Why MSK Care Requires A More Comprehensive Solution

Duncan Sibson, Krish Maypole

Half of American adults suffer from a musculoskeletal (MSK) disorder. These disorders are broad in scope, ranging from mild injuries like sprains and strains to more severe conditions that require surgical intervention. For such a wide range of possible diagnoses, designing effective standardized care is difficult: patient needs are highly individualized, and traditional entry points to care might not be appropriate.

“Even primary care physicians are not always well equipped to guide patients to the most appropriate practitioner that will address their specific needs,” says Icon Health advisor Dr. Bojan Zoric, an orthopedic surgeon and a physician for the U.S. Women’s National Soccer Team. In general, complex, patient-centered care is most successful when a team of multi-specialty providers collaborates to manage the journey of each patient across the care continuum. Unfortunately, patient journeys take place within a complex, siloed healthcare system, leading to frustrated patients and uncoordinated MSK care. 

Across the fragmented continuum of MSK care, from diagnostic imaging to surgery, costs and outcomes are highly variable. As with the U.S. healthcare system as a whole, however, higher costs don’t translate to better health outcomes. In 2016 alone, the U.S. spent $380.9 billion on MSK care, half of which came from employer spending. Still, MSK conditions cause more missed workdays than any other major health condition (more than 10 per employee per year). On top of spending, productivity losses end up costing employers in excess of $100 billion annually. Despite the persistent mismatch between costs and outcomes, employer-sponsored MSK spending has steadily increased year over year since 2016, with the exception of a pandemic-related aberration in 2020.

Employer-Paid MSK Spend

Source: GEHI

Employer costs are projected to increase 38% compared to pre-pandemic levels following the release of pent-up demand for MSK services, as well as increased prevalence and severity of MSK conditions. Such increases in healthcare spending are generally considered unsustainable. Moving forward, MSK care needs renewed focus on decreasing costs to employers and improving outcomes for employees.  

Analysis of commercial claims data from 2017-2019 reveals a familiar trend: surgery makes up 47.4% of total MSK spend, the largest of any category. Conservative therapies, including physical therapy (6.9% of total spend), have been lauded as a way to decrease the incidence of total surgical procedures and costs. In particular, the efficacies of digital solutions are still open questions because they rely on patient reported opinions, rather than clinical outcomes, to quantify ROI. Still other approaches attempt to decrease surgical costs by keeping patients in-network.

MSK Spend by Category

Source: Icon Health 2017-2019 Claims Data Analysis

Many employer-focused MSK solutions provide technology-dependent home exercise therapy. These solutions can be effective for certain minor injuries, but they are limited when addressing the care needs of patients with moderate-to-severe MSK conditions. While physical therapy, and conservative therapies in general, are valuable components of an MSK clinical pathway, a more comprehensive solution is necessary to support the whole MSK patient population, which has a broader set of care needs. 

Other MSK solutions focus on surgical centers of excellence, network optimization, and provider selection. Each of these solutions can provide value for certain types of MSK patients dependent upon condition severity, geography, and technical aptitude. That said, these stand-alone solutions leave large gaps in patient care and lead to a fragmented experience. Ultimately, they  fail to adequately address challenges that patients face when navigating MSK care on their own.  

Tremendous potential exists for the implementation of a comprehensive solution across the MSK care continuum. In future Icon Insights, we’ll examine the financial and clinical benefits of Icon Health’s patient management and care navigation services for employers.

To learn more about Icon Health please visit www.iconhealthco.com or send us an email at hello@iconhealthco.com.