THE CONNXION – VOLUME 01, ISSUE 04
Musculoskeletal (MSK) ailments can impact a person’s life in many ways. These conditions can affect the bones, joints, and muscles, resulting in osteoporosis, traumatic fractures, osteoarthritis, and other health issues. Generally painful conditions such as back and neck pain are a less serious, but no less impactful, result of these ailments.
Reporting in 2021 revealed that over half of the American population suffers from MSK ailments such as back, shoulder, knee, and other joint pain. With such a wide range, it shouldn’t come as a surprise that these conditions play a significant role when it comes to employer-based healthcare costs.
Of the many costs employer-based healthcare faces, between 20% to 30% are derived from muscle and joint injuries, with 40% of those injuries being initially misdiagnosed – leaving employers saddled with up to millions in wasted healthcare dollars. And when you factor in the average 360 million days of lost productivity per year due to MSK ailments, you now have the single largest healthcare expense for American employers – that’s more than the annual costs of heart disease, cancer, and diabetes.
MSK, overall, is an enormous $420B annual market.
Because MSK medical spending poses such a threat as a top cost driver for many employers, it can be helpful to take a deeper look into the underlying trends behind rising costs and how employee benefits leaders and health plans can redefine and manage better spending when it comes to MSK care.
Digging Into the Latest MSK Healthcare Trends
Despite the massive growth in costs, the actual MSK population remained relatively constant over the last decade. Between 2010 and 2019, MSK costs doubled, surging from $10 billion to $20 billion in a sampling of 40+ million Americans. As costs rise, an easy hypothesis is that growing claims are the cause – but the numbers point to a different answer.
Looking at how MSK costs have doubled in the last decade, this rise in cost was driven primarily by two trends. The first of these trends was the 40% increase in per-member costs spanning from 2010 to 2019. The second was the 42% growth of the number of health plan members in the same measured dataset during this time. However, while member-base grew, it’s worth noting that the number of members filing MSK medical claims remained almost the same.
If MSK healthcare spending has grown this much in the last decade, but the number of members filing medical claims has not, it stands to wonder: where are these increases coming from?
For lumbar spine conditions, studies make it clear that common treatments such as surgery, imaging, opioids, and injections are not effectively resolving back pain. Studies also make clear that there are too many spinal procedures done in the United States. While these approaches may provide temporary relief, the issue is just that: it’s temporary. Instead of taking a long-term look at solutions, increased access to expensive procedures like spinal injections can create a dependency, leading to a continued cycle of treatment that drives up costs.
The quickest growth in MSK spend comes from three facilities: ER, outpatient facilities, and inpatient hospitals. Emergency rooms rounded out as the fastest-growing source of MSK medical claims, growing by 155%. Outpatient hospital care facilities, responsible for MSK surgeries, procedures, and injections without an overnight stay, saw their claims grow 149% in the last ten years. Surgeries and procedures that required overnight stay, provided by inpatient hospital care, grew 100%. With slightly lower rising costs than outpatient facilities, ambulatory care center claims grew 95%. To put it in better perspective, in the time that health plan memberships grew 42%, MSK costs shot up by 155%.
The growth in these facilities is ultimately driven more by unit cost increases rather than demand. The research shows that members are not increasing – rather, it’s the cost for the treatments and services provided to these members that drives prices up so high. With the shift to working from home, MSK conditions are only growing more prevalent as well. 70% of employees with MSK conditions reported that their pain either intensified or they experienced new pain altogether since starting remote work.
Where Do We Go from Here?
The good news is that more and more, members are beginning to use lower-cost outpatient facilities. This frees these patients from the heavy overnight-stay price common at hospitals by giving them access to same-day surgeries and procedures instead. MSK patients are increasingly opting to look for better options and better costs – which is where WLT and Upswing Health come in.
Together with Upswing Health, a surgeon-founded MSK healthcare innovator, WLT looks to combat rising prices in MSK healthcare by making Upswing’s “virtual front door” MSK services available to businesses and their members.
WLT & Upswing Health’s partnership aims to directly confront the current challenges and costs of MSK treatment by giving employees:
- Immediate access to care, with accurate pre-diagnostic screening
- On-demand consultations with certified athletic trainers
- A library of physical therapist created exercises that can be used to effectively treat over 60% of MSK injuries
- Access to orthopedic specialists within 24 hours when indicated
Through this partnership, Upswing Health’s value-based care services will be embedded in WLT’s technology infrastructure and made available to WLT’s nationwide network of over 65 Third Party Administrators. Using a virtual platform that combines member coaching, sophisticated technology, and orthopedic specialists, Upswing Health helps MSK patients resolve many of their conditions from the privacy of their own home. The delivery model developed by the partnership will deliver care to patients with MSK conditions and reduce their costs by up to 40%.
Prices per member for MSK treatment may have grown in the last decade, but Upswing Health counters these costs. Instead of the average $1000 per episode many U.S. employers are forced to pay, Upswing’s cost runs at $250 per episode, addressing MSK ailments in a correct and informed manner and cutting costs dramatically. Offering immediate access to care, Upswing Health also seeks to decrease the amount of lost productivity due to MSK ailments, lowering costs for employers in those areas as well. Upswing’s outcomes data shows a savings of $1100 per engaged member.
MSK ailments can prove to be a major detriment to a person’s life. Dealing with the effects is difficult enough – adding on the stress of the financial burden and extended doctor wait times can only make it that much worse. It’s time for businesses and members to experience a better way, with streamlined access to reduced costs and high-quality care for members who need it most.
To learn more, visit https://upswinghealth.com/.