August 28, 2022
15:57
It is the first mobile health application whose use is (temporarily) reimbursed by the Inami. Back on this obstacle course with its founder.
An adventure that began at the end of 2015, even if it took until 2017 for him to embark on it full-time. The starting point? The questioning of the gang doctor. “An orthopedic surgeon, he wondered regarding the variability of results in his patients.” In the viewfinder, the placement of a knee or hip prosthesis. “In Belgium, there are regarding 60,000 per year. Average age of the person operated on: 65 years old.”
Personalized rehabilitation
Questioning and monitoring patients: it starts with good old paper questionnaires, which then migrate to tablets. “One of the main issues is that of chronic pain. One year following a knee operation, there are still 20 to 30% of people complaining of pain, a sign that the intervention has not solved everything.”
“We realized that rehabilitation was not always adapted to the level of physical activity of the person, and to his lifestyle.”
Here is the founding idea of moveUP: offer a personalized rehabilitation path. “We realized that rehabilitation was not always adapted to the person’s level of physical activity and lifestyle. Result of the races, for a sedentary person: stiffness and risk of thrombosis. That person needs to be stimulated. For a person with a hyperactive tendency, inflammatory concerns, because they don’t give their body time to recover. This person, on the other hand, we have to limit him.
“Mobile health call”
The machine is launched, the first activity “trackers” are distributed, with step goals and personalized exercises. The boost comes from the authorities: in 2016, Maggie De Block (Open Vld), then Minister of Health, launched the “mobile health call”, in which the young shoot took part. “It was brilliant, smiles Charles-Éric Winandy: in six months, we were able to demonstrate our therapeutic effectiveness. Inami financed a study involving three hospitals and two hundred patientswhich delivered very good results.”
“We sought legal advice and started using classic physio codes.”
The rest takes the “classic” course of the start-up: fundraising, development of the company, improvement of the application. “We get our ‘CE’ mark, which makes us ready to market.” With a catch, however: for everything related to reimbursement, it’s a big leap into the void. At moveUP, we are trying a kind of forced passage. “We sought legal advice and started using classic physio codes.”
With some success. “In 2018, we are working with around ten hospitals and are seeing around a hundred patients arrive per month.” Enough to start hiring physiotherapists internally for patient follow-up. And submit a reimbursement request file to the Inami. “There was no standard document yet, we had to put together the file ourselves.”
things get complicated
It was in 2019 that the worries began, locates the boss. Mutual funds stall on the use of the code for the “classic” physiotherapist. And the Inami closes the door to teleconsultations, which leads all these people to the Council of State. With this progress, all the same. “We started talking regarding the framework for reimbursement.” It is a question of landing for the end of 2019. Then a wave called covid swept through the world, upsetting priorities and placing teleconsultations at the top of these.
The file starts to move once more at the beginning of 2021, when the study begins to prove the socio-economic interest of moveUP. “A huge randomized study, with regarding fifteen hospitals and, initially, having to count a thousand patients. Horribly complex: we are at 40%; the Inami has accepted that we stop including patients on September 30, 2022 .” Pending the verdict, scheduled for the end of 2023, the Inami has decided to temporarily reimburse the use of the application. “Three months of use plus the fees of the physiotherapist, that comes to regarding 750 euros, reimbursed at 80%.”
“Insanely Complex”
“The difficulty is such that the health insurance companies cannot find their way around, that there are a lot of errors and that people give up along the way. And we end up with fewer patients than before the start of the study.”
All with a good dose of complexity. “For normal follow-up, all you need is a physio prescription from the surgeon; a single code is enough for the entire rehabilitation. But to go through moveUP, there are 23 different codes. The initial focus was to avoid abuse, I understand. But the difficulty is such that the mutuals cannot find their way, that there are plenty of errors and that people give up along the way. And we end up with fewer patients than before the start of the study.“
Already it is not easy to convince healthcare providers to come on board. “Because it involves a new way of workingexplains Charles-Éric Winandy. It’s a fairly conservative environment, which needs incentives to adopt new technologies.” So if you add a layer of administrative imbroglio… ” But hey, with moveUP, we were pioneers and wiped the plasters. Those who get started now may face fewer problems.”
Heading to the US!
“Do we really want to go through such a complicated process for reimbursement, all to end up with fewer patients?”
We are a bit sorry for resorting to an old proverb, but “scalded cat fears cold water”. After hips and knees, moveUP has moved into bariatric surgery. Key query. “Do we really want to go through such a complicated process for reimbursement, all to end up with fewer patients?” Here is the approach that currently prevails in Europe: do without “tailor-made” reimbursement codes. “We use teleconsultation codes.” Whether in Germany, France or Belgium.
Belgium where the measuring the quality of care is not yet part of the habits. “We measure a lot of things, but not the quality of care: the survival and reoperation rate says nothing in orthopedics. We do not know if the patient is satisfied or if he is dying of pain. Digital solutions open the door to collecting information on patient satisfaction, but this is met with resistance.”
In the meantime, the company has crossed the Atlantic. “We are expanding into the US market. We cannot afford to wait seven years for each European countrywith different rules each time.” That said, Charles-Éric Winandy wants to be on the safe side. “It is certain that being reimbursed in Belgium gave us visibility and credibility.“
Belgium, not so bad!
Because despite the obstacle course mentioned, all is not so bad in Belgium. “The ecosystem is super dynamic, there are plenty of start-ups that are developing.” Nonchalantly, public support and funding make the difference. “It’s a bit of a paradox: there are plenty of initiatives developed in Belgium that are taking off abroad.”
“It’s a bit of a paradox: there are plenty of initiatives developed in Belgium that are taking off abroad.”
It’s a fact: financial support, moveUP has received. “Flanders funded 50% of the development of the application. In Brussels, we received a 50% subsidy to progress on the analysis of walking via the smartphone camera, in order to adapt the exercises according to the evolution of the patient In Flanders, we also received support on the ‘motivation’ part linked to bariatric surgery. Everything related to development and financing works very well!“It is on the side of “implementation” that it would be necessary to oil the wheels.
The key phrases
- “It is not easy to convince the care providers. Because it involves a new way of working. It’s a fairly conservative environment.where it’s very difficult to push new technology.”
- “In Belgium, we measure a lot of things, but not quality of care. We don’t know if the patient is satisfied or if he’s dying badly.”
- “It’s sure that being reimbursed in Belgium gave us visibility and credibility.”
- “Anything to do with development and at funding works very well!”
