Health IT

An avatar to keep patients happy and soothe bundled care woes

An avatar might be a way by which hospitals contending with the bundled care payment in orthopedics can lower costs and get joint replacement patients to recover well and at home.

The Vera avatar, left, guides joint replacement patients in virtual rehab program

The Vera avatar, left, guides joint replacement patients through a virtual rehab program

There are two specific related questions in healthcare that every player in the industry is looking to answer effectively: how to lower costs, sometimes forced upon by bundled care payments, and how to move healthcare outside the doctor’s office.

One startup that fits smack dab in the middle of that discussion is Reflexion Health, a San Diego-based digital health company targeting joint replacement patients.

The startup has developed the Vera avatar on the Microsoft Kinect platform that helps patients get their daily exercise for physical rehab done at home in front of a TV after their hip or knee replacement. This reduces the need to go to a physical therapist to get the exercises done post-surgery, or keep them moving in between sessions, though the patient’s physical therapist is in charge at all times and can choose to bring them in at their discretion. The system also provides a technology solution for hospitals eager to lower their costs to treat joint replacement patients, many of whom are now part of the bundled payment environment instituted by the Centers for Medicare and Medicaid Services.

“I was at a CEO innovator roundtable in Boston and I was one of the presenters, and a wonderful woman at the back of the room, who said she represented 16 hospitals said, ‘You know what. A lot of people are talking about this bundled thing and you appear to me to be the only one offering a solution, so thank you very much,” recalled Joseph Smith, CEO of Reflexion Health in a recent phone interview.

In early March, at the annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida, panelist after panelist talked about how post-operative care accounts for nearly 40% of joint replacement costs. That’s when patients are typically released from the hospital and sent to a skilled nursing facility to recoup before they can be transitioned to the home.

And that is the movement that Reflexion’s FDA-cleared Vera system can speed up.

Here’s how it works. An orthopedic surgeon will prescribe the technology that gets set up inside patients’ home, ideally prior to surgery, which helps them get familiar with the technology, Smith said. After the surgery, the patient can do the exercise while being coached by Vera, the avatar that can even correct them when they make mistakes in the rehab routine. There is a telemedicine portal that connects patients to physicians and physical therapists. The technology also facilitates the remote collection of data that CMS requires, Smith pointed out.

Those are the Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS), range of motion data as well as patient reported outcomes data.

And that data analysis is something Smith believes is lacking in the world of physical therapy and rehab, which historically have relied on tradition and insight guide activity, according to Smith.

“… the opportunity to put it all in a quantitative framework so that you can know exactly what was recommended, how much of it was done, when it was done and then you link that to patient-reported outcomes and objective assessments, so that (allows) you (to) persistently refine the field,” he declared.

Under Smith, who took over initially as interim CEO in December 2015 from the co-founder and then CEO of the company, Reflexion Health is looking to have a solid commercialization phase that kicked off earlier in the year. In June the startup raised $18 million in a Series B funding round.

The technology has sparked interest from hospitals contending with CMS’ bundled care plan – Comprehensive Care for Joint Replacement.

The Vera system is currently in use in a skilled nursing facility — typically the place that racks up a lot of expenses in post-acute care for joint replacements. As a results hospitals are either cutting how often patients are sent to SNFs, or if SNFs are part of an integrated health system, look for ways to reduce expenses there. Vera is used in a SNF that belongs to a latter category.

“That is a skilled nursing facility that is owned by the parent organization that is already in the bundle,” Smith said without identifying the associated health system. “So the economics then are aligning.”

Even outside the bundled care environment, there is a role for Reflexion’s virtual rehab program. It’s better for patients to get out of hospitals sooner and transition to home because of the danger of hospital acquired infections.

Smith declared that the data on hospital safety continues to be “alarming” with respect to healthcare associated infections, and that is another factor contributing to interest in the Vera technology.

“I think it remains to be proven that we can do this better at home, but I certainly think in terms of HAIs, there’s plenty of data that says you’re not going to get that at home,” Smith declared.

There are other companies in the virtual rehab arena — the FDA-cleared Jintronix, RespondWell, Virtualrehab, which has a Class I medical device designation, —but Smith said that the market is under penetrated and can support multiple players.

Smith will be a panelist at MedCity’s patient engagement conference, ENGAGE, in San Diego, Oct. 18, in a session that will address how care is moving beyond the doctor’s office.

“It is long overdue that healthcare as much as possible is decentralized and democratized and even demystified,” he said, noting that Reflexion Health empowers that trend.


Here’s a video of the Vera system being used by Brooks Rehabilitation, a medical rehab center in Jacksonville, Florida.

Photo: Reflexion Health