Digital Solutions for Managing MSK Disorders and Diabetes

The past 10–15 years have been marked by the emergence of companies that have proposed digital technologies to support patients and providers in treating or alleviating symptoms of severe diseases or disorders. 

With more than 38 million Americans suffering from type 2 diabetes, which is the eighth leading cause of death in the U.S., and with $412.9 billion of total healthcare spending in 2022, diabetes is at the top of the list of affections that impact the quality and length of patients’ lives and account for a significant chunk of healthcare expenditures. 

Diabetes prevalence has increased significantly from 10.3% in 2001–2004 to 13.2% in 2017–20203 — and is estimated to accelerate in the next ten years.

Musculoskeletal (MSK) disorders impair more than one in three Americans’ daily activities, affect their productivity, limit their ability to work and enjoy a full life, and cause high healthcare expenditures: in 2016 the estimated direct cost was $380.9 billion, exceeding diabetes whose spending was at that time of $309.1 billion.

Moreover, MSK disorders, split by The National Academies of Medicine into three categories (disorders of the back that include chronic low back pain, osteoarthritis category covering issues related to the knee hip, wrist, and hand, and arthropathies that includes issues like psoriatic and rheumatoid arthritis) are the Number 1 cause of disability in America.

In two research reviews published this year, Peterson Health Technology Institute (PHTI) has analyzed how much digital solutions contribute to effectively managing these affections. Their findings are shedding a new perspective on what we know.

Let’s dive into these reviews!

The Digital Diabetes Management Solutions review was published this year in March and revealed interesting (and unexpected to some extent) conclusions. 

Conducted by a team of health technology assessment experts and informed by clinical advisers, this thorough analysis reviewed more than 1,100 articles and checked eight digital health tools from Teladoc (Livongo), DarioHealth, Vida Health, Glooko, Omada, Perry Health, Verily (Onduo), and Virta Health. 

The study focused on reductions in HbA1c as the standard form of measurement of glycemic control in diabetics. Glycemic control is essential because excess sugar circulating in patients’ bloodstream increases the likelihood of being affected by heart, vascular, eye, kidney, immune, and nerve damage. High blood glucose levels also decrease the quality and length of patients’ lives and increase healthcare expenditures.

The review took into consideration three ways that digital diabetes management solutions support patients:

• Remote patient monitoring - enables clinicians to help with the blood glucose level monitoring of patients between in-person visits.

• Behavior and lifestyle changes - support patients with a mix of programs that change their behavior and lifestyle and the glycemic feedback. 

• Nutritional ketosis — induces a state of ketosis in patients, with the help of intensive dietary guidance targeting diabetes remission. 

The findings (based on the criteria set in the Assessment Framework) of the analysis indicated that:

Remote patient monitoring and behavior and lifestyle changes deliver small incremental benefits in HbA1c (0.23 to 0.60 percentage points) compared to usual care. These digital tools can have better clinical benefits in patients who have started using insulin recently and in those with higher starting HbA1c levels. 

However, these solutions “increase total health spending over 1–3 years because the cost of the solution exceeds the savings from improved clinical outcomes. If 25% of eligible users participated, remote patient monitoring solutions would increase Year 1 spending by $21.3 million per million commercially- insured lives; behavior and lifestyle modification would increase spending by $5.1 million per million enrollees in Year 1.”

Nutritional ketosis can deliver superior and durable benefits in glycemic control compared to other digital health tools for diabetes monitoring, including remission in patients who stick to the diet.

For patients using this solution, PHTI estimates that annual spending will “increase by $484 for commercial insurance patients, by $513 for Medicare patients, and by $574 for Medicaid patients”.

The Virtual Musculoskeletal Solutions assessment, released in June, reviewed more than 2,000 articles and used an evidence-based framework to evaluate virtual MSK tools from DarioHealth, Omada Health, Hinge Health, RecoveryOne, Kaia Health, Limber Health, Vori Health and Sword Health.

The solutions presented were split into three categories:

• App-based exercise therapy solutions - the physical therapist’s involvement is limited and a self-directed exercise program is established. This therapy is based on care plans created and updated primarily by algorithms, on-body motion sensors, or data from computer vision analysis.

• Physical therapist–guided solutions - the physical therapist’s involvement is larger and resides in defining exercise therapy programs, onboarding patients, and monitoring their health. These solutions entail more interactions between the physical therapist (PT) and the patient and feedback received with the help of on-body sensors and computer vision.

Remote therapeutic monitoring (RTM) - consists of self-directed exercises and supplements the care provided by in-person PT. The physical therapist continues to direct and monitor the patient’s progress status remotely, improving adherence to care plans between the in-person meetings with the patients.

The review concluded that “virtual MSK solutions assessed in this report deliver clinically meaningful improvements in pain and function compared with usual care (which generally includes physician visits and pain management but not PT) for people with a range of MSK disorders”. 

From the three categories included in the study, app-based exercise therapy solutions show potential effectiveness for patients with lower acuity. 

Physical therapist–guided solutions can serve as an alternative to in-person PT and could decrease healthcare expenses. 

Remote therapeutic monitoring solutions are suitable for severe MSK disorders due to increased costs.

According to the review, if 25% of in-person PT users with low back pain would switch to the MSK platforms assessed at a yearly price of $995, it could save an “estimated $4.4 million per 1 million commercially insured individuals”.

Why are these reviews important and what do they tell us?

Both emphasize that digital health tools for monitoring severe conditions work. Maybe not at the maximum of their potential, but at a time when retail giants like Walmart close their health centers and virtual care service, the digital health industry must keep its ground and deliver what it promised: remote, quick, and easy access to health information and healthcare services for anybody, anywhere. 

While Digital Diabetes Management Solutions has faced some criticism mainly from the Digital Therapeutics Alliance (DTA) regarding the lack of endocrinologists as clinical advisers to contribute and review the report and the small sample size used for drawing a conclusion affecting all diabetes products, it also brought into the spotlight Virta Health's solution, whose declared objective is to reverse Type 2 diabetes with the help of remote medical care and customized nutrition plans.

The report tells us clearly that it should be the goal of the next generation of digital solutions for diabetes management to clinically improve glycemic control by adopting solutions like GLP-1 obesity medications and continuous glucose monitors.

The review acknowledges that “the information, data, and know-how that this sector has acquired is valuable, and should be leveraged toward better performance going forward” and recommends payers (including employers and health plans) to adjust “their contracting approach” to request transparency regarding the benefits and usage of these solutions within covered populations.

The Digital Diabetes Management Solutions breakdown has also identified a “silver lining”: diabetes remission by adopting nutritional ketosis can be supported with effective digital solutions. The care providers can initiate this process by determining the feasibility of these solutions and identifying the patients most likely to achieve this remission.

Unlike its “brother” published in March, the Virtual Musculoskeletal Solutions assessment published in June has sparked interest and generated enthusiasm all across the industry, with the American Physical Therapy Association (APTA) stating “this report is a critical contribution to efforts to advance cost-effective solutions in health care” and “virtual musculoskeletal solutions, when led by a physical therapist, could drive needed reforms to increase delivery of high-quality, affordable, and accessible care for improved patient health”.

Another merit of the report is that it outlines a needed change that must be implemented now: the integration of virtual MSK solutions into medical benefits and not employee wellness benefits as they are currently listed. This shift would enable providers and health plans to detect the patients who would benefit the most from virtual MSK solutions and would increase the number of people who decide to see a PT or begin to follow remotely an exercise program designed to alleviate or cure their disorders.

The review also highlights the importance of providers and MSK specialists recommending PT (virtual or in-person) before suggesting other diagnostic or path of treatment.

Another finding is that virtual solutions like MSK solutions could address the access gaps to PT, particularly in older and rural populations or people who cannot reach an in-person PT because of mobility or transportation limitations, or geographic barriers. 

Virtual MSK tools could improve adherence to physical therapy programs, leading to lower healthcare spending across the population affected by MSK disorders. 

Conclusion

Digital tools for monitoring ailments like diabetes or MSK disorders are changing how healthcare services are provided, accessed, and paid for. The findings in these two reviews show us that digital solutions can address many health issues in convenient ways for patients and with the potential to decrease healthcare spending.