If we want to move the needle on healthcare costs, we need to start with a key driver of those expenses: musculoskeletal (MSK) pain and dysfunction.
While many advisers and plan sponsors have implemented population health strategies that target metabolic syndrome and diabetes, a PBM solution or mental health, all require significant financial investments that can yield tepid results.
What these programs have in common is the need for physical activity and movement to achieve desired results. But if employees have MSK pain that's preventing this from happening, then they are just another expense and symptom-based band-aid with a big cost.
Most of us will experience, at some point, what it's like to have pain limit our movement. The likelihood grows with age with the onset of
Painful MSK conditions severely hamper people's potential to modify their lifestyle, lessening the negative effects of obesity, heart disease, cancer, arthritis and diabetes common to many Americans. A correlation between such conditions and
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More than half of all U.S. adults, an astonishing 124 million people, have reported suffering from an
People of working age who have MSK issues experience increased self-reported health issues, a greater need for healthcare and reduced activity, leading to
The U.S. Centers for Disease Control and Prevention warns that MSK disorders can lead to significant financial costs for employers, including absenteeism, reduced productivity and increased spending on healthcare, disability and workers' compensation. These so-called
This notion of multimorbidity is shared by others such as the
There is no escaping the prevalence and impact of MSK pain except by examining health plan design holistically to not only address cost, but also employee experience and engagement. It only gets worse with the current model. Yet in talking with hundreds of health benefit advisers and plan sponsors, few do much — if anything — to address this ubiquitous problem beyond typical care. Digital physical therapy, a surgical center of excellence bundle and reference-based pricing (RBP) are in short supply. And with
Many may be unaware that this spreadsheet cost is likely a driver of other plan costs. I'll put it in simple terms: When we don't move, blood pressure gets worse, increasing the risk for progressive cardiovascular disease, heart attack and heart failure. Atrial fibrillation and stroke are on the other side of that coin.
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Diabetes also gets worse with glucose levels increasing, driving the need for more medication and insulin, adversely impacting kidney health, weight and progression toward dialysis. Pre-diabetes is already rearing its ugly head on 90 million Americans and accelerates during times of inactivity.
With inactivity, weight increases, which is known to exacerbate back and knee pain. Obesity is connected to at least
All of these conditions have one other thing in common: inflammation. Systemic inflammation fuels diabetes, dementia, cardiovascular disease and arthritis. It's a vicious cycle that cannot be addressed by fixing parts of the health plan. People in pain are high utilizers of healthcare, which affect the entire health plan spend.
MSK pain will touch PBM, diabetes, mental health, ambulatory and hospital costs. RBP in these instances is reactionary to an underlying problem, leaving many people on the sidelines in pain and burdening the health plan with additional costs.
Multiple studies show that
Current conservative treatment for knee arthritis actually makes it worse with steroid injections accelerating the degenerative process, and increasing risks of infection after surgery. Non-steroidal anti-inflammatory drugs make knee arthritis worse and hasten degenerative changes. Hardly any of this information is new, which doctors know, but because insurance pays, we continue to do it.
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Is what we're offering and paying a good value for human health and plan sponsor money? At what point is knowing this and continuing to do it going to raise questions with ERISA and plan fiduciary for both the employer and their benefits adviser? When conservative care stops helping and current treatments are no longer the best option, what's next?
There's a compelling solution now available. Autologous, cell-based procedures using the patient's own blood platelets, also known as platelet-rich plasma, and bone marrow concentrate can replace the need for up to 70% of elective orthopedic surgeries. These needle-based procedures represent a new medical specialty called interventional orthopedics, which keep the patient whole and intact. They come with no facility fee, nor do they require anesthesia – both significant cost drivers in and of themselves.
These procedures can significantly reduce costs on the top three surgeries (i.e., knees, spine and shoulders). A third-party validated
The American Academy of Orthopedic Surgeons has stated that
Alternatives to elective orthopedic surgery are becoming more popular, demonstrating cost-savings value, reducing the need for surgery, down time, rehab and medication use. Patients are actively seeking them out, while physicians see the value and are offering these solutions on a daily basis.
Self-funded employers are increasingly offering this type of solution, which provides their employees an option in care. The orthopedic care continuum and treatment options are expanding rapidly, with benefit advisers and employers finally catching on. Nearly 100 third-party administrators adjudicate thousands of claims per year for more than 1,300 employers that have added needle-based procedures to their health benefits.
Implementing strategies to reduce the need for elective orthopedic surgery, improve pain and function, as well as minimize MSK multimorbidity, has the potential to significantly reduce costs to the entire health plan while simultaneously improving overall individual health.
