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MUSCULOSKELETAL CONDITIONS

Creating proactive solutions from advanced analytics and connected data across the care spectrum to engage members,
improve outcomes, and reduce costs.

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Man with back pain

Musculoskeletal conditions are painful and pricey for everyone.

More than 50% of Americans aged 18 and over1 suffer aches and pains due to bone, joint, or muscle conditions, also known as musculoskeletal (MSK) conditions. But care for these conditions is fragmented, resulting in frustrating patient experiences, ineffective treatments, and unnecessary spend.

Through predictive models, personalized guidance, and navigation tools, our fully-connected MSK solutions empower members to take charge of their health — and enable health plans, employers, and members to avoid unnecessary spend. 

1. The Burden of Musculoskeletal Diseases in the U.S.: Prevalence, Societal and Economic Costs (BMUS). www.boneandjointburden.org.

MSK conditions are the most costly chronic conditions.

~2/3

of plan spending on MSK conditions is driven by treating pain due to wear and tear2

 

2. National Health Interview Survey (NHIS)_Adult sample, 2015. http://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm. July 23, 2016
 

3M

years of productive life is lost in the U.S. every year due to back pain3 
 

 

3. Evernorth Research Institute. MSK in the USA Report. 2022.
 

$420B

estimated costs to the US health care system for MSK conditions4

 

4. Payers Have Room for Improvement in Delivering Pain Care, Study Says. (2018). https://www.ajmc.com/view/payers-have-room-for-improvement-in-delivering-pain-care-study-says 
 

Evernorth Guided Musculoskeletal Care

By transcending health care fragmentation, we empower members and put them at the center of their care.
CLOSED CARE GAPS

Leveraging advanced data and analytics, our coordinated care experience addresses comorbidities, leading to better outcomes.

LOWER TOTAL MEDICAL COSTS

Our predictive models and personalized decision support helps to reduce the need for unnecessary interventions.

SUSTAINABLE OUTCOMES

By addressing a variety of factors and offering behavioral screenings, physical therapy and pre/post-surgery support, we are able to optimize outcomes.

Our Member-Centric Approach

Members are at the center of our approach to care, and we are with them every step of their MSK journey. 

Our advanced predictive models allow us to identify members at elevated risk for MSK surgeries up to a year in advance, so we can engage and guide them to the right care at the right time for their unique conditions and goals. Whether it's connecting them to in-person or digital physical therapy, in-network behavioral health providers, or support before and after surgery, we are there to help improve health outcomes and lower costs.

Learn more about our capabilities

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Advanced MSK Predictive Modeling

Through our proprietary analytic toolset, we use a series of machine learning, predictive models that allow us to identify and engage at-risk members as early as possible and align them to the most appropriate clinical steps—when and where our health advocacy services and tools can have the greatest impact.

Our models continually review member data to predict a likely health-related occurrence, such as surgery, with a high degree of accuracy. For example, members at elevated risk for back, knee or hip surgeries can be identified up to a year in advance with 73%-92% accuracy, so we can help them take action to avoid surgery.5

 

5. Accuracy metric is an “overall model performance measure” where the model ranks people in the right order 80% of the time. Depending on the use case, we would set the model to a certain True Positive threshold that would determine how much of the target population we predict and how many false positives we would identify. Some conditions have higher “False Positive” members, for example knee surgery or spine surgery, but the member would still benefit from coaching/steerage. The model helps to identify “high risk pain/osteo” customers rather than just targeting only members who will go on to surgery, especially for the further out timeframes.

Partners in Value Creation

From risk sharing, to performance guarantees, to enhanced reporting, we will collaborate with you to deliver a range of options that ensure members receive exceptional care.
Early Identification

We identify and proactively outreach to members at elevated risk for MSK surgeries up to a year beforehand using advanced predictive models and adaptive artificial intelligence.

Engagement & Navigation

We empower members with educational content, an intuitive digital experience, treatment decision support, and navigation tools to guide them to the right care, improve engagement, and increase compliance.

Personalized Care

We combine clinical and behavioral data to enable truly individualized care, including pre and post-surgery support, that optimizes health outcomes.

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Together, we can improve health outcomes and lower spend for your members with musculoskeletal conditions.
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Powerful Capabilities, Connected with Purpose

Powered by our trusted businesses, our capabilities help you take on health care’s most complex challenges.

We’ve designed them to work together in new and expanded ways to better anticipate and deliver what you need.
PHARMACY+

Get specialized solutions to treat general and complex conditions—personalized to you and meaningful to your people.

 

Learn about Pharmacy+

BENEFITS MANAGEMENT+

Save costs with personalized pharmacy and medical solutions that are built to work with you and for you.

 

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CARE+

Elevate employee productivity, quality of life, and whole-person health, with accessible behavioral and clinical care.

 

Learn about Care+

INTELLIGENCE+

Unlock opportunities and value, for you and your people, with advanced analytics, predictive models, and tailored insights.

 

Learn about Intelligence+