The Impact of Early MSK Intervention and Virtual Care

When thinking through your employer-sponsored health plan, how much attention is given to employee musculoskeletal health? Many health plan designs today don’t encourage early intervention for musculoskeletal (MSK) conditions as well as they could. This oversight can lead to missed opportunities to save costs for both employees and health plans, but more importantly, it can begin the shift to a more proactive strategy, as early intervention efforts can result in improved patient outcomes and enhanced cost containment.

When a physician makes a referral to physical therapy (PT) for a musculoskeletal condition first, it can result in an average savings of $4,700 per episode compared to starting with an MRI or CT scan [1]. These savings are comprised of the money that would typically be spent on specialist visits, imaging, pain management prescriptions, injections, and in some cases, surgery.

Let’s take a look at a couple examples to better understand the impact of this pathway issue by looking at two common patient scenarios.

Example #1: Wait-and-See

Carrie, a 50-year-old tennis coach, injured her knee while pivoting to return a serve. It wasn't serious enough for urgent care or the ER, but it was affecting her at practice. With her high-deductible health plan, each visit costs her over $100, which she couldn't afford on her salary. So, she decided to "take it easy" for a few weeks but ended up spraining her ankle during practice. This time, she couldn’t avoid seeking treatment. This more serious injury now required an urgent care visit, imaging, and a referral to an orthopedic specialist—just to get a diagnosis.

If her out-of-pocket costs were lower, Carrie's reaction to her initial injury may have been more proactive. Carrie may not have hesitated to see a physical therapist after her knee injury and might have fully recovered in six or seven sessions.

Example #2: Taking the Long Way

Jim is mindful of his health and knows when he needs a check-up or a referral from his doctor. When his back pain flared up for the third time, he scheduled a visit with his general practitioner, who prescribed muscle relaxers and referred him to an orthopedic surgeon. The orthopedic surgeon ordered an MRI, and when the results showed no major issues, he referred Jim to physical therapy for 7-10 sessions to help him recover.

After a few physical therapy sessions, Jim decided not to finish his treatment plan due to the compounded cost of his co-pays for each physical therapy visit. This increased his risk of further injury, potentially requiring more costly or complex treatment down the road, such as injections or surgery. Research has shown that, had Jim started physical therapy earlier, he may have reduced the duration of care, cost of claims, and number of physical therapy visits required altogether [2].

Thoughtful Resolutions

While some employers may not have control over plan design changes or policies, innovative musculoskeletal solutions offer an alternative that can be added to a health plan. These solutions give plan members full access to conservative musculoskeletal care without the usual insurance limitations. They place physical therapy at the start of the treatment process, making it a cost-effective way to diagnose and manage MSK conditions. By waiving costs for employees, it encourages early and frequent use, preventing conditions that could otherwise cost the plan thousands of dollars.

For those facing barriers to treatment access, a virtual PT solution can provide easy connection to therapists when in-person visits aren't possible. A recent report from the Peterson Health Technology Institute found that virtual MSK care led by physical therapists offers benefits comparable to in-clinic PT. Beyond saving on treatment costs, using physical therapy as a conservative care option can relieve pressure on overburdened healthcare providers, improving overall healthcare system efficiency. Reach out to your AssuredPartners team to learn more about moviHealth and the importance of the virtual care options that may be available to your population.

References:

[1] Fritz JM, Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Serv Res. 2015 Dec;50(6):1927-40. doi: 10.1111/1475-6773.12301. Epub 2015 Mar 16. PMID: 25772625; PMCID: PMC4693839.

[2] Phillips TD, Shoemaker MJ. Early Access to Physical Therapy and Specialty Care Management for American Workers With Musculoskeletal Injuries. J Occup Environ Med. 2017 Apr;59(4):402-411. doi: 10.1097/JOM.0000000000000969. PMID: 28628049.