Transforming Musculoskeletal Care: A Conversation with Dr. Mary O'Connor of Vori Health

Dr. Mary O'Connor, a distinguished orthopedic surgeon with over 25 years of experience, is a leader in both clinical practice and healthcare innovation. She co-founded Vori Health, a nationwide virtual-first musculoskeletal (MSK) medical practice, and is also an investor focused on value-based healthcare solutions. In this interview, Dr. O'Connor shares her insights on the evolution of MSK care, the challenges of the current healthcare system, and the power of aligning investment with clinical impact.

Interview

Q: Dr. O'Connor, with your extensive experience as an orthopedic surgeon, what motivated you to move into venture investing, and how does it complement your clinical work?

A: Clinicians witness firsthand the transformative power of new treatments and innovations. Breakthroughs can fundamentally change patient outcomes. I saw this clearly with the introduction of biologics for rheumatoid arthritis. During my training, we specialized in joint replacement surgery for patients whose joints were ravaged by the disease.  Biologics changed that.  They controlled the disease, preventing joint destruction and largely eliminating the need for joint replacement surgery. It was a life-altering advancement for these patients.

That kind of disruption requires research, which, in turn, requires funding. Much of this research comes from startup companies innovating around new products and services.  Think about the evolution of ultrasound technology – from large, hospital-bound machines to portable devices used at the point of care. That's transformative, especially in resource-limited settings globally.  It enables clinicians to "see" inside the body in ways previously unimaginable.  This type of innovation only happens when companies take risks, and investors are willing to support that vision.

Q: This is a great segue into your work at Vori Health. Could you describe Vori's vision for improving patient outcomes and innovating within the MSK space?

A: Our vision is to transform the delivery of musculoskeletal care, making it truly patient-centered and value-driven. The current system faces significant challenges.  MSK conditions represent a huge burden in terms of medical expense, disability, and lost workdays. Patients often see their primary care physician, who may not have specialized MSK training.  They might be referred to a surgeon like myself, or a spine surgeon like my co-founder, Dr. Ryan Grant, who is a neurosurgeon.

Vori Health focuses on helping patients get better without surgery. So many people find it surprising that the company was founded by two surgeons. Both Ryan and I know that surgery can be life-transforming treatment for the right patient. But, and this is a very big but,  we also know that surgery, advanced imaging, and procedures are highly overutilized.  This isn't to demonize any part of the healthcare ecosystem, but to acknowledge systemic issues. Surgeons aren't always extensively trained in non-surgical MSK care, and there's a natural bias towards operative care by surgeons, particularly within a fee-for-service model. But these inappropriate surgeries put patients at risk of postoperative complications and adverse outcomes. Moreover, they are costly, to both the insurer as well as the patient through out-of-pocket expenses. 

Our approach is to prioritize virtual-first care. Unless a patient has an urgent need, like chest pain or a traumatic injury, they should start with a virtual consultation.  This allows for appropriate clinical triage to in-person care if needed or the prompt onset of virtual care. Our patients all receive a personalized, holistic care plan. This plan often includes physical therapy, health coaching, and lifestyle modifications addressing sleep, nutrition, stress, and mental well-being.

Most patients improve with this approach.  If they don't, we order imaging for further diagnostic evaluation or refer them to a surgeon if necessary. We're not anti-surgery; we're anti-*inappropriate* surgery. The current system incentivizes surgical volume because hospitals often rely on profitable service lines like orthopedics and spine to offset losses in other areas. This is a fundamental flaw in the traditional payment system.

Q: How has Vori Health's business model adapted to navigate the complexities of the existing payment landscape?

A: From the outset, Dr. Grant and I knew we wanted to focus on value-based payment models. This aligns with the direction healthcare is heading, and it gives us the flexibility to provide the services we believe are best for our patients. For example, traditional insurance often doesn't cover health coaching, an important component of our care model.

We operate primarily under two models: bundled payments, where we receive a set fee to care for a member for a year, often with milestone-based payments; and a population health approach with a per-engaged-member or per-member-per-month fee. This allows us to tailor care to individual needs.

Q: How do you approach collaborations and partnerships as Vori Health grows and navigates its position in the industry?

A: We've found strong alignment with self-insured employers. They are acutely aware of their healthcare costs and the utilization of expensive services. They want high-quality care for their employees, but they also need to manage rising costs. We strive to ensure our services don't result in out-of-pocket expenses for patients. For example,  co-pays for traditional physical therapy can often be a barrier to patients completing a full course of care.

We also partner with large insurers, who are increasingly interested in our model. . They recognize the need to innovate and partner with providers like Vori to offer solutions that deliver both clinical results and cost savings. The pressure from their clients – the employers – to control premium increases is driving this change. The overall environment is becoming more receptive to innovation in care delivery.

Q: You've been a strong advocate for improving access to specialty care. How are technology and new care models addressing the disparities that exist?

A: Healthcare disparities are a significant concern, and it's crucial to understand that they extend beyond urban underserved communities to include rural America. While race, ethnicity, sex, and gender bias certainly exist, poverty is a primary driver. Lack of affordable insurance, or even inadequate insurance, creates significant barriers to access.

Technology, particularly telemedicine, is a powerful tool for democratizing access. Most people have a smartphone, so even those without computers can often access virtual care. This eliminates the need to live near a specialty care center. While ensuring widespread Wi-Fi access remains a challenge, the potential to provide more equitable care through telehealth is immense.

Q: Is there still a need for patient education and trust-building with this shift to virtual care?

A: That's an excellent question. Virtual care has both advantages and disadvantages. You lose the physical touch, the ability to hug a patient, which I valued. However, you gain focused, direct attention. Our clinicians are fully present with the patient during video calls, creating a sense of connection, not looking at the computer while in an exam room with the patient in the in-person setting. Patients want to be heard, and the virtual environment is surprisingly supportive of establishing a trusting relationship between the patient and clinician.

The convenience of virtual visits is often a deciding factor. Patients who experience the ease of virtual physical therapy, for example, are often reluctant to switch to in-person sessions, even when our clinicians recommend a few sessions of  hands-on therapy. The time savings and reduced disruption to their lives are significant, especially for busy individuals.

Q: Shifting gears to your work with Global Health Impact Fund (GHIF), as an LP, what excites you most about its mission, and how do you see its impact evolving?

A: What's unique about GHIF is the significant level of clinician input in investment decisions. It's not just about identifying companies with a good financial outlook; it's about identifying companies that will genuinely improve healthcare. This aligns perfectly with my values. I want to invest in companies that are making a positive impact.

People want their investments, whether philanthropic or financial, to align with their values. GHIF provides that alignment. It brings together investors who want to see both a financial return and a positive impact on healthcare. The network of clinicians provides invaluable insights, eliminating the need for external consultants.