Largest Home Health Nonprofit Pilots Avatar Tech for Rehab

The Visiting Nurse Service of New York (VNSNY) isn’t yet using robots to administer care, but the New York-based home health care agency is about to start offering some of its patients an innovative rehabilitation program. The tech utilizes avatars, which are cartoon-like personas, that will guide patients through on-demand physical therapy at home and offer feedback for better results.

VNSNY, a 125-year old home health care agency, is the largest not-for-profit home- and community-based health care organization in the nation and is among the first providers to try out the rehab avatar for in-home care.

VERA—Virtual Exercise Rehabilitation Assistant—is an FDA-cleared at-home program for patients recovering from surgery created by Reflexion Health, a San Diego-based technology startup. VERA engages patients in a virtual rehab and physical therapy experience that tracks their movements and monitors their adherence to the program with the goal of boosting outcomes and guiding patients to better health.


“Our hypothesis is it will improve our outcomes because we can track the progression and make adjustments as we need to, and lower the cost overall to get the patient out of the hospital sooner and transitioned from home care,” Susan Northover, senior vice president of patient care services of VNSNY, told Home Health Care News.

VNSNY is starting out with a pilot with Reflexion in early April, in the hopes of getting up to 200 patients to try out VERA.

Pilot study


VNSNY’s pilot group will be specific to those who are post-operation knee patients. The agency will work with its physician partners to identify the pilot group, according to Northover.

“The people need to be mobile enough and adept enough to be able to turn it on and follow the instructions, and be somewhat independent with their exercise program,” she said.

The technology is not meant to replace any visits at home with therapists, Joe Gallagher, head of therapy at VNSNY, told HHCN. Instead, it will enhance the care already provided as more older adults look to stay active and undergo total hip and knee replacements. However, the technology could help complement home visits, particularly as the industry faces a caregiver shortage.

“We’re looking at a tsunami of patients coming at us, not just in our setting, but across the whole continuum,” Gallagher said. “The other challenge is in regard to personnel. The physical therapy workforce is not expected to increase by the needed amount…The challenge is how do we deal or change our way of getting patients the care they need.”

Northover echoed these points, emphasizing that the technology will likely help manage patients better from afar.

“At this point, we’re not planning on replacing visits,” Northover said. “We want to monitor the outcomes, and feel strongly there is absolutely a benefit to a face-to-face encounter. In the future, it will replace some visits, yes, but not eliminate the need of the face-to-face encounters and evaluations of the environment at home.”

Reflexion Health has plans to come out with its next generation of VERA, VERAHome, which has a smaller kit, Spanish-speaking options, and more videos on what patients can expect throughout their experience, Anang Chokshi, chief clinical officer at Reflexion, told HHCN. Its future VERAClinic offering is “a more comprehensive approach for managing patients,” before and after surgery. VNSNY is Reflexion’s largest client to date, according to Chokshi.

Patient behavior

One of the most critical ways that the VERA program could boost patient outcomes is by improving adherence to therapy instructions, as well as tracking how well patients are doing their instructed exercises.

“Therapists give a home exercise [and] we entrust the patient is going to do it,” Gallagher said of VNSNY’s current therapy regimen. “And we come back and check on how they are doing, but we are not sure just how compliant they are or how well they are doing it. Instead of a piece of paper, we have VERA. Reflexion can track compliance and accuracy, and we have a true record. Through virtual visits or through the therapist who goes into the home, [we] can help give the pointers on how to do it better.”

Furthermore, with bundled payment initiatives such as Comprehensive Care for Joint Replacements (CJR), surgeons are more likely to give this patient group more thought when it comes to boosting outcomes and finding new innovations. VNSNY is “absorbing the cost of equipment” as part of the agency’s value-based arrangements with its payers, according to Northover.

“Now, with orthopedic and total knees and hips, the surgeons also need to be innovative with how they are delivering care,” Gallagher said. “This group is open to new ways of managing their patients. Technology for them is something they’re used to using. They are a good group of early adopters.”

Over time, VNSNY could extend the therapy technology to other patient groups. With the knee replacement group, surgeons will help VNSNY identify which patients are right for the program. Working with the surgeons and partners has been “key,” according to Northover, who says they talk to patients upfront or in a pre-surgery setting so adherence to rehabilitation after the surgery is understood. This strategy has a less than 10% dropout rate of patients in similar programs, according to Northover.

VNSNY found the VERA technology within its innovations group, which looks to solve problems the agency already has, rather than just “throwing technology at people,” Northover said.

“We’re looking at technology that is not a replacement, but more of a way to progress patients and have them massively involved in their own care,” she said.

Written by Amy Baxter

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