Beyond the Pain: How Digital Solutions Are Transforming MSK Healthcare

In this episode of "Healthcare on the Rocks: Employee Benefits with a Twist," David Pittman and new co-host Nicole Belles cover the world of musculoskeletal (MSK) health with Aaryn Pure, Chief Commercial Officer at Hinge Health. The episode kicks off with Aaryn joining from Chicago amidst Hinge Health's bustling annual conference, Movement, providing a “man on the street” backdrop to the discussion. 

Aaryn shares his extensive background in healthcare, emphasizing his personal and professional commitment to improving MSK care. He recounts his journey from working with health systems on electronic medical records to his current role at Hinge Health, highlighting his personal experiences with MSK issues that add a relatable touch to his professional insights.

The conversation covers the substantial economic and personal impacts of MSK conditions, which affect one in two Americans annually and account for significant healthcare spending. Aaryn discusses Hinge Health's approach, which emphasizes preventive care and non-invasive treatments like the innovative Enso device—a nerve stimulation tool that helps manage pain without surgery or drugs. This approach not only alleviates pain but also significantly reduces healthcare costs and improves quality of life. The episode is packed with information about the challenges of traditional MSK treatments and how digital health innovations can transform care delivery.

Key Takeaways:
  • MSK conditions are a top cost driver in healthcare, impacting half of the American population each year.
  • Preventive and non-invasive treatments can significantly reduce healthcare costs and improve patient outcomes.
  • Digital health tools like Hinge Health's Enso device offer effective alternatives to traditional care methods, providing immediate and long-term pain relief.
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Episode Transcript

[00:00:00] David: Welcome back to Healthcare on the Rocks, Employee Benefits with a Twist, where we blend insightful discussions with a dash of fun. If you listened to our last episode, you know we said goodbye to Jennifer Jones. One of our original podcast hosts from when we started three years ago. She will be missed, but I have an excellent new partner in Nicole Belles, our Senior Vice President of Product.

Nicole, welcome to the spotlight.

[00:00:26] Nicole: Thank you, David. Yes, Jen will be missed, but it is great to be here representing Springbuk.

[00:00:32] David: And we're happy to have you. So, Nicole, before we introduce today's guest, tell us a little bit about yourself and your role here at Springbuk.

[00:00:41] Nicole: Sure. As you noted, I'm the Senior Vice President of Product and manage our great product and methodology teams. I've been in the healthcare and data analytics space for over 20 years, so I'm really, really passionate about this industry. 

But we're thrilled to have Aaryn Pure, the Chief Commercial Officer at Hinge Health and a trailblazer in the digital musculoskeletal care space.

So, Aaryn, thank you for taking the time to be with us today. We understand this is a pretty big day for Hinge. Your annual conference is happening right now, is that correct?

[00:01:18] Aaryn: It is, it is. First of all, thanks for having me. And yeah, we have over 350 of our clients, partners that we work with, health services companies, consultants, and hopefully future clients all here in Chicago for an action-packed couple of days.

[00:01:38] Nicole: That's awesome. I love those events, like just networking alone, and learning from other employers and how they're using Hinge must be pretty incredible.

[00:01:48] Aaryn: A lot of energy here. It's off to a great start, but I wholeheartedly agree with you.

[00:01:56] Nicole: Well, let's jump right in and have you tell us a little about Hinge and your role there. What does your day-to-day look like in terms of expanding access to MSK care?

[00:02:06] Aaryn: Yeah, maybe I'll even just give you a little bit of background on me. So, just really quickly, I'm based here in Chicago, where we're hosting Movement. I have three little kids here in the suburbs. I got three under four years old. So when I'm not focused on Hinge, I'm chasing toddlers around and trying to sneak in a round of golf from time to time. 

But, prior to Hinge, I've been in healthcare my whole career; I started off working closely with providers at leading health systems to transition them from paper to electronic medical records, worked for a public company here in Chicago called Allscripts, and, about 10 or so years ago left and, was the, the first salesperson, at a company that would be called Livongo, one of the early pioneers in digital health, held a number of different commercial leadership roles there over the years, and then fast forward, merged to Teladoc. I stayed on at Teladoc for about 18 months and led our employer business unit, and then, yeah, it's now been two years as the chief commercial officer here at Hinge, where I look after our various sales teams, and account teams, operations across the, the many segments we serve today.

So, back to your original question: what does my day-to-day look like? One of the things I love about the role is that the day-to-day can look very different. I do try to spend at least 50 percent of my time a week out in front of our clients, our partners, the market, if you will, to keep up.

A good understanding of where, not only how things are going today, but where things are going. And then, yeah, as a senior leader here at the company, there's a fair amount of internal work that needs to be done – forecasting, planning, board meetings, and all that other fun stuff. But it's always a mix.

[00:04:15] Nicole: So, your experience is fantastic. It's very intriguing to be able to work in different areas, all really focused on condition management or helping an employer just make their population healthier and get people access to the right type of care. Why is solving musculoskeletal pain a mission that's close to your heart?

[00:04:42] Aaryn: You know, it's very relatable to, to me, but not just me, one in two Americans suffer an MSK, injury or, or experience pain in a given year, so, it's also one of those conditions that doesn't have a lot of stigma around it either, people don't like to talk understandably openly about maybe mental health or diabetes, But it's hard to, go to a happy hour these days and not hear someone complaining about back pain or waking up with a stiff neck or something like that or acute injury that they experience over the weekend.

Growing up, I'll give myself the benefit of being called an athlete for at least some period of my life. But I suffered from acute injuries that turned into lingering injuries, and now, if I just carry the kids wrong, I get some lower back pain for a couple of days, but there's a lot of people today that are challenged with pain. I think that the last I saw, $600 billion, is what pain costs here in the United States. It's About 450 million of that is attributed to MSK pain, so $450 billion one in two Americans. And that's why, to your point, employers, it's generally a top five cost driver for, for most employers, uncommon for it to be outside the top five.

And, not all healthcare problems, have as clear of a path to reduce costs, maybe in my opinion. You can certainly improve the experience for other conditions like cancer and mental health. However, MSK has a very clear path to cost savings and clear cost savings opportunities. And if you can support people to work through chronic pain with exercise, physical therapy, and noninvasive pain management tools, like our Enso device, the downstream impact to costs, like imaging, office visits, injections, and most importantly, surgery, is very clear.

And it doesn't take three years for the patient or the consumer to see that impact. It's weeks and months, and on the payer side, whether that's an employer or a health plan, we're generally able to show the return on investment in 12 to 18 months and not many years down the road.

So, my personal run-ins with MSK over the years have been a big challenge for all of us. Unfortunately, this is not the only challenge that healthcare faces, but it is certainly a big one for us to try to solve.

[00:07:41] David: Yeah. So, I just yesterday contributed some portion to that 450 billion because I'm going through some therapy right now for a little bit of an elbow and shoulder issue. And so you were just talking about challenges there. So, what do you think? I've got my opinion on this, but I'd like to hear yours on some of the main challenges with the current healthcare systems' approach to MSK issues and pain.

[00:08:12] Aaryn: Yeah, I gotta ask first, is that that sound like a pickleball injury?

[00:08:16] David: How did you guess that?

[00:08:18] Nicole: Oh my gosh, that's awesome!

[00:08:21] Aaryn: I'm guessing some tennis elbow mixed in with some overusing or overcompensating with the shoulder, and there's a lot of pickleball injuries these days, so I got lucky there.

But, yeah, what are the challenges with the current system? It's a great question. David. The problem is that I'd say over 90 percent of those who receive MSK care that this system is set up to cut us open; this doesn't mean that you go to your doctor, you tell them your elbow and shoulder hurt, and the next day you're on the operating table. Still, if you are referred to an orthopedic surgeon because most primary care providers don't know how to or want to engage in MSK care, they may prescribe PT or pain management opioids. Still, the likelihood of your cost ballooning when you get referred outside of primary care and that you endure more invasive care, it just increases dramatically.

You'll get x-rays and MRIs, they will ask if you've tried PT, and even if the answer is no, surgeons will be putting you on a path for a quick or sustainable fix. And if you go get a second opinion, which you absolutely should, you'll get more X-rays and more MRIs. In either circumstance, you may be referred to get an MRI within a local health system, where that MRI is $3,500.

When a standalone imaging center can be, it can do the exact same image with the same machine for $400. Still, it's pretty clear that 30-50 percent of MSK surgery is deemed avoidable, unnecessary, or ineffective, meaning that the pain or the issue is not addressed or not fully addressed post-surgery, so we put the patient through a terrible, unnecessary journey that costs a lot of money for a surgery that doesn't always work.

And there's no real accountability for that today. Is it the primary care physician who made the original referral? The radiologist who read the image? The ortho who suggested and performed the surgery? Or is it the healthcare system that has been set up in a way that makes reimbursement for preventative care, more conservative care, much harder than it should be?

So this is our opportunity at Hinge Health to deliver exceptional preventative or conservative care early on the MSK journey, or the pain journey, so we can really deliver for that consumer and whoever is paying the bills for that healthcare, removing co-pays, making access more accessible and, and being there for them 24/7 before the cost curve starts to really increase.

[00:11:51] David: Yeah, let's dig into that just a little bit more because that is the big story here. And, as you said in your intro remarks, you've got a lot of history in digital health companies. So, what is it about Hinge that, that sets you apart from other digital health providers and certainly from the more traditional approach that you were just talking about?

[00:12:19] Aaryn: We are very focused on solving MSK, and other, smaller digital health companies are solely focused on one condition as well. But we're a large company today in the digital health space in terms of the number of employees, revenue, and lives covered, and we still want to focus on MSK.

There is that much opportunity and wasted cost. We believe we can build a very large sustainable company that helps and empowers millions and millions of people by just getting better and better at impacting MSK. And so, the flip side of that is that companies try to do a lot of different things.

Things, right, diabetes and mental health and cancer and, as we're, as we're seeing even the biggest companies that are so good at so many things struggle in healthcare, whether it's Walmart who recently decided to shut down their, their virtual care and there's plenty of others.

Healthcare is complex, and you really have to focus on not too many things to increase your likelihood of having success, so I look at the team; we have over 600 clinicians at the company, really focused on creating the best clinical experience possible, and then we have 600 people in our R& D organization. We have over 1,000 people in our R&D organization, that's product and engineering that are focused on creating an unmatched technology experience and marrying those two together to really try to make the best of both worlds. We're not just going to be clinical services. We're not just going to be a tech company. It's the marriage of the two that we're blending together that is setting us up well for success.

[00:14:34] Nicole: That's always impressed me about Hinge, your focus on innovation and your use of technology. And you briefly mentioned Enso, but could you tell us more about Enso and then other technology and innovations that Hinge uses to help manage musculoskeletal conditions?

[00:14:51] Aaryn: Yeah, happy to. I think our philosophy, just from a product experience standpoint, at least today, could always change, but we want to own as much of that core consumer experience as possible. And Enso is a good example, and I'll have another one as well, but, Enso is a non-addictive nerve stimulation device that sends high-frequency pulses into your body.

It's about the size of a silver dollar, and it can be worn on most areas of the body. It's an FDA-approved device, seamlessly connected in the Hinge Health app, and depending on what part of the body and your pain levels, we can, or you control, the amount of that frequency going into that body part. It is, time and time again, shown to really decrease pain both in the moment but also over time.

 We acquired Enso maybe three or four years ago. It was predominantly being sold and used by the VA for our veterans; it's a delicate population when you think about opioid use, chronic pain, and lingering injuries. So, we have helped the company commercialize it and integrate it into the Hinge Health experience.

And now, over 50 percent of our members are utilizing Enso as part of their pain and MSK treatment plan. The last thing I'll say is there's a fair amount of people who sign up for Hinge that may be in too much pain even to start physical therapy or exercise therapy. So Enso is just a great way to help them start to alleviate some of that pain and begin to move again.

[00:17:06] Nicole: It's pretty amazing to me the trajectory of the industry, so when I started over 20 years ago, working for a competitor, one of the first analyses that I did for an employer was we were going into the population, and we were identifying physicians who were over-prescribing opioids for low back pain. And that was like just right at the cusp of physicians now being told that these were safe and that they could prescribe for pain management, and now here we are in kind of an opioid crisis. 

Springbuk is really focused on our Insights, uncovering these opportunities in our employer's data and showing them and modeling to them what savings potential could be uncovered if they took certain action steps.

That led us to our Activate marketplace, where we can actually show them partners that can help manage these opportunities. You spoke a little bit earlier about the populations at risk for invasive surgical procedures like heat, knee, and hip replacement, and we showcase that or excessive imaging and how the employers in our system can then go and find a partner within our platform like Hinge that can help them manage.

How do you anticipate Hinge will continue to contribute to and help employers and their employees achieve independence through the use of Activate? 

[00:18:39] Aaryn: It's a great innovation story; what you've built, curated, best-in-class solutions, and help take data, is it real-time? How recent is the data that,

[00:18:55] Nicole: Monthly.

[00:18:57] Aaryn: Yeah, versus waiting for their annual review and to get some high level slide on MSK is, is an emerging issue.

Even the largest companies benefit from leaders who are under-resourced, right? So even if that it's a problem or exactly what problem you're trying to solve for, the bandwidth to go out and find best-in-class solutions and understand the impact that does best in, like, the business case for, for, investing.

It's, it's a lot. It's part of the job, but it's not like the core part of the job. So, I think you all being able to kind of synthesize that data and surface the highest impact opportunities for clients is a huge win. And I'd say that even for the largest clients, but especially for mid-market and large markets, we all have our different definitions, but there is a huge opportunity. It's a great opportunity for us because it allows us to get closer to those clients who understand that it's a problem. We spend less time telling them or trying to convince them that it's a problem and they should look at their data.

They already know that, and now they're kind of matched up with us in building the right solution for them to impact that problem.

[00:20:33] Nicole: that's awesome. 

[00:20:35] David: Aaryn, tell us a little bit about who your ideal customer profile is right now. Is it a large company, medium size, or small?

[00:20:45] Aaryn: it's no secret we started calling on the largest companies first, or early on, and, as we've continued to grow Hinge, build some of these great relationships, 90 percent of the 600 plus deals that we will, or the 600 plus clients that we'll add this year will come from, 10,000 lives and below.

So again, everyone has different definitions. I talked very early on about where most of our business today is with employers of all sizes, but again, most of the new partners will be below 10,000 lives. We're also starting to see a lot of expansion opportunities in a fully insured population, such as Medicare Advantage.

We've built some unique programming and services for the older adults. So, fall prevention or balance programs and some of these other pelvic health support areas impact STARS ratings. 

We're not solely focused on any particular market because MSK pain isn't just in retail, it's not just in blue collar and white collar, but just in terms of where the volume, most of our volume comes through today, it's kind of looks like the landscape of, employers in America where most of that, most of the new additions are in that 2,000 to 10,000 space.

[00:22:28] David: Everybody has pain at some point. It's a great thing that you're able to serve them all.

[00:22:33] Nicole: Do you have a note, like a success story or a notable piece of feedback you heard from one of the employers engaged with Hinge and seeing a real impact on their population? 

[00:22:44] Aaryn: We get it from employers, and we get it from the actual consumers themselves. That's always the most interesting part of Movement. We'll have that session later today, where we'll have a panel of users come up and talk about the life-changing impact that they've experienced.

We've had people talk about how they never thought they would be able to go upstairs that then started running marathons, other folks that all they want to do or get on the ground with their grandkids and, and Hinge has allowed them to, to be able to get on the ground and, and play or simple stuff that we take for granted, putting on socks.

Those are the stories that you start to see people choke up a little bit in the audience because you get away from these big numbers of 450 billion and one and two, these are real people that aren't able to have a fulfilling life, and we're able to impact that in partnership with folks like you all, the, whoever's paying for the healthcare, the employer, and that's, that's probably the most impactful part of our Commercial kickoff, which is an internal meeting in a, in a meeting like Movement, and then, and then, yeah, the client impact is, is excellent too.

We have no shortage, at least today, of clients who are willing to get up on stage with us at big conferences and talk about the number of emails that they get from their own users about what an amazing benefit Hinge has been for them and their family, and or the cost savings impact that they've seen or reduction in healthcare utilization.

So that's certainly the fun part of the job, where you start to get great feedback from the market at both the consumer and the client level about what we're building here.

[00:24:54] Nicole: Yeah, that's a great impact on quality of life. 

[00:24:58] David: Yeah, for sure. All right, Aaryn, I know it's a busy day for you, so we're going to let you go soon, but tell us if you would; maybe this is something that you guys will be talking about today on the main stage, what's next for Hinge, and we're eager to hear your future plans and how you see the landscape evolving.

[00:25:19] Aaryn: We will be touching on our term roadmap here, probably, I think it's our last session of the, of the, the conference, but, yeah, at the highest level, we are going to continue to make meaningful investments in AI. We believe it will never take the place of the care providers that play a very important role in care, not just for MSK but outside of MSK.

However, making the providers as specialized, impactful, and knowledgeable as possible by synthesizing and normalizing data helps drive them toward the next best step. Then, AI can be used to really personalize the consumer experience as well. We have some new specialized pathways coming out very soon, especially across our women's health suite. So, more on that. 

And then, it's not as impactful to most employers, but our fall prevention balance and some of the investments we continue to make in Medicare Advantage is an area we'll focus on over the next few months. We are not agnostic or against in-person care.

We are trying to find the right hybrid approach to meet with people that do want in-person care or that we feel a certain, part of the care journey should be in person. And whether that's Hinge Health performing that or somebody else, a partner of ours, or a network of ours. But our Hinge at Work offering, which is sending Hinge physical therapists to our client's offices, has a ton of momentum right now, and so we're continuing to hone in on that and look at workplace safety, prevention opportunities, and that's certainly an exciting area that we're seeing a lot of momentum.

Yeah, we have a number of strategic opportunities we're very much looking at discussing almost weekly that you'll probably see play out over the next 12 to 18 months that are maybe a little bit more jump off the page, innovation, but it's, it's some exciting stuff, so maybe leave you with a little cliffhanger on that one.

[00:27:46] Nicole: Yeah, we'll be watching. That's a good point about balancing virtual and in-person care. I know that over the last couple of years, we've gotten more and more virtual, and I even feel very comfortable having virtual office visits and things like that. However, there are other members of different generations who need to hold their hands in the virtual space.

So that's awesome that you have that balance.

[00:28:16] David: Are you talking about older adults like me? You are,

[00:28:19] Nicole: No, talking about my mom.

[00:28:21] Aaryn: You're in the young athlete category, playing some intense pickleball, so very, very different.

[00:28:29] Nicole: Well, Aaryn, it has been an absolute pleasure speaking with you. If people want to connect with you or your team to learn more about Hinge, how would they do that?

 You can either just send me an email, Aaryn, A A R Y N, so it's not O N, it's Y N, A A R Y N, at Hinge Or just look me up on LinkedIn, Aaryn Pure; I would love to connect with you.

[00:28:59] Nicole: That's awesome. Thank you for that. Well, that's going to do it for this episode of Healthcare on the Rocks: Employee Benefits with a Twist. Be sure to subscribe to your favorite podcast player so you don't miss an episode, and watch the Springbuk blog next week for additional content about Hinge and MSK issues.

[00:29:18] David: And we will include links to Aaryn's contact there in our show notes. So be sure to check that out and then connect with him on LinkedIn. Finally, please remember to take a second to give us a five-star rating and leave a review on your favorite podcast platform. Be gentle, be kind. It's Nicole's first episode. So, we want to, we want a nice five stars there. 

Nicole, thank you very much for hopping on, and I look forward to working with you on the rest of the series. Aaryn, congratulations on Movement, and thank you so much for joining us today.

[00:29:55] Aaryn: My pleasure. Thank you so much for having me; I look forward to seeing what reaction we get from the audience.

[00:30:04] David: Yeah, that's great. Okay, everyone. That's it for today. Thanks for listening.