For most patients—and for many drug developers—healthcare reimbursement policies can present a daunting maze of restrictions and uncertainties.
But for some tech companies, those policies can be accelerants that boost the chances that new products will be adopted. That’s the case for Reflexion Health, which benefits from U.S. insurance coverage regulations that create openings for the use of its “virtual physical therapy” system for patients trying to recover a full range of movement after surgery, says CEO Joseph Smith.
Insurers are now holding surgeons accountable for the success of the recovery period, Smith says, so payments for operations are bundled with reimbursement for rehabilitation services. Reflexion wants its Web-based therapeutic exercise programs to be part of those bundled contracts. Its FDA-cleared online system is called Virtual Exercise Rehabilitation Assistant, or VERA (pictured above). On the screen of Reflexion’s standalone device, a virtual physical therapist called Vera guides the patient through a set of exercises prescribed for recovery from operations such as hip or knee replacements.
San Diego, CA-based Reflexion’s selling points to the surgeon and insurer: Patients are more likely to comply with an exercise regimen they can do at home rather than having to travel to see a therapist. The company sends streaming video of the exercise sessions to therapists, so they can make sure patients are doing the work, and can also instruct patients if they’ve got the movements wrong. The tech-based solution can be less costly to insurers than clinic visits, Smith says.
That cost-savings incentive was also one motivating force behind the recent passage of the the Chronic Care Act, part of a bipartisan collection of laws and regulations designed to help Medicare beneficiaries stay well and at home, rather than sick in the hospital, as the New York Times reported. The Act, which calls for broader services, such as nurse visits, for seniors with chronic conditions, also encourages the use of remote telehealth consultations with doctors.
The tech-friendly policy climate creates an opportunity for companies such as Reflexion and another rehab tech company, MindMaze, to test their inventions in real-world settings, even if it doesn’t guarantee them a major market success. MindMaze, whose rehabilitation systems are geared for recovery from neurological damage rather than surgery, received FDA clearance to market its portable MindMotion GO system for outpatient therapy this month. In 2017, the FDA cleared MindMaze’s hospital-based movement recovery system, MindMotion PRO.
Lausanne, Switzerland-based MindMaze, whose U.S. headquarters is in San Francisco, was an early explorer of the potential of virtual reality and other emerging technologies in healthcare. MindMotion PRO, its first product, is designed to help stroke victims regain the use of an arm, wrist, or shoulder disabled by a neurological injury.
Patients look at a screen showing what appears to be a straightforward video of themselves performing a movement of one of their arms. But when they move their functioning arm, the MindMaze software shows the movement being successfully carried out by their afflicted arm. The idea is to motivate patients to continue practicing the movement with their disabled arm or hand, because their efforts seem likely to be rewarded—a benevolent trick on the mind. In theory, the brain might respond to the mirroring trick by growing new nerve connections in the stricken part of the brain, the company suggests. MindMotion PRO is used in the early days of a patient’s recovery in the hospital.
The company’s portable system, MindMotion GO, doesn’t deploy the mirroring technique to motivate patients to persevere in their rehabilitation. It uses a simpler 2D screen image to guide patients through game-like exercises that work specific muscles of the arms, lower limbs, and trunk. The portable unit is designed to continue a course of physical therapy for patients in a supervised outpatient setting after they leave the hospital.
MindMaze is now working to extend the use of both the hospital-based and outpatient MindMotion systems to rehabilitate not only stroke victims but also patients suffering from other neurological conditions such as multiple sclerosis, traumatic brain injury, and spinal cord injury, co-founder and CEO Tej Tadi says.
While MindMaze plans to make its systems compatible with 3D headsets in the future, for the time being the company finds that a 2D screen is easier for hospital patients to use, Tadi says.
Reflexion’s Smith says his company’s home therapy system is also simpler than some original versions of its rehabilitation product, which included 3D imaging.
“A lot of patients found it confusing,” Smith says.
As Reflexion responded to real-world user experiences, the company tried to pare away anything that would hinder patients from doing their exercises. That meant not only a simple remote and a touch screen, but also a built-in Internet connection so that users don’t need their own service provider to get on the Web. All they need is a plug in the wall, Smith says.
“People in their 90s, living in mobile homes, can use it,” Smith says. “We want it to be as accessible as possible.”
Reflexion also needed to engineer a bond between patients and the on-screen physical therapist who provides instruction. It chose a brunette avatar named Vera who was the favorite in a survey of patients. They found her “engaging and not confrontational,” Smith says.
As the Vera avatar demonstrates exercises, the screen also displays a silhouette of the patient copying the movements. Reflexion learned that patients preferred the silhouettes to full video. “People don’t like to see their own image,” Smith says he learned from patient feedback.
The technology behind the scenes of Reflexion’s simple user experience includes Microsoft’s Kinect spatial camera; motion-sensing technology that tracks 22 joints of the body as their positions change during an exercise; and the analysis of those patterns to compare with the ideal motions that would lead to healing rather than pain. Streaming video of the exercise sessions is also sent to therapists. (Reflexion is assessing other camera systems, in case Microsoft’s Kinect’s system is discontinued, Smith says.)
MindMaze augmented its own motion-tracking system with the 2017 acquisition of motion measurement and analysis company GaitUp. The company has also developed another high-tech product it expects to incorporate into its rehabilitation systems someday—a foam VR headset insert called MASK that picks up signals from the face and interprets them as facial expressions. That reflects MindMaze’s broad ambition to create an interface between technology and the brain.
But for now, both MindMaze and Reflexion are aiming for market traction with their initial products.
Smith says Reflexion may expand the scope of its system to rehabilitation for shoulders and back pain this year. He says the company has a “large and growing” group of customers, but didn’t reveal numbers. Since Reflexion raised $18 million in a Series B funding round in 2016, it has received incremental investments that haven’t been publicly disclosed, he says.
MindMaze raised $100 million in a funding round led by the Hinduja Group in 2016, when investors agreed on a valuation of more than $1 billion. The company’s MindMotion PRO systems are available on the European market, where 1,300 patients at 45 treatment centers have used them, Tadi says. But he declined to say how many of the systems have been sold or leased.
Asked whether government and private insurers have agreed to reimburse the cost of MindMaze’s products or services, Tadi says, “Every country has a unique way of calculating reimbursements, and we are working with various stakeholders on these issues so that we can find a way to provide support for as many patients as possible.”
Photo courtesy of Reflexion Health