How Musculoskeletal Complexities Impact American Workers and Their Families

In the US, 50% of adults are actively dealing with a musculoskeletal (MSK) condition, making MSK one of the top drivers in healthcare spend for employers. From ankle sprains and chronic back pain to rotator cuff injuries, postpartum conditions and more, MSK conditions can not only cause persistent pain for sufferers, but also limit mobility and dexterity. But there’s more to the story for employers than just high utilization – let's take a deeper dive on MSK complexities and how they can impact American workers.

Root Causes of Elevated Musculoskeletal Spending

On a typical claims utilization report, you can find important data points like total cost, site of service, number of claims, diagnosis, etc. What you won’t find is how long someone has been seeking a diagnosis, what diagnostic testing (such as imaging or lab work) was performed to achieve diagnosis, or the time deficit related to costs incurred.

• Healthcare Navigation Confusion: We’ve all been there. “Where do I go? How much is it going to cost? Where will they refer me? How long will it be before I can get an appointment? Is this something more serious than I think?” When employees don’t know where to start, many times, they pick the path of least resistance or the one most familiar to them. The result is often time and money spent bouncing around from specialist to specialist, many times with unnecessary imaging. In some cases, by the time a patient gets where they need to be, their resources have dwindled, energy sapped, and condition worsened.
• Misdirection: With musculoskeletal conditions, the most expensive care is often encouraged first. Seeing an orthopedic surgeon, obtaining diagnostic images, and follow-up visits to the surgeon for treatment planning means patients are taking on the most expensive out-of-pocket costs before taking non-invasive action toward a potential recovery.
• Access to Care: Wait times to see a specialist can range anywhere from several days to several weeks — assuming it aligns with a patient's schedule. In more complex cases, medical travel with more extensive wait times may be necessary, further delaying care and recovery.

New Pathways to Care

By changing the patient's pathway and positioning physical therapy (PT) as the first line of defense for MSK conditions, many improvements can be seen for both the patient and the health plan. Research shows that when PT is used as first-line treatment for lower back pain, there is a 15% reduction in ER visits, a 28% reduction in advanced imaging, and an 89% reduction in opioids prescribed.

When a patient starts with physical therapy, the savings go beyond out-of-pocket expenses; in fact, Physical Therapists can diagnose and begin treatment all within the first visit, meaning patients can achieve diagnosis and begin a treatment plan – often all within a single visit! This accelerated PT pathway saves patients the time and frustration often associated with navigating the healthcare system, all while yielding plan savings and getting employees (or caregivers) back to work sooner!

Implementing MSK Programs

Because musculoskeletal conditions can impact family members of all ages and include various conditions requiring physical therapy support, ranging from postpartum care, geriatric care, neurological care, and orthopedic and/or sports-related injuries or chronic conditions, it is important for employers to consider the potential impact of MSK on their employees and dependents and the value that a more formal MSK program may bring to employee and employer bottom line!

Luckily, there have been several advancements made in the overall patient experience for physical therapy sessions. Implementation of some of these solutions is less complex than many organizations may anticipate and doesn’t require plan design changes. When considering musculoskeletal programs in the marketplace today, it is important to identify a program that:

• Provides immediate access to physical therapists for diagnosis and treatment of MSK conditions.
• Positions Doctors of Physical Therapy as the initial and ongoing care providers to prescribe evidence-based care and ensure engagement.
• Delivers personalized care based on an individual’s condition and unique circumstances.
• Leverages a technology platform that provides your employees with a fully integrated care experience.
• Incorporates a national network of physical therapists and avoids care hand-offs between providers.
• Facilitates whole person wellness by applying biological, psychological and social principles throughout treatment.
• Meets patients where they are by offering both in-person and virtual care options.

By providing employees with a well-designed physical therapy support program, organizations can support family members of all age ranges dealing with a variety of conditions. If your organization is interested in learning more about mōviHealth, a fully integrated hybrid musculoskeletal platform, or for more unique solutions to support your employees, reach out to your AssuredPartners team.