Dan Rubinstein of Physera: 5 Things We Must Do To Improve the US Healthcare System

Start with a foundation of basic healthcare coverage that everyone can access (potentially with supplemental insurance and coverage for those that desire it). The pandemic has shown us very clearly how connected we all are and how important it is for everyone to have access to good care. We don’t want people to come to work sick and infect others; we don’t want people ignoring symptoms and delaying treatments.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dan Rubinstein.

Dan Rubinstein is the CEO of Physera, the provider of high quality, evidence based virtual care for musculoskeletal (MSK) conditions. With a nationwide network of licensed physical therapists, Physera’s program provides care navigation, MSK triage, diagnosis, and personalized guided exercise therapy through the convenience of your smartphone.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

My father had been misdiagnosed with sciatica. After months of Advil and incorrect treatment, he discovered that it was not sciatica but stage four lung cancer that had metastasized to his bones. In particular, chronic pain is difficult to diagnose correctly, and those dealing with it are four times more likely to start with an opioid prescription compared to those who get treatment, commonly recommended by the CDC. The experience with my father drove home how important it is to get the diagnosis right the first time.

My experiences in product development at Google and Facebook made me wonder why healthcare was not making better use of today’s data and technology capabilities. Cameron Marlow, who led data science at Facebook, Todd Norwood, PT, DPT, and I came together to try and address this issue.

We set out to change the way healthcare is delivered, starting with musculoskeletal conditions, leveraging technology, and data and creating a smartphone app platform that would bring expert-guided recovery and personalized physical therapy to everyone. US clinicians are excellent, but the time they get with patients continues to dwindle. This creates a lack of high-quality, individualized care. Assistive technologies can support their decision making, but it has been slow to mature.

Can you share the most interesting story that happened to you since you began leading your company?

Even though I knew the statistics around pain, it was eye-opening to have so many people at parties and networking events share their own stories and experiences with me when they learned about what we were doing. Everyone experiences musculoskeletal pain at some point, and unfortunately, our existing healthcare system is not optimized for dealing with it.

I had an episode of debilitating shoulder pain where extending my arm to put on a jacket or a backpack was excruciating. I’m very active, so this was unusual for me. I talked to one of our clinicians and asked, “What’s going on. Why is this happening suddenly?” He told me that the small muscles in my shoulders were weak even though I was regularly going to the gym and lifting 180 pounds. These muscles were critical for making sure my shoulder blade was moving correctly, and this was causing me this incredible pain. Fortunately, he gave me some exercises, and my condition improved dramatically within a few days. This personal experience made me realize that our body changes as we age — even though we may be active. With a few minor MSK adjustments versus going to the doctor and getting pain prescriptions, you can feel better in everything you do.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

In some early sales conversations, when we said we do “telehealth,” some health plans and employers interpreted that to mean “telephonic conversation” — i.e., audio only. They couldn’t fathom how we could do physical therapy by merely talking to someone. Unfortunately, this was often correlated with calling into sales pitches, versus using video chat, so they were unable to see our slide materials. It’s essential to have a shared view of what’s being discussed to help illustrate points and supporting evidence.

What do you think makes your company stand out? Can you share a story?

We provide evidence-based care quickly and conveniently. Patients that use Physera recover faster with better overall outcomes. Over 95% of patients who complete the program report improvement in their area of chief concern and over 80% leave the program with no plans to seek additional care. I’m proud that Physera patients are not prescribed opioids and, in many cases, can avoid costly treatments such as imaging, injections, and surgery.

My son caught an edge while skiing and painfully twisted his knee. Before rushing to the ER, I secured a video chat appointment with one of our physical therapists (PT), who was able to run through a battery of assessments and mobility tests. During the appointment, the PT concluded that it was very likely just a muscular sprain. I was grateful that we could figure out what was wrong and what to do about it.

A few weeks later, I was explaining what Physera does to a prospective VC investor. He lit up and recounted how his son had twisted his ankle while playing soccer, and he rushed him to the ER where they did an MRI. He recounted how he was now fighting with his insurance company about whether it was medically necessary.

My son was skeptical about video chat but the PT calmed him down, and the experience completely won him over. Physera PTs average over 10 years of clinical experience. They have been specifically hired and trained to understand the underlying causes of patients’ pain so we can prescribe the most effective, evidence-based treatment. This is what makes us stand out. I hope for the day when everyone has access to Physera, covered by their health plans, and can get the expert care they need, when they need it, and avoid unnecessary procedures and expenses and get better faster.

What advice would you give to other healthcare leaders to help their team to thrive?

Don’t forget the importance of the human connection. Good healthcare is reliant on good relationships, having a provider who listens and asks questions and is with you every step of the way on your journey to a full recovery. Too many companies are relying on technologies to fill the place of live providers. Healthcare should be built on patient care, and then layering on the best technology to enhance the experience. Our approach is to combine the best of both worlds.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

Start with the money: fee-for-service reimbursement models drive all the incentives. When we pay for procedures instead of outcomes, that’s what we get: expensive treatments that may not drive better health outcomes. This also drives people to avoid early treatment and preventative care until things are much worse (and more expensive to treat). All the layers of administration, billing, and associated costs funnel money out of the system that would have otherwise been focused on delivering care to patients.

Coverage: if the pandemic has taught us anything, it’s that we are all in it together. We cannot have a functioning society if we don’t have a basic healthcare level available to everyone regardless of where or for whom they work.

Data sharing: having access to the right data, in the right ways — protecting individual privacy, while being able to share the underlying data in an anonymized way — will be transformational for healthcare. Today, regulations make it very difficult to build the right kinds of solutions across providers. Still, countries and integrated health systems that have access to patient data can do more to deliver better care.

Care delivery: Focusing on musculoskeletal conditions specifically, care pathways are unnecessarily complicated and expensive. For example, the CDC recommends physical therapy as the first line of treatment in musculoskeletal disorders. Instead, patients are often sent to other specialists, treated with opioids or even surgery before seeing a physical therapist.

The lack of assistive technologies: We would be able to treat so many more people, more effectively if we had the right systems and tools in place. Healthcare is behind other industries here, and the reasons are complex — there are large incumbents who benefit from the status quo; there are fragmented regulations that don’t serve patients’ interests (why should telehealth be regulated on a state by state basis?). The pandemic has focused us as a nation, and some things have changed very quickly, especially around telehealth reimbursement. Hopefully, there will be continued momentum from this crisis to fix things that have been broken for a long time.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1. Start with a foundation of basic healthcare coverage that everyone can access (potentially with supplemental insurance and coverage for those that desire it). The pandemic has shown us very clearly how connected we all are and how important it is for everyone to have access to good care. We don’t want people to come to work sick and infect others; we don’t want people ignoring symptoms and delaying treatments.
2. Move from fee-for-service to value-based/outcomes-based care. Incentivize health, not the treatment of illness.
3. Licensing and regulations need to evolve to fit our modern world. There is a complicated web of regulations that hinder telehealth providers from delivering care. Fifty state-level boards and one in the District of Columbia regulate the physical therapy practice and require physical therapists to be licensed in each state they may want to deliver care. This is an outdated system that is a roadblock to one of the key benefits of virtual solutions — the ability to provide care anywhere. In many parts of the country, there is a shortage of providers, and telehealth can be the solution to close the access gap and serve areas with the greatest needs. However, our current regulations are an unnecessary barrier to access. It also allows people to remain connected to care providers even if they change locations, a widespread occurrence in our modern society.
4. We must use the technology and tools available to deliver care to the patients who need it. Our healthcare system is strained, and it is essential to activate available care options, whether or not we are dealing with a global crisis. Virtual care solutions can remove the barriers — such as time and distance — that keep people from seeking and receiving care. It is also a tool that can protect patients and healthcare providers in an era of social distancing.
5. Better literacy on telehealth. There is still a lack of education about telehealth and its benefits — this applies to both consumers and clinicians. For example, we have heard anecdotes from consumers during the COVID-19 crisis who were unaware that they could access physical therapy remotely.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

We must collectively champion vision and innovation. Individuals, corporations, and communities can work together to hold our system accountable for removing the barriers to care. Individuals are frustrated but often feel powerless to change the system, but as consumers of healthcare, they have a powerful role. Get educated about the system and champion innovative changes such as telehealth with your employer, healthcare provider, and elected officials.

Corporations are bearing a large share of the healthcare burden and should become partners in driving change. Many of the problems they are looking to solve, such as lower costs and localized service can be solved by better utilizing technology and tools that are available today.

Leaders must view this as a human issue and not a partisan one. We need our leaders to support innovation and eliminate barriers such as reimbursement and antiquated regulations that stand in the way of efficient, effective care.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

We need a holistic approach. We have more than enough evidence that mental/behavioral health and general health are interconnected, so our treatment approach should be comprehensive. We see this in patients that have chronic pain; it not only impacts their quality of life but also has an impact on their mental health. We should adapt to how we train healthcare clinicians and evolve how we diagnose and treat patients.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is one that listens to patients and is never satisfied with the status quo but willing to continue learning and innovating to deliver better care. Good product development takes a user-centric approach. The analogy in healthcare is to focus on treating the patient holistically, not narrowly focusing on just the disease.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Be like water.” When Physera was in its early days, one of our first investors advised us that healthcare is complicated, particularly concerning regulatory compliance and multiparty buying processes (e.g. employer, benefits consultant, health plan). Water flows and calmly finds the lowest energy path around obstacles.

Are you working on any exciting new projects now? How do you think that will help people?

We were acquired by Omada Health a few months ago. We are excited to have a comprehensive health offering that addresses the most pressing chronic healthcare conditions, such as diabetes and mental health. We are now the most and only complete digital care provider on the market. The way people access their care has irrevocably changed, with implications that will last far beyond the current crisis. Now, more than ever, we believe effective digital care must empower human connection, instead of seeking to replace it with automation. Accessibility issues laid bare by the pandemic over the last several months and have made this imperative more urgent than ever. Our comprehensive solution will help patients access the care they need. Our employer and health plan partners have told us they want a single, clinically-validated solution that addresses their top healthcare needs.

More than 75% of patients with type 2 diabetes, or who are obese, report at least one joint mobility issue. Nearly 75 percent of those with depression are overweight or obese, while 62 percent of those with anxiety fit into one of the same two BMI categories. We know these issues are top of mind for our clients, and this type of care is already being delivered effectively digitally and through telehealth. It is exciting to address these issues and move healthcare forward.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I really enjoy “How I Built This” — a compilation of inspiring interviews with founders walking through the challenges they encountered while building their businesses.

On the healthcare side, I am really inspired by Atul Gawande’s insightful perspectives, like those found in his book, “Being Mortal.” He discusses the great lengths, often futile, of extending lives under conditions that don’t provide much benefit in terms of quality of life. He takes a very empathetic and pragmatic approach to healthcare. I think if we look through these lenses of empathy and pragmatism at many of the problems with our current approach to healthcare, we will come up with very different solutions.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I grew up in Canada, and I often wonder why Americans aren’t pushing for a basic “Medicare for All” (with potentially supplemental private insurance for those that want it/can afford it). The pandemic has essentially ushered in a version of this for COVID-19 related issues, where many plans are waiving patient copays, and HHS is reimbursing providers for tests and treatment. Ultimately, basic health is a public issue (much in the same way that basic education is), and we are all better off if everyone has a basic level of health (and education!).