Webinar Recap: Musculoskeletal Healthcare Delivery Challenges

By Todd Peterson — AVP, Health & Wellness Services May 01st, 2024

Did you know musculoskeletal (MSK) treatments account for roughly a quarter of commercial healthcare spending?

With this in mind, we asked Captive Resources’ Vice President of Health and Wellness Services, Todd Peterson, to talk about MSK cost containment strategies employers are implementing in our recent Health Risk Management webinar.

Continue reading for a recap of Peterson’s presentation.

Introduction to MSK Disorders

The MSK system consists of muscles, nerves, tendons, joints, cartilage, and spinal discs. Injuries within the MSK system are very common. In fact, 58% of American adults and 68% of adults aged 65 or over have a self-reported MSK issue.

Consider the following data on MSK disorders:

  • 85% of employers rank MSK conditions as one of the top three health conditions impacting their costs.
  • Mean direct cost per year per individual patient with MSK disease is nearly $7,800.
  • Healthcare spending on MSK disorders in the United States has reached $380 billion annually and has been estimated as high as 900 billion annually when indirect costs are factored in.

Before we dive into the drivers behind MSK spend, let’s discuss the different types of MSK disorders.

Categorizing MSK Disorders

There are four types of MSK disorders:

No. 1: Traumatic

Traumatic MSK disorders account for 19% of all MSK disorders. Examples of traumatic disorders include fractures and crush injuries that can be caused by events like a car crash or sports injury. Surgery is often necessary when it comes to traumatic MSK disorders.

No. 2: Non-traumatic

Non-traumatic MSK disorders account for 64% of all MSK disorders. Examples of non-traumatic disorders include osteoarthritis, injuries without an obvious cause, strains, sprains, and minor muscle tears.

No. 3: Autoimmune

Autoimmune MSK disorders account for 17% of all MSK disorders. Examples of autoimmune MSK disorders include inflammatory conditions such as rheumatoid arthritis.

No. 4: Red Flags

Red-flag MSK disorders account for 1% of all MSK disorders. Examples of red-flag MSK disorders include cancer and infection.

Barriers to Quality MSK Care

In addition to Peterson’s presentation, we heard from six vendors that specialize in MSK care about the main drivers behind MSK healthcare spend. Here are the main takeaways:  

No. 1: Unnecessary Care

As we discussed in last month’s health risk management webinar, nearly half of Americans don’t regularly see a primary care doctor. Because of this, when someone experiences an MSK disorder, they are often directed to see a specialist too soon in the process, often leading to unnecessary and costly surgery.

Early adoption of imaging is also a big issue when it comes to MSK disorders. According to Peterson, early MRIs are associated with more frequent surgery, greater use of Rx opioids, high final pain score, and greater acute care costs for back pain patients. In fact, it’s estimated that roughly half of imaging is unnecessary.

No. 2: Variety in Care Recommendations

According to Peterson, there are too many different care routes available to those suffering from an MSK disorder. Patients are finding they get the wrong answer initially, leading them towards unnecessary and expensive care.

No. 3: Time Commitment for Conservative Care

Conservative care, such as physical therapy, can be daunting for patients in today’s fast-paced world. It’s often hard for patients to commit their time to recovery, leading them to explore options such as surgery, which is costly and often ineffective.

Implementing Cost-Containment Strategies

A wide array of MSK cost containment strategies is available to group captive member-companies; however, for these strategies to be effective, employers must do the two things below.

Find the Right Vendor

Peterson said it’s important to find the right partner to reduce MSK healthcare spending. These vendors' main goal is to help employees avoid unnecessary care and find alternatives to expensive and unnecessary surgery, imaging, and medications. Every vendor offers something different, and it’s crucial to pick the vendor that best suits the needs of your employees and the company overall.

Educate your Employees

For MSK cost containment strategies to be effective, employers must regularly educate their employees on the available care options. By encouraging their employees to utilize these resources, employers can better the lives of their employees while reducing the associated costs.

Member-Company Spotlight

During the webinar, Peterson was joined by a representative from a member-company of one of the Medical Stop Loss group captives we support. The member shared several tips based on their successful implementation of MSK cost containment strategies.

Tip No. 1

Provide employees with the opportunity to seek conservative care options such as acupuncture and chiropractic services.

Tip No. 2

Utilize conservative care options and include more covered visits for their employees. After adding more visits, the company continued to see fewer surgeries and some of its employees could even stop taking certain medications, significantly reducing their MSK healthcare spend.

Tip No. 3

Listen to employees, analyze their data, and adjust plan guidelines accordingly.

Tip No. 4

Be specific with plan guidelines, limiting unnecessary add-ons from physicians.

Tip No. 5

Regularly educate employees on the new options available to them.

About the Webinar

This presentation was part of Captive Resources’ Medical Stop Loss Webinar Series — regular installments of webinars to educate medical stop loss group captive members. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect Captive Resources’ positions on any of the above topics.

Share this article