The Rise of Hinge Health and Digital MSK Care

An overview of the weird musculoskeletal care market and Hinge Health itself

Most think that heart disease, cancer, congestive heart failure, and cancer are the primary focus of health innovation. They are among the leading causes of death after all. This is generally why they receive so much public attention—as they should. However, it is easy to make the mistake in assuming they also contribute the most to the national health care expenditure. You may be surprised, then, to see the top 10 conditions ranked by spending based on a 2020 study by Dieleman and colleagues looking at 2016 health expenditures. I, too, was surprised when this first came out.

Low back and neck pain topped the health care spending list in 2016 with $134.5 billion, followed closely by other musculoskeletal disorders at $129.8 billion. Diabetes ranked third with $111.2 billion in spending, while ischemic heart disease accounted for $89.3 billion. Falls represented the fifth highest cost at $87.4 billion, with urinary diseases close behind at $86.0 billion. Skin and subcutaneous diseases required $85.0 billion in care, while osteoarthritis claimed $80.0 billion. Dementias and hypertension rounded out the top 10 with nearly identical spending figures of $79.2 billion and $79.0 billion respectively. These figures highlight that musculoskeletal (MSK) conditions (combining categories 1, 2, and 8) collectively represented the largest health care expenditure category in the United States, accounting for over $344 billion in 2016.

Thus, we can understand that there is likely a need for innovation, prevention, and a better understanding of this market. I have historically been quite bored with MSK, but it is clearly an important area, and, in light of the Hinge Health initial public offering (IPO), I will begrudgingly write this article since this is the biggest news in health tech in a long time.

Finally! I can write about something unrelated to the future hopes related to artificial intelligence in health! This article has very few mentions of “AI!”¹

Understanding the Market for MSK Care

MSK disorders represent one of the most prevalent and costly health challenges in modern society. These conditions affect the muscles, bones, joints, ligaments, and tendons that enable movement and provide support for the body. According to the NIH about half of U.S. adults have an MSK pain disorder, a staggering figure that highlights the scope of this often-overlooked segment. This helps to make sense of the finding that lower back and neck pain is the top spending category for U.S. health expenditures. But, unlike cancer, heart disease, and diabetes; these conditions often do not kill people (aside from falls that result from these conditions and aging!). This creates some complicated incentives for payors, providers, and patients.

High prevalence and patient demand for a solution to MSK pain and function issues eventually meet a health system with very high prices. The key concepts to know in MSK are that of “wasteful and low value care” which stem from spending on unnecessary imaging for up to 30 percent of patients, as well as unnecessary and costly procedures and operations, many of which are also ineffective. The rate of failed surgery for back pain alone reaches 46 percent. MSK care pathways are often expensive and may not actually solve the problem for patients.

The economic impact is significant. Altogether, the grand total of MSK care exceeded $380 billion in 2016. Recent data from Evernorth reveals that patients seeking treatment for an MSK condition comprise 27 percent of commercial health plan volume. When factoring in indirect costs such as lost productivity in the workplace, the total economic burden of MSK conditions approaches $600B to $1.3 trillion annually in the United States across a range of estimates and models.

Several factors are contributing to this growing health challenge. An aging population, increasingly sedentary lifestyles, and limited access to effective physical therapy services have created a perfect storm for MSK-related issues. Traditional care models, often requiring in-person visits and extended treatment periods, struggle to address this mounting demand efficiently and cost-effectively. Thus, the use of digital technologies, guided exercise programs, and virtual care models have grown in this space.

Hinge Health is not alone. Companies like Limber Health, Vori Health, Sword Health, and several others grew out of a clear need for more cost effective solutions to MSK health issues and MSK-related pain. Each company has a slightly different business model focused on difference insurance markets or self-insured employers, and a different operating model for how their clinical impact is achieved. However, as of yet, Hinge Health is the first to seek an IPO.

Introducing Hinge Health: A Digital Solution to Physical Pain

Against this backdrop, Hinge Health has emerged as a pioneering force in the digital health landscape. Founded with the mission of making high-quality MSK care accessible and effective, Hinge Health suggests that they combine advanced technology with evidence-based care protocols to create a comprehensive digital solution for MSK disorders.

Hinge Health's platform leverages AI-driven software, motion tracking technology, and wearable nerve stimulation devices to deliver personalized care that addresses the full spectrum of MSK issues. From acute injuries and chronic pain to post-surgical rehabilitation, the company's digital approach enables patients to receive therapeutic interventions from the comfort of their homes.

What sets Hinge Health apart is its self-proclaimed holistic approach to MSK care. The platform integrates technology with a care team of licensed professionals, including physical therapists, physicians, and health coaches. This combination ensures that patients receive both the technological advantages of digital health and the human touch that remains essential in health care delivery.

The Patient Experience: How Hinge Health Transforms MSK Care

For patients dealing with MSK issues, Hinge Health offers a dramatically different experience compared to traditional physical therapy or orthopedic care. The platform makes care accessible, affordable, and effective through several key innovations.

Convenience stands at the forefront of Hinge Health's value proposition. By providing services digitally via mobile app, patients can engage in therapy sessions whenever and wherever, thus eliminating the need for time-consuming clinic visits and travel time. This accessibility is particularly valuable for individuals with mobility challenges or those living in underserved areas with limited health care resources.

Recognizing the well-established connection between chronic pain and mental health, Hinge Health incorporates psychological support alongside physical treatment. This whole-person approach addresses both the physical symptoms and the emotional impact of MSK conditions, leading to more comprehensive healing.

For pain management, Hinge Health offers non-invasive solutions through its wearable device, Enso, which provides drug-free pain relief using electrical nerve stimulation. This approach aligns with contemporary concerns about over-reliance on pain medications and their potential side effects.

Perhaps most importantly, Hinge Health's technology-driven model enables scalable access to care. By reducing dependence on human intervention for routine aspects of therapy, the platform can efficiently serve more patients while maintaining high-quality outcomes. When needed, patients who are unable to progress or adhere to the digital solution—as is often the case with digital health technologies—can still access in-person standard of care as needed.

The ultimate economic goal of these platform is to solve clinical problems for ~10 - 20% of patients in a more cost effective manner thus reducing expensive care and yielding clinical improvement for patients. Hinge and the other MSK companies, like Limber Health, have focused on downstream cost avoidance for payors in a way that other digital health companies have not.

Clinical Outcomes and Evidence

In a 2017 study, the Hinge Health 12-week digital care program (DCP) for chronic knee pain (CKP) demonstrated significant clinical benefits in a single-arm study of 41 participants (predominantly female, average age 52). After completing the program, which included sensor-guided exercises, education, activity tracking, and psychosocial support through coaching and cognitive behavioral therapy; participants experienced substantial improvements in pain and function. Specifically, they showed clinically significant increases in KOOS pain and function scores, along with 57% and 51% reductions in knee pain and stiffness, respectively. Perhaps most notably, interest in surgery decreased by 67%, and participant satisfaction was extremely high at 9.2/10. Crucially, these improvements were maintained or enhanced at the 6-month follow-up, suggesting that digital care programs may offer an effective, evidence-based alternative to traditional interventions for chronic knee pain sufferers.

Building on the single-arm study where the results could be due to a placebo affect, the Hinge program has been studied in a randomized trial against an active control. This randomized controlled trial evaluated Hinge Health's 12-week digital care program for chronic knee pain, involving 162 participants divided into treatment (n=101) and control (n=61) groups. The intervention included sensor-guided exercises, education, cognitive behavioral therapy, weight loss guidance, and personal coaching, while the control group received only basic educational materials. Results demonstrated significantly greater improvements in the treatment group across all primary and secondary outcomes, including KOOS Pain scores (7.7 points better than control), physical function, and self-reported pain and stiffness. Notably, surgery intent decreased substantially among treatment participants across 1-year (-9.4%), 2-year (-11.3%), and 5-year (-14.6%) timeframes. Those completing the program showed a remarkable 61% reduction in pain versus 21% in the control group. The researchers estimated significant cost savings from avoided surgeries: $4,340 per patient at one year and $7,900 at five years. The study provides strong evidence that comprehensive digital MSK care can effectively treat chronic knee pain, including osteoarthritis.

Here is a link to a 10,000 patient longitudinal study as well.

While these studies were funded and executed by Hinge Health itself, the study design of the RCT appears to be reasonable to conclude causality resulting from the program.

The Business Model: Creating Value Across the Healthcare Ecosystem

Hinge Health's business model is designed to create value for multiple stakeholders in the health care ecosystem. The company primarily partners with employers and health plans to offer its digital MSK care platform to their members.

For clients, Hinge Health presents a compelling value proposition centered on cost savings and improved employee/member health outcomes. The company's 2022 Employer Claims Study estimated a return on investment of 2.4x for clients, based on an average cost savings of $2,387 per member over a 12-month period compared to the cost of the program. These savings stem primarily from reduced health care utilization, decreased surgical interventions, and improved productivity.

Hinge Health's contractual approach further strengthens its business model. The company typically serves as a client's sole digital MSK care provider for their contracted lives, with an average contract term of three years. This arrangement creates a recurring, predictable revenue stream and allows Hinge to continuously enroll, engage, and re-engage eligible members throughout the contract period. Churn is a problem for health plans and for digital health companies.

The effectiveness of this approach is reflected in the company's impressive retention metrics. Hinge Health reports a 12-month client retention rate of 98% and a client net promoter score of 87, indicating high satisfaction among its business partners. Additionally, the company's net dollar retention stood at 117% as of December 31, 2024, suggesting that existing clients are expanding their relationship with Hinge over time.

The Road to IPO: Hinge Health's Growth Story

Hinge Health's journey toward an initial public offering (IPO) reflects its rapid growth and market leadership in the digital MSK space. The company has secured substantial private funding, including a $400 million Series E round in October 2021, led by Tiger Global and Coatue Management. Additionally, Alkeon and Whale Rock acquired ownership as part of a $200 million secondary investment. In total, Hinge Health reports having raised more than $1 billion from investors.

This funding has enabled the company to expand its service offerings and market reach. In recent years, Hinge Health has launched several new products to complement its core MSK platform. In 2023, the company introduced a movement-based menopause support offering to help women alleviate common symptoms such as hot flashes, joint and muscle pain, and pelvic floor disorders. That same year, Hinge Health also rolled out physical therapy house call services, combining in-person visits with digital follow-up care.

Strategic partnerships have further strengthened Hinge Health's market position. In December of the previous year, Amazon added the company to its health conditions program, connecting more customers with Hinge Health's virtual care benefits. These expansions and partnerships have positioned Hinge Health as a comprehensive MSK care provider with multiple growth avenues.

Now, Hinge Health is preparing to list its Class A common stock on the New York Stock Exchange under the ticker symbol "HNGE." The IPO will include shares offered by both the company and selling stockholders, though proceeds from the latter will not go to Hinge Health. Post-IPO, the company will maintain two classes of common stock: Class A shares with one vote per share and Class B shares with fifteen votes per share, a structure that allows the company's founders and early investors to retain significant control.

The IPO Landscape and Hinge Health's Positioning

Hinge Health's IPO comes amid renewed activity in the health care and health technology sectors. The digital health commenters are going wild with this announcement. It may be true that, “We are so back!²” Last year saw several notable public debuts, including health care payment software maker Waystar, which raised $967.5 million in June, marking the largest health tech IPO since 2022. Precision medicine company Tempus AI also went public in June, raising $410.7 million. In my opinion, the biggest issue for precision medicine is still Medicare reimbursement. Be careful here with the hype.

Other health care IPOs in the recent past include BrightSpring Health (a home- and community-based healthcare services provider), hospital operator Ardent Health (which raised $192 million in July), and KindlyMD (a telemedicine services provider that completed its IPO in May, raising $6.8 million).

Hinge Health's IPO is being led by prominent financial institutions, with Morgan Stanley, Barclays, and BofA Securities acting as lead book-running managers. Additional book-running managers include Evercore ISI, RBC Capital Markets, Truist Securities, Stifel, William Blair, Piper Sandler, Canaccord Genuity, KeyBanc Capital Markets, Needham & Company, Raymond James, and KKR Capital Markets LLC.

The Future of MSK Care and Hinge Health's Vision

Looking ahead, Hinge Health is positioning itself at the forefront of a fundamental transformation in health care delivery. The company's leadership articulates a bold vision in their S-1 filing: "We didn't come this far with digital physical therapy to stop at digital physical therapy. Whether it takes 10 years or 30, most care will one day be delivered scalably via technology."³

This vision is supported by compelling market trends. The demand for physical therapy is expected to increase significantly due to demographic shifts and lifestyle factors. An aging population, coupled with increasingly sedentary lifestyles, will likely drive greater need for MSK interventions in the coming years. Importantly, MSK conditions are a font that seems to spring eternal.

Hinge Health aims to not only meet this growing demand but to expand the market through "better outcomes, more convenient access, and a highly personalized member experience."

The company's competitive strategy centers around what executives describe as a "double-walled moat." The first wall is technological innovation that goes "beyond what health care incumbents are able to develop in-house." The second is a robust client base of approximately 20 million contracted lives across 2,250+ clients and 50+ health plan partners, creating a ready market for new innovations.

The valuation on Hinge at and post-IPO will be very interesting to watch. Is this a software company trading at 20+ time earnings or is it a health care provider at 3 - 10?

In Conclusion

Hinge Health's journey from startup to IPO-bound digital health leader illustrates the transformative potential of technology in addressing longstanding health care challenges. By reimagining the delivery of musculoskeletal care through digital tools, AI-driven personalization, and a whole-person approach, the company has created a scalable solution to a problem affecting hundreds of millions of people worldwide.

As Hinge Health enters its next chapter as a public company, it stands at the intersection of several powerful trends: the growing burden of MSK conditions, the shift toward value-based care, and the increasing adoption of digital health solutions. Its success or failure as a public entity will offer valuable insights into the market's appetite for innovative health care models and the potential for technology to fundamentally reshape how care is delivered.

Most digital health IPOs have been a bust due to soaring valuations from Covid-19. We will see if Hinge can change the narrative. Importantly, we will see how defensive their moat is in a field of competitive products.

1. I love AI and predictive analytics in health care, but I can use a refreshing new topic to read sometimes.

2. At the rate avian influenza, measles, and TB are going coupled with an HHS Secretary who will do anything in his power to help spread disease; we may yet achieve Covid-19-like returns in digital health once more.

3. I don’t think scalably is a word.