New Digital Health Platform Targets 50 Million Americans With Chronic Pain

Avi Dorfman has had a front row seat to the toll of chronic pain. He spent years trying to help a loved one find relief—to no avail.

After visits to primary care doctors, chiropractors, and physical therapists didn’t help, Dorfman’s friend Dr. Jacob Hascalovici said to him, “You know I’m a pain doc, right?” Dorfman hadn’t realized Hascalovici, a Board-certified neurologist with a PhD in neuroscience, specialized in interventional pain management.

A consultation with Hascalovici helped, giving Dorfman’s loved one many months without pain.

“It was remarkable,” Dorfman said. “[Hascalovici] immediately understood what the issue was,” Dorfman said.

That positive experience after so much frustration left Dorfman with a question for his friend: “Why did it take us so long to get to you?”

The answer is relatively simple: supply and demand. Hascalovici is one of fewer than 6,000 pain management physicians in the United States. But there are an estimated 50 million adults in the U.S. living with chronic pain, according to the CDC.

To improve access to pain care, Dorfman and Hascalovici teamed up with another friend, Yakov Kagan, to launch Clearing, a digital pain management platform. Last week, Clearing announced that it has raised $20 million in seed funding.

“We’re here to make sure that people in pain, regardless of gender or color or economic status, can get access—for less than the cost of a copay—to a best-in-class treatment protocol,” said Dorfman, who serves as Clearing’s CEO.

Clearing aims to offer medically sound alternatives to opioids, which it does not prescribe.

“Pain is a unique space,” said Steve Kraus, partner at Bessemer Venture Partners, one of Clearing’s lead investors.

Along with physical, psychological, social, and emotional components of pain, Kraus said, there is also often a stigma to it. He cites the opioid epidemic for contributing to that stigma.

Hascalovici, Clearing’s chief medical officer, acknowledged that pain management can carry a taint left by unscrupulous actors who sell unproven treatments. “There unfortunately were some bad apples in the field,” he said.

In contrast, Clearing plans to take a strictly science-based approach, according to Kraus. “We want to be gold standard, best-in-class, outcomes-driven—the opposite of the pain management huckster.”

To start, Clearing will offer “stage one interventions”—a physician-prescribed, personalized home exercise program and prescription-strength topical pain relievers  based on a detailed patient questionnaire.

To compete with many patients’ first stop—the over-the-counter pain relief aisle at a drug store—Clearing customers get a free 30-day trial and then pay an average of $50 per month for the personalized program and products.

Clearing’s approach resembles the way Hascalovici practices in person, based on industry standards. For every new patient he sees in his office, Hascalovici starts at square one—with exercise, physical therapy, and topical pain relievers—before escalating slowly from there as needed.

“I don’t think [first-line treatments will] help every single chronic pain sufferer completely, but I definitely think that they’re part of every single chronic pain sufferer’s journey,” Hascalovici said.

Dorfman calls Clearing’s approach “a medical hug,” grounded in both science and empathy.

This approach could help reduce long-standing bias in the recognition and treatment of pain, particularly for women and people of color.

“I think you eliminate bias from a patient perspective when you ask the patient how they feel,” Dorfman said. “It’s not about, ‘Are you this color or that color or this gender?’ It’s about, ‘How do you feel?’ It’s your version of reality that matters to us most, not our perceived version of your reality.”

Clearing users self-report their symptoms and experiences, sharing their own stories on their own time. Doctors review the information to inform a personalized treatment plan. Hascalovici believes this asynchronous communication should increase capacity to treat more patients.

The new investment in Clearing is part of a massive wave of direct-to-consumer digital health funding.

Venture capital investment in digital health overall reached nearly $7 billion in the first quarter of 2021, the largest funding quarter ever for the digital health sector.

Among the largest 2021 deals so far is Hinge Health—an in-home musculoskeletal therapy company—which raised $300 million. Other companies tackling chronic pain include AppliedVR, which has raised $29 million, and Spine Zone, which raised $12 million earlier this year.

Kraus said he used to think the direct-to-consumer (DTC) healthcare market was “dead on arrival,” but a host of factors have opened up the DTC healthcare economy.

“People are often reaching into their pockets to pay for healthcare,” Kraus said, noting that nearly 60% of consumers now have a deductible of $1,000 or more, double what it was a decade ago.

Also at play are generational differences among consumers accustomed to getting everything on demand—from food to cars—and a younger generation of doctors who are more digitally savvy.

Covid-19 only accelerated these trends.

“Telemedicine went from [being] in the first inning to the sixth or seventh inning of a baseball game overnight,” Kraus said.

Kraus doesn’t expect DTC to work for every aspect of healthcare. Think cancer treatment or kidney dialysis where in-person care is still essential.

But he is optimistic about DTC’s potential for indications in “first-dollar healthcare,” where consumers are directly involved in decision-making and increasingly paying for treatments out of pocket.

Pain management is one such opportunity, but the value may be broader than financial in Kraus’ view.

“I think there’s going to be the power of this community and this set of doctors and this experience that makes [patients] feel heard and felt and validated,” he said. “That’ll do something that is psychologically and emotionally healing for them as well…That’s what I hope it would do for the health of people and for the system.”

Clearing’s cofounders agree.

“I think there is an enormous opportunity to help people,” Hascalovici said. “This is a digital healthcare revolution that we’re seeing unfold. It might just be the major paradigm shift that chronic pain care has needed to really help push our field forward.”

The original article can be found at: Forbes (Innovation)