A mobile application developed by a small startup company in Madison has shown strong results in treating one of the most common and costly medical conditions: lower back pain.
The company is Kiio, and two pilot projects have found the company’s app effective in helping people with lower back pain while significantly reducing medical costs.
The pilot projects were done by Quartz Health Solutions, based in Sauk City, and WEA Trust, based in Madison.
Kiio’s app was found to reduce visits to emergency departments and urgent care clinics by more than 90% and opioid prescriptions by more than 20%. Imaging tests, such as MRIs, and steroid injections also were reduced.
Medical costs were 54% lower, excluding the savings on the cost of prescription drugs, for people who participated in Quartz’s pilot project. And costs were 64% lower for those who participated in WEA Trust’s pilot project.
“What we’ve seen confirmed and even surpassed our expectations,” said Kyle Humphrey, vice president of sales and marketing for NeuGen, which manages health plans for WEA Trust and Health Tradition.
WEA Trust invested $1 million in Kiio after its pilot project.
Kiio for Low Back Pain starts with an online screening that asks a series of evidence-based questions.
“These are essentially the questions that your doctor would be asking you in the office,” said Lydia Zeller, Kiio’s vice president of product strategy.
The answer to one question will determine the next question — what’s known as a decision tree — and the questions generally take five to 10 minutes to complete.
The questions establish a baseline for pain and impairment. The app also assesses the person’s risk and the type of back pain.
For roughly one in five people, the Kiio app will refer the person to a primary care physician or physical therapist. For others, it recommends a customized exercise program.
The app has illustrations and animated models that show how to do the recommended exercises and for how long.
The exercises are broken into three levels, starting with those for range of motion and gentle stretching. The second level consists of exercises to strengthen core muscles that support the back. The exercises in the third level increase range of motion and core strength.
The app will monitor people’s perceptions on whether they are making progress as well as track whether they are doing the exercises and how often. It also provides information on the medical condition. And people who use the app have access to care managers.
The average reduction in pain is 50%, according to Kiio. This is based on the Numeric Pain Rating Scale, in which patients rate the intensity of their pain on a scale of 1 to 10.
And roughly nine out of 10 people have said they would recommend the program.
Part of the appeal is convenience: People can exercise when they want at home as opposed to going to a physical therapist.
“It’s a pretty simple idea,” said Rob Plesha, an actuary and consultant who worked for Quartz during the pilot project.
The information is not new but is presented in a way that is more accessible and helps people make better decisions, he said. It also is an example of an innovation that can help control health care costs.
Kiio’s app is part of an emerging part of health care known as “digital therapeutics” — software programs to prevent, manage or treat medical conditions.
More evidence is emerging to demonstrate the clinical value of digital therapies, particularly for medical conditions that benefit from continuous patient engagement, according to McKinsey & Co., a consulting firm.
Lower back pain often is caused by compression of the spinal cord that can pinch nerves. The result can be excruciating pain. It’s the reason physicians will prescribe pain medication, such as opioids.
Physical therapy or an exercise program can help. And in most cases, the pain passes within a few months.
“That’s what your body is designed to do — it’s designed to heal,” said Humphrey of NeuGen. “And often, if you give it the right exercises, it will do that.”
That is little consolation for someone in pain — and why tens of billions of dollars are spent each year to treat lower back pain.
“It is a massive cost driver — not just for us but for any health plan out there,” Humphrey said. “Part of the reason for that is it affects such a broad number of people.”
A visit to an emergency department for back pain costs on average about $1,300, he said. Spinal injections can cost $1,200 each and typically several are required.
Several hundred people in WEA Trust and Health Tradition health plans now are using the Kiio app at any given point, Humphrey said.
WEA Trust and Quartz presented the results of their pilot projects at a conference held by the America’s Health Insurance Plans, or AHIP, the largest trade group for health insurers.
“It gave us credibility,” said Zeller of Kiio.
The company, which employs 14 people, has raised about $7.6 million and hopes to raise $5 million to $7 million in its current financing round.
It was founded in 2012 as a spinoff from Lifeline USA, a company that made fitness equipment and that was bought by Escalade Inc. (The owner of Lifeline later sold his interest in Kiio.)
Kiio initially developed software that included 1,800 fully animated exercises that would enable a physical therapist to create a customized program that a patient could do at home. The program could include specific recommendations, such as range of motion and how quickly do to the exercises.
The company learned that it was difficult to sell software to health systems that could reduce their revenue from physical therapy. Kiio shelved the product in 2016, but the software became the foundation for the mobile app.
Kiio now has seven health plans as customers, including a national insurer and another company that are running their own pilots, Zeller said. Kiio also has employers as customers, including one that is among the 50 largest companies based in the United States.
“Our traction has increased significantly in the last six months,” she said.
The company hopes to introduce similar apps for neck and knee pain in next year.
Kiio, which declined to disclose its revenue, has competitors. And it still faces hurdles — other than the challenge of raising additional money.
One is making people aware of the app when it is available through a health plan or employer. The company draws on email, direct mail and newsletters as well as working with onsite clinics, telehealth companies and health plans’ care coordinators.
But Zeller acknowledged that the coming year promises to be interesting.
“We’ve done the hard work,” she said. “We’ve got the clinical outcomes. We’ve got the financial results. Now we just need to rev it up.”