Upswing Health combines AI and telehealth to improve MSK care and cut costs

Musculoskeletal (MSK) is routinely one of the three most expensive categories of care (along with cardio-metabolic disease and cancer care). Dr. Steve Schutzer, an orthopedic surgeon for 34 years, is working on this pain point as co-founder and COO of Upswing Health, a virtual clinic for MSK/orthopedic issues.


“More than one in two Americans will draw attention to an MSK event each year,” Schutzer said. “This has placed an enormous burden on the American health care system. The total addressable MSK market now approaches $800 billion annually in total direct and indirect costs. Unfortunately, 25-40% of that care is attributed to waste and inefficiency, and to low value, no value or even harmful interventions.”

The founders of Upswing Health, Schutzer and Dr. Jay Kimmel, wanted to tackle this massive problem by reinventing MSK healthcare delivery. Based on their years of practical experience, they came to the conclusion that they needed to ‘blow it up’, revolutionize it and start over, rather than tinkering around the edges.

Instead, they purposefully designed Upswing Health around the way they believed contemporary MSK care should be delivered to patients.

“The essential and most urgent problem to solve was also the most fundamental: access to care,” Schutzer said. “The average wait time to see a doctor in the US is now 26 days, and for some specialists as high as 42 to 63 days. This unacceptable state of affairs is undoubtedly exacerbated by the Bureau of Health Workforce, which has projected a workforce shortage of nearly 82,000. physicians, including more than 5,000 orthopedic surgeons, by 2035.

“But patients who develop acute MSK problems need more than just access; they need immediate and easy access,” he added.

Schutzer gave this example as an example.

“You’re walking with some friends when you trip over a tree stump and roll your ankle,” he said. “What are the first two pressing questions that come to your mind? 1) What have I just done, and 2) Where should I go? You need answers to these questions quickly. Often you have no choice but to go to the emergency room. seeking treatment at the emergency room or emergency room – and are faced with long waiting times and high out-of-pocket costs.

“It was very clear that alternative solutions had to be put into practice,” he added.


To solve the need for immediate access to care, the founders concluded that Upswing’s platform would put smart technology first so that MSK patients could have their questions answered in minutes – wherever and whenever their problem occurs also occurred, 24/7/365.

“Together with our team of healthcare professionals, we built a unique, one-of-a-kind MSK-specific symptom assessment tool,” Schutzer explains. “Using decision tree logic that replicates traditional doctor-patient interaction, we have created algorithms for more than 160 different MSK conditions.

“Patients first answer a series of intuitive questions about their injury and then within seconds are provided with a differentiated list of possible injuries and conditions they may experience,” he continued. “They are then connected to curated, injury-specific content pages where they can read about their condition and learn when to see a doctor or go to the emergency room.”

They also receive advice, self-help tips and rehabilitation tools to help them on the road to recovery. The sensitivity of Upswing’s algorithms has been field-tested among orthopedic surgeons and physician assistants and has a 75% concordance for diagnostic accuracy, Schutzer reported.

“Upswing is now in the final stages of refining the next version of our symptom assessment tool, which we expect will further improve diagnostic accuracy,” he said. “This uses machine learning to access the world literature on specific characteristics of MSK conditions and also applies natural language processing to analyze patient responses.

“It will include elements of the physical examination and even uploads of the patient’s diagnostic imaging reports,” he continued. “We expect that with increasing use, AI will improve accuracy by processing and analyzing large amounts of data, learning from the pattern of patient responses and making predictions and decisions based on that data. We expect the release of this updated product in the first quarter of 2024.”

To further strengthen and improve its technology and virtual offerings, Upswing recently entered into a partnership with Xtravision uses large language models and machine learning, powered by generative AI, to predict acute and chronic MSK conditions. The company’s motion capture technology also generates in-depth data on range of motion, strength, balance and other biometrics for better decision making under common MSK conditions.

“We will integrate this technology and predictive analytics with our coaches and telehealth platform as the foundation for our new, fully virtual spine injury prevention program launching later this year,” Schutzer said.

But Upswing’s technology wasn’t enough. The founders knew that patients often want more: they want to talk to a real person. That’s why they decided to complement Upswing’s AI-first technology with a virtual care component and built a telehealth platform with access to the company’s frontline coaches (certified athletic trainers) 12 hours a day, 7 days a week, or with its orthopedic specialists from Upswing within 24 hours. o’clock.

“This hybrid approach meets the demand for immediate access to care by harmonizing elegant smart technology with compassionate and intelligent human relationships,” said Schutzer.


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Upswing’s platform was launched in late 2019, just prior to the COVID-19 pandemic. It has been deployed in two different markets. In the direct-to-consumer market and in the self-funded B2B employer space.

“Given the timing of our launch, the virtual platform served as an important resource for patients with MSK issues when no other options were available,” Schutzer explains. “During the early days of the pandemic, when our population was in lockdown mode and physical appointments with healthcare providers were halted, thousands of patients had access to Upswing’s technology at no cost, and many were able to resolve their issues on their own.

“To date, between 2,000 and 2,500 patients from around the world come to Upswing Health every day for this important information and guidance – nearly 1.47 million in total,” he reported. “The site is so popular that without any D2C marketing initiatives, ten of Upswing’s MSK terms rank #1 in Google SEO analytics – ahead of WebMD, Cleveland Clinic and other notable MSK sites – and on the first page for another 60.”

In January 2023, Upswing was selected by a large, self-funded employer (a state health plan) to manage the MSK needs of its 225,000 members and beneficiaries. The goals of this engagement were to use Upswing’s virtual front door for MSK care to: 1) align the patient care journey from their ‘ouch’ moment to recovery, 2) deliver a satisfying patient experience to provide, 3) provide excellent clinical outcomes, and 4) Reduce the use of MSK services, leading to predictable cost savings.


To date, nearly 800 patients, including a preliminary pilot program with this major employer, have used the fully virtual Upswing platform.

“As a testament to the success of this model, patients who used Upswing instead of traditional MSK care approaches consumed a total of 38% fewer MSK services – 61% fewer injections, 49% fewer surgeries, 46% fewer physical therapy/chiropractic visits, 30% fewer imaging, 25% fewer ER visits and 21% fewer doctor visits – saving the client an estimated $1,100 per member involved,” Schutzer reported.

“81 percent of patients had their issues resolved using technology and Upswing coaches alone, while 19% also had a telehealth visit with an Upswing orthopedic specialist,” he continued. “Despite the fact that 71% of patients had experienced an exacerbation of chronic MSK disease, there was a 51% reduction in chronic patients with an episode duration of only 52 days.”

Finally, Upswing’s most recent net promoter score, as a measure of patient experience and satisfaction, is 84.


“Some of the problems faced by patients with MSK problems are in fact not unique – and plague patients in the general population with a range of health problems,” Schutzer noted. “Access to quality care, issues with disjointed and disjointed adventures full of gaps in care, and a lack of affordability are now unfortunately endemic to American healthcare.

“We must do better as a nation – and the time is now,” he continued. “Old models have failed to meet even the most basic health needs of our population, which continues to struggle with these issues. There is a growing and widespread concern today that ‘financial toxicity equals health toxicity’ – we need to do better.”

In the future, technology-enabled models that hybridize a smart AI-derived symptom assessment tool (which can provide patients with immediate insight into the nature of their health condition and then treat or triage patients appropriately) with the human touch that builds on relationships and natural design appears to offer a compelling and feasible solution to these deep-seated problems, Schutzer said.

“As healthcare organizations begin to transition from traditional fee-based reimbursement models to accountable care and assume financial risks to outcomes and population health, it seems prudent that they adopt this approach and exploit the recognized benefits of these emerging and scalable technologies. which will only continue to evolve over time,” he concluded.

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