts without judging them. You are not defined by your body, what you hear, or what you think. You can simply observe each of these without letting them take over who you are.

When you accept your pain and commit to your life, you can suffer a lot less. This approach isn’t magic; it doesn’t get rid of your pain, but it does help you avoid sadness or anger taking over your life. It’ll allow you to get back to things that make you happy, even when your muscles and joints aren’t 100% better.

An introduction to ACT

Have you ever felt like your pain takes a lot of space in your brain? Or that the more you think about easing your pain, the more it takes away from other things in your life? If so, acceptance and commitment (ACT) might be a good approach for you. ACT comes from the idea that pain hurts, but it is the ongoing struggle with pain that causes people to suffer. With ACT, you can learn to accept that you have pain, but that you don’t have to put your life on pause to manage it.

The first step of ACT is to accept your pain. Most people spend a lot of effort trying to get rid of their pain. How much energy do you put into fighting negative thoughts and feelings about your pain? As odd as it sounds, mental attempts to “fix” your pain can cause more harm than good. Think of it this way: compare the force it takes to hold a beach ball underwater (i.e., fighting your pain) versus the energy it takes to let it go and allow it to float at the surface (i.e., accepting the sensation of pain in your body).

Beyond letting yourself accept pain, the ACT approach asks you to commit to taking actions that will get you the things you love. Take a moment to reflect on what gives your life meaning, whether it’s your health, relationships, career, or other things. Ongoing pain can cause you to lose touch with what you value. You might even try to avoid things that are important to you because you are focused on your pain. In ACT, it’s key to define your values and choose actions that move you to things that give your life meaning. When you focus on your values, you can keep doing what you care about — even when you’re having pain or have to adjust how you do things.

Running tips: Stay healthy and avoid getting hurt

The COVID-19 pandemic has changed daily routines for a lot of us. No longer do we leave the house to stop for coffee, drive the 40 minutes to work, or move about the office for meetings. While working from home has had many pros and cons, it has caused a lot of us to be less active throughout the day.

To make up for this lack of action and social time during the day, many people have turned to more intense workouts. Sales of remote fitness products, such as Peloton, Mirror, and Nordic Track, have boomed during the past year. Of all types of activity, running has seen a huge surge, with many people running to help their physical and mental health.

With more running comes more risk for injury. Before COVID-19, most of us had not prepared our muscles and joints to handle so much impact and mileage. Common running-related issues include shin splints, ankle sprains, plantar fasciitis, stress fractures, knee pain, and back pain. To avoid getting hurt, follow these tips:

  1. Maintain your shoes. Both miles and time affect your running shoes. Not only does the impact of running wear down your shoes, but the material of your shoes breaks down even if you’re not using them. We suggest you change your running shoes every 300 miles or every year, whichever comes first.
  2. Warm up and cool down. Going straight from the couch to a sprint is not a good idea. Try doing some light calf and quad stretching to loosen up your muscles. You can also start with a walk for the first few minutes, then ramp up to a jog, and then walk again at the end of your run. Warming up and cooling down protects your heart by making the change between resting and moving more gradual.
  3. Don’t tire yourself out too much. As you get tired, your form gets worse, which can cause injuries like sprained ankles. The “talk test” is one great way to measure if you’re overdoing it or not (i.e., would you be able to chat with a friend while running?) Another is the Karvonen heart rate formula, which can help keep you in a healthy heart rate zone during your exercise session.
  4. Avoid doing too many types of sports. Instead of jumping into hardcore circuits, biking, and running all at once, try sticking with one type of workout at first. Then, try adding in a second type once you have built up some strength. This will help you prep your body for the added stress of a new workout.
  5. Take days off. While many of us may want to come out of this year fitter than ever, working out every day can get you hurt. Take a break every other day, and make sure to take stock of how you’re feeling before you work out.
  6. When in doubt, seek someone out. If you have questions, don’t hesitate to reach out to a health care provider for guidance. Your routine may have changed a lot in 2020 and 2021, so it’s important to consult with an expert before you exercise. If there’s anything that COVID-19 has taught us, it’s that our health and safety should be top concerns.

Pacing yourself: How to keep moving when times are tough

It’s common for humans to avoid things that make us feel bad, and pain is no different. When moving makes you feel pain, you might want to stop moving. The more you avoid movement, the more you’re afraid of it — and soon enough, you don’t want to move at all. This lack of activity can actually make your pain worse, reduce your muscle strength, and make it harder for you to do certain motions. Once you’re stuck in this cycle (fear of movement, avoiding movement, and worse pain), it can be hard to get out of it.

To prevent this cycle of pain and fear, you can try an approach called pacing. Pacing is the balance between movement and rest. When you pace yourself, you won’t overdo it when you’re feeling good and underdo it when you’re not feeling great. Here are some ways you can pace yourself in physical tasks you want to do:

  1. Break tasks into smaller parts, with rests in between.

Do your tasks with frequent rest breaks. In the long run, you will be able to get more things done if you don’t do too much at one time.

  1. Work at a slower, less intense pace.

Slower ways of movement, like walking instead of running, can keep you from overdoing it when you’re feeling good. Going slower doesn’t mean that you’re not working hard; rather, you’re taking better care of yourself.

  1. Switch tasks often.

Instead of doing the same task for long periods of time, switch it up. Get up from your desk after some time to give your neck, back, and arms a rest. Instead, try doing something that requires you to stand.

  1. Use different parts of your body throughout the day.

If you’ve been using one part of your body for a physical task, move to actions that use a different body part every once in a while. This will keep you from putting too much stress on one area.

Now that you’ve learned about pacing, take some time to reflect. Have you ever over- or underdone it with exercise? If so, how did that make you feel? How do you catch yourself doing too much or too little, and what will you do if it happens again? What are one or two ways you could try pacing this week?

While pacing might mean you adjust the way you move about, you can still feel good as you achieve things each day. You can apply these tactics to your chores, hobbies, and physical therapy exercises.

MSK Disorders Have Largely Gone Untreated During the Pandemic

untreated back injury COVID pandemic

What Happens Now?

During the ongoing COVID-19 pandemic, usually busy operating rooms across the country have often stood empty as hospitals paused elective surgeries to focus resources on treating patients affected by the virus and patients delayed care for fear of exposure. Overall hospital visits hit a record low in April, dropping 33 to 62%. A huge drop in treatment for musculoskeletal (MSK) disorders played a major role in declining volumes and hospital revenues, with hip replacement surgeries down 79%, knee replacements down a stunning 99% and spinal fusions down 81% during a two-week period in March and April 2020 compared to the same period in 2019.

But, of course, these declining volumes don’t mean that the need for MSK care lessened. While utilization rates have been significantly lower for these services during the peak, as states reopen and elective surgeries are rescheduled, a tidal wave of demand for care that has been delayed could swamp the system. At the outset, it may be difficult for patients to schedule surgery in a timely manner as demand surges while providers limit the number of patients they see—further delaying much needed treatment. MSK patients who put off care and now face an additional delay in accessing care may require more complex and costly treatment because their condition has worsened. 

Beyond the issues surrounding delayed MSK care, stay at home orders have left most Americans seeking a cure for severe cabin fever. After months of limited activity, more people are getting outdoors to run, walk, and bike, or are starting new home workout routines to help them get back in shape and avoid the “quarantine 15” weight gain. Unfortunately, this sudden increase in activity is likely to further swell the numbers of those with MSK problems, from back and knee pain to the exacerbation of previous disorders such as herniated discs and arthritis. 

An innovative approach to getting people the MSK recovery care they need now

While additional care delays may be difficult for patients, they provide employers and payers with an opportunity to put in place an early intervention system that provides ready access to care to mitigate the severity of MSK disorders without the need to risk COVID-19 exposure in a bricks and mortar healthcare facility.  

RecoveryOne can serve as that early intervention system, delivering digital PT and coaching to guide a structure program that helps people manage and reduce the pain and loss of function caused by MSK disorders. Not only does this recovery care have the potential to decrease pain, it can also reduce the use of opioids, lowering the risk of overuse of these highly addictive medications. Our comprehensive virtual recovery program is also a safe alternative for people who remain hesitant to seek care at a healthcare facility or undergo surgery, especially those who are older or have underlying conditions that mean they are at greater risk from COVID-19.

Personalized Musculoskeletal Recovery phone app

Our digital MSK recovery solution also has the potential to help employees and plan members avoid surgery in many cases. In fact, many MSK specialists recommend PT as the first line treatment for a wide range of musculoskeletal problems. One study published in the Annals of Internal Medicine found that for people diagnosed with lumbar spinal stenosis, those who underwent six weeks of PT achieved the same improvement in physical function as those who underwent surgery without experiencing the complications of infection, delayed wound healing and repeat surgery.  Our data, based on millions of digital sessions, shows that this model can improve function for both acute and chronic low back pain by over 90% while significantly reducing pain to an average of 1.5 on a scale of 1 to 10. It can also reduce surgical procedures and lower costs for health plans and employers while keeping users happy and engaged.

Of course, surgery is sometimes the most appropriate course of treatment. When employees and plan members need to undergo a procedure for their MSK condition, RecoveryOne’s digital PT and coaching solution provides a comprehensive prehab program from the safety and convenience of home. We provide a structured exercise program that follows rigorous clinical pathways to help them get stronger and healthier so they can better tolerate surgery. RecoveryOne also provides the post-surgical rehab support these employees and plan members need to recover more quickly, feel better sooner, and get back out there.