This topic was the focus of a breakout session at Outcomes+ 2022.
Musculoskeletal (MSK) pain, stiff joints, swelling and aches affect major areas of the body such as back, hips and knees and can significantly impact member health, productivity and costs. Members with MSK conditions lose an average of 10 workdays and often have non-optimized medical and behavioral co-morbidities which further impact their care.
The key drivers affecting cost of MSK condition care
As members try to manage their painful MSK conditions, they often face a fragmented and complicated journey, resulting in a variety of issues that profoundly impact cost:
- Receiving unnecessary, poorly timed and costly advanced imaging including MRIs and CT scans
- Visiting lower value sites of care or providers
- A lack of coordination across the care journey
- Overuse of opioids and other controlled substances
- Having avoidable and/or preventable MSK surgeries
When surgeries are necessary, costs can vary 300%-400% due to subjective care recommendations and low value sites of care1.
Another important driver of medical expense is the continued rise in chronic conditions with higher use of both prescription therapies and care for co-morbid medical and behavioral health issues which impact members’ health and wellbeing.
Studies and data suggest that this ripple effect of inflated costs and ineffective treatments can lead to 25-40% “waste” in MSK care spend.
How plan sponsors can address MSK care cost challenges
It’s critically important for plan sponsors to identify and engage members at elevated risk of MSK related issues early in their health journey, but predicting risk alone is not enough. Plan sponsors should use advanced analytics to prioritize the clinical actions that will drive behavior change and bend the MSK cost trajectory.
The key is to build a connected experience that guides members to high quality, low cost care and treatment options. This may include holistic and conservative approaches, like chiropractic care and physical therapy or more advanced and invasive procedures when appropriate like back or knee surgery.
Providing access to care navigators, or clinical experts in bone, joint and spinal care, along with digital tools, can empower members to take control of their health and open up access to behavioral health support, physical therapy, chronic condition health coaching, weight loss nutrition programs, and more.
When surgery is necessary, proactive planning is critically important to mitigate surgical risks and costs. For example, managing health risks such as weight, tobacco use and sleep, combined with preventative rehabilitation can increase the chances of a successful surgery. Participation in post-surgery activities like physical therapy and safe pain management can avoid complications, opioid dependence and hospital re-admissions.
MSK condition care can be costly and challenging, but it doesn’t have to be this way. By taking a data-driven, holistic approach that also looks at co-morbidities, behavioral health, and member lifestyle, plan sponsors can reduce their spend, while ensuring that their members achieve sustainable healthy outcomes.
1 Blue Cross Blue Shield. (2019, January 23). Planned knee and hip replacement surgeries are on the rise in the U.S. Retrieved April 14, 2022 from bcbs.com.