|02.04.20| Telemedicine coaching, Noom app reduce binge eating symptoms; Hinge Health's $90M Series C

New study results published online in the American Journal of Psychiatry suggest that a binge eating treatment strategy combining cognitive behavioral therapy (CBT), telemedicine consultations and Noom’s self-monitoring app could be effective in reducing symptoms compared to standard care.

Announced back in in 2015, the investigation — conducted by researchers from Mount Sinai, Kaiser Permanente and Noom — evaluated 225 Kaiser Permanente Northwest patients diagnosed with binge eating disorder or bulimia nervosa over a 52-week window, among the first 12 weeks of which the intervention was delivered.

“The purpose of this study was to evaluate the robustness of the intervention when delivered by non-specialist health coaches in a community health care system via telemedicine,”Dr. Thomas D. Hildebrandt, lead author and the chief of the Center of Excellence in Eating and Weight Disorders at The Mount Sinai Hospital (as well as a Noom advisory board member and equity owner), said in a statement from the health system. “We were encouraged by the results that showed that this intervention is effective and can be scaled outside of specialty clinical programs.”

TOPLINE DATA

Compared to those receiving standard care (n = 111), patients in the intervention group (n = 114) reported significantly fewer days in which they experienced objective binge-eating episodes (β = -0.66) at 52 weeks.

This group also logged higher remission rates than the controls (56.75 versus 30%), “suggesting that the effects of the intervention continued to facilitate changes within the follow-up period that were not observed among those who received standard care,” Hildebrandt said. Reclassifying all missing reports as treatment failures also yielded a similar remission rate ratio (33.3% versus 10.8%).

Further, the researchers noted similar remission rate improvements in regard to patients’ compensatory behaviors such as vomiting, laxative use or excessive exercise; various eating disorder symptoms; and clinical impairment. No significant difference in quality of life was observed at the end of the follow-up period.

HOW IT WAS DONE

Between April 2016 and March 2017, researchers enrolled Kaiser Permanente Northwest members aged 18 to 55 years. Those eligible were mailed a study brochure that referred to an online questionnaire, with those indicating loss-of-control eating at least once per month screened over the phone to determine whether they met the study criteria for objective binge episodes.

The intervention consisted of telephone coaching sessions with a Kaiser Permanente Northeast-employed health coach, once per week until week four, and then biweekly until week 12. Alongside these the researchers provided a CBT-guided self-help book and the Noom Monitor smartphone app, a customizeable self-monitoring system that lets users log their meals and behaviors. The participants were provided with instructions on how to use this app, while their coaches could monitor their progress through a provider dashboard.

Of note, standard care at Kaiser Permanente Northwest did not consist of any services specific to binge-eating disorder, but “unrestricted access to clinical resources within the health plan.”

Researchers assessed the patients at baseline, and at weeks four, eight, 12, 26 and 52 using several questionnaire assessments of primary and secondary outcomes of interest.

THE LARGER TREND

A handful of studies and pilots have looked at the ways in which digital behavioral health tools and telemedicine can promote healthier lifestyles. A 2018 study in the Journal of Telemedicine and Telcare, for instance, found weekly telemedicine sessions to significantly assist obese patients trying to lose weight. Another in the Journal of Internal Medicine highlighted described similar benefits from a hybrid CBT counseling and online behavior change support system.

Noom, for its part, made headlines in May of last year with the announcement of a $58 million fundraise to support Noom Weight Loss Coach, its current signature product.

IN CONCLUSION

“Scaling and implementing empirically supported interventions have become an important priority across mental health conditions and our study shows that CBT-[guided self-help] via telemedicine is effective and scalable as an intervention for binge eating disorders,” Hildebrandt said.

Hinge Health, the maker of digital programs for chronic musculoskeletal (MSK) health, has closed $90 million in a new round led by Bessemer Venture Partners. Lead Edge Capital also took part in the Series C, as did prior backers Insight Partners, Atomico, 11.2 Capital, Quadrille Capital and Heuristic Capital.

Hinge had been courting investors throughout the course of the last quarter, and ultimately decided to turn away some of its courters, Daniel Perez, the company’s CEO and cofounder, told MobiHealthNews. With this, the company’s lifetime fundraising jumps to roughly $126 million.

WHAT THEY DO

The San Francisco-based company’s digital platform uses wearable sensors and one-on-one health coaching to deliver in-home MSK therapy. The programs are sold to to individuals and, more commonly, self-insured employers, Perez said, the latter of which benefits from integration tools, employee population-tailored campaigns and other tools designed to ensure an effective rollout.

According to Perez, these offerings have allowed Hinge Health to triple its customer base within the last six months. He said the company has completed more than 200 enterprise implementations, and is yet to lose a customer over the course of its five-year run.

“Over the past 18 months since our last funding, our team has quintupled in size, we’ve expanded our product offering to all major joints, offer our clients the ability to bill via all major health plans, published our [second and third] peer-reviewed studies (with our [fourth] on the way), and our customer base has grown 10x — and along the way we’ve maintained 100% customer retention,” he said.

Of note, Perez said that he views Hinge Health’s emphasis on peer-reviewed data as a major differentiator for the company’s clients. That embrace of evidence-based outcomes — alongside IT security — is an strategy that he said is unfortunately uncommon across the broad spectrum of digital health startups.

“I think there are a lot of claims that you’ll find that are being bandied out there by early-stage startups playing fast and loose with their claims, and that’s something that hurts the industry when that happens,” he said. “So we like to hold ourselves accountable to peer-reviewed research. … We’re certainly not the only one [that provides evidence], but unfortunately there are quite of few who don’t.”

WHAT IT’S FOR

Perez said that the company was able to hold off on organizing its latest funding round for several months due to “very strong” revenue and customer growth. But now, Hinge Health’s leaders believe that the time is right to dip into private equity so that the MSK company can expand its product lineup and workforce.

“Firstly, we’ll be doubling headcount over the next 12-18 months from over 200 today, to around 400,” Perez said. “Additionally, we’ll be investing heavily in product development and continuing to invest in our enterprise readiness, to ensure that buying Hinge Health remains not just the best choice from an outcomes perspective, but also the easy choice from an implementation perspective too.”

MARKET SNAPSHOT

While they might not have raised quite as much as Hinge Health, there are still a healthy number of digital platforms looking to either provide MSK and physical therapy care.

Just a couple of months ago saw Risalto Health bag $7 million more for its AI-enabled concierge service for patients seeking MSK health providers in their area. Around the same time, Reflexion Health kicked off a new version of its digital physical therapy platform, called HelloPT, that includes telehealth and recovery plan features. The preceding months also saw Kaia Health land $8 million for its digital therapy platform, and an $8 million round for MSK remote consultation app Physera.

ON THE RECORD

“US employers and health plans are looking not just for outcomes, but also meaningful engagement and — critically — enterprise experience and maturity. That’s why we’ve invested in Hinge Health,” Steve Kraus, a partner at Bessemer Venture Partners who will be joining Hinge Health’s board, said in a statement. “Rarely have I seen customers more enthusiastic about a product. In all of my customer reference calls (and there were many), the praise for Hinge Health’s product and especially their ease of implementation was universal — which explains why they’ve never lost a customer.”