While there’s plenty of discussion about how telemedicine might be implemented, the folks at RespondWell say they can prove the benefits of using connected rehabilitation methods in the home environment. We chatted with Ted Spooner, co-founder of RespondWell who became VP of Connected Health for RespondWell after its recent acquisition by Zimmer Biomet. We asked Spooner about the need for home based rehab:
Ted Spooner: I’m 58 and when people like me, and maybe you and others, live a long active life, parts of their bodies wear out and as a result stuff hurts or needs to be fixed.
Tech50+: I understand completely, since I recently received a new kidney. My transplantation center has allowed me to do video clinical visits, but the process is still sort of hit and miss.
Ted Spooner: That’s just the problem. It’s really about access. With people of our age and older investing in the technology side of their lifestyle, not just because they want to communicate with each other and with their family, but because it’s really a lifestyle that drives more awareness about your health that telerehab is really a way to act on that awareness. Because accessibility is greater because of technology, the bar for getting out of your house and getting someplace for care or the bar for getting more frequent care at a lower cost is being lowered because of telerehab.
Tech 50+: But with telerehab and just about everything else in connected health, the big question is who is going to pay for it?
Ted Spooner: That really continues to be the gating factor. We’re in a world where regulation moves slower than reality and the tech world, which is where I come from. I’ve been an entrepreneur in software my whole life and developed multiple companies, developed the first company that delivered online banking systems to banks and online bill pay systems to banks and so I’ve been doing this a long time…. The pace is- they’re two different worlds. What we’re finding right now is consumer tech that is starting to really cross over into the kind of healthcare services that healthcare providers have traditionally provided is moving faster than healthcare providers can adopt technology. That’s partly because healthcare providers buy technology from medical device companies or companies that are used to operating in a space where the FDA regulates much of what they do and controls much of what they do and imposes standards on them that are very strict, and in some cases appropriately strict, but in other cases inappropriately applied. Today we’re operating in a world in which the FDA has recognized that but hasn’t really acted on it very much yet. So the guidance around mobile medical apps for instance is a really great recognition that the FDA sees that innovation is moving faster than they can regulate. But that puts a risk lens to that reality and says it’s okay that technology’s moving faster than we can regulate it because in most cases it’s doing things that aren’t harmful. As long as you’re not using technology to turn on and off your pacemaker, but you’re using technology to motivate you to eat healthier or live healthier or to compare yourself against other people that have other chronic conditions or similar injuries, that’s fine. We’re not going to impose a standard on you. But it hasn’t really taken effect in a way that allows us to really bring technology to the market really fast. And as a result, payers and CMS haven’t yet seen it as something they should reimburse for. In a broad way, in small ways obviously in telehealth we’ve begun to see the evolution of codes that support the kind of visits that you’re talking about. But the kinds of things that are really scalable, the kinds of things that we do, they work in the bundle for instance because the bundle is essentially one check for an entire procedure for total joint replacement for instance. And that’s what really led Zimmer Biomet to us and led them to invest in having a capability in telerehab that could be applied in the total joint replacement reimbursement model and so in that case it literally is not specifically paid for, but it’s indirectly paid for because the provider now has responsibility for the 90-days post surgical care that anybody who gets a knee or hip replaced has a right to, at least under CMS rules. But even beyond that with private payers, I was at the 3rd largest private payer in the country last week with the senior executive team really at their request helping to educate them in telerehab and the way that essentially its reach can effect populations in ways that are better for the patient and certainly better for the economic underwriter of the care, the payer and that it’s real, it’s really happening, it’s going to be a couple of years before we get real hard data on the benefits but that those are eminent and that we need to partner with them which we are and others to make what seems intuitively obviously kind of quantitatively obvious.
Tech50+: It sounds like the insurers are now coming to the realization that there is a quantifiable benefit here and I guess what you guys are saying is that same thing is extending to physical therapy in terms of what you’re doing and not just the monitoring of blood pressure and weight and so on.
Ted Spooner: It doesn’t require an elimination of the human factor in physical therapy because there are aspects of physical therapy that while on the surface seem kind of biomechanical, they’re really about movement, but there are aspects about it that are psychological, they’re really about benefits of support, of coaching, of encouragement and a sense of responsibility to somebody and so we try to do it in a way that continues to involve that staffed and that human connection but then allows that person to use technology to spread their care across a greater number of people at a lower cost. So you can think of what we do as being this toolkit that traditional physical therapy and other kinds of post-operative therapy or even preventative therapy like for osteoarthritis, it’s a toolkit that they can use to really expand the number of patients they can effectively reach and provide care for.
Tech50+: Walk me through the physical parts of this. What is that patient actually working with? Is it a video screen, is it something else, is it a group of sensors? How does this work?
Ted Spooner: Like a lot of things, especially in your experience and my experience, there is on a technology basis really wonderful mousetraps that can be built that can do everything. So we can sensor people up, we can monitor their mobility and their capacity for mobility and do it at a very finite level and then stick a big capable system in front of them that’s motion detecting, identifying their joints and looking at their movements in 3D space. We can do all of that. We can build a really capable but complicated mousetrap to address this problem and we’ve done that. What we’ve found is that it just creates friction to use in larger and increasingly needy populations so what we’ve done is we’ve pulled back much of that technology and we’re increasingly moving to, at least from the patient’s experience, a single screen that they already own and then a system of monitoring that involves easily attainable consumer devices that you wouldn’t view them as being medical grade but they are measuring mobility and then we augment that with essentially self-reported metrics. Are you feeling pain today as opposed to yesterday as opposed to a week ago? Are you on an increasing or decreasing self-reported pain trajectory? If you are, then we can increase the level of support that we provide you or guidance. And a big part of physical therapy, and we found this while doing this over the last few years, is education. It’s really people just understanding what they need to do and then having that behavior reinforced. It turns out we don’t really need that many gizmos and that many really expensive and/or magical 
motion sensing or body tracking systems. What we really need to do is educate people on what they need to do and then monitor that they’re doing it. What we found is that when we do that it lowers the cost of entry for sure, but still produces the same results. At the end of the day it’s really just about engaging people in their health and then staying there. Not shoving them out the door, putting them in a situation where they’re on their own, not being there to answer questions, it’s really engaging them and then being present for them when they’re in a critical episode of care or when they’re increasingly in a disease state where they’re hurting more or their mobility is declining or they’ve got other kind of issues that somebody should really know about.
Tech50+: In addition to the home rehab side, are you doing anything in terms of prevention? Specifically falls, which is one area I think probably should be getting a lot more attention because as you’ve noted and as the doctors keep saying and the insurance companies keep saying, one in three folks over 65 is going to take a fall this year.
Ted Spooner: We did a falls prevention software solution with Philips Home Monitoring. I’m very tight with Philips, the whole team that runs the home monitoring division, and I’m with them quite often and even though I’m now really focused in orthopedics, we did that program with them, we are going to do more with them around the growth of monitoring that is available in the home today, but the falls prevention side obviously is so important. Once you get to our age you know people who have died early as a result of a fall, maybe not directly but indirectly for sure and so it’s something that’s personal to me.
Tech50+: I want to step back a bit so I get a better grasp on what it is that your product does and how it works.
Ted Spooner: You can think of it as a toolkit, but essentially on a preoperative basis for total joint replacement a patient enters some sort of, and you can generalize it as joint camp, some sort of education about how to prepare for surgery and what to do post surgically. We get introduced as a solution in joint camp. We align patients that are willing to use technology and motivated to adhere to a regiment of mobility and patient education and then we give them a tablet and that tablet has our application on it and then allow them to take that home and then their caregiver, usually a PT but sometimes it’s a nurse navigator or in some rare cases it’s the actual orthopedic surgeon themselves gets in front of our application that faces the clinician, sees the patient in terms of where they are in their surgical timeline or what their condition is, presses a button and then allows either some standard therapy to go to them or some customized therapy to go to them. So they essentially publish a therapy program to them and then the patient gets that therapy on their laptop or on the table that we give them and it talks to them. We have a character inside of the product named Maya and Maya is the first thing you encounter once you log in and Maya greets you and says here’s what I have for you for today and then she might have patient education for you, she could 
have an actual mobility routine or exercise routine for you, she could have some range of motion testing for you, she’ll definitely have questions about pain or questions about any other things that might be going on with you, you know did you hydrate today or have you had a bowel movement today and so forth. But it’s all driven by this calendar that the clinician sees that allows them to manage your presurgical activities on a daily basis and your postsurgical activities on a daily basis, kind of all rolled up into a program. And so you see that every day, Maya tells you you have something a little different, she coaches you and encourages you and then from there your adherence is measured back to the provider and as an individual or as part of a population they’re able to see that you’re compliant, that you’re improving and essentially do kind of what technology should be doing which is to triage that population and then if members of that population are in the red, call them. Go get them. Call their family caregiver. Do whatever they have to do to escalate that. But for people that are really adhering, getting better, seeing less pain, increased mobility, getting some weight transfer, then obviously these people are great and you don’t need to expend the resources that you might otherwise. The product lives in front of the clinician and it lives in front of the patient but there’s a link so the information goes two ways.
Tech50+: And is this through a web browser, or a piece of software?
Ted Spooner: Both. We’ve got an implant. If somebody’s using a Windows machine or a Mac it’s an actual software program that can be downloaded to them, but if for whatever reason they can’t do that and they want to just use a browser, we support the browser as well. But we see this as a relatively early stage, because of the adoption of smartphones, we’re going to move very quickly to the lowest friction delivery system and smartphones and very very simple consumer wearables, but very capable consumer wearables, are really the next frontier, especially when it comes to gait. Gait is indicative of so many different conditions and changes in conditions that we are focusing in those areas with partners and you’re going to see some very interesting things from us in the next two quarters.
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