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Musculoskeletal (MSK) conditions are often the highest and fastest growing expense for employer-sponsored health plans. The National Institutes of Health reports that 80 percent of adult Americans will suffer from low back pain at some point in their lives. Currently, more than 116 million Americans suffer from chronic pain, and an article in the Journal of the American Medical Association estimates the direct annual cost of MSK conditions at $184 billion. This puts the cost of MSK conditions ahead of both cardiac-related care ($175 billion) and cancer care ($115 billion). It’s no surprise that many employers list “musculoskeletal” as their #1 healthcare cost driver, but what is the role of human resources in managing these costs? Recognizing that pain and injuries will happen no matter how many preventive measures are put into place, what can HR implement today to make employees smarter shoppers when care is needed?

Symptoms of the Problem

The challenge presented by MSK conditions is multi-faceted and often exacerbated by a transaction-based approach to care. “Relieving Pain in America,” a report by the Institute of Medicine, concludes that imprecise diagnostic evaluations and treatment planning, low utilization rates of non-invasive, non-pharmacologic and evidence-based approaches, and poor management of pharmaceutical interventions are driving excessive pain care expenditures. The New England Business Group on Health highlights that surgery is appropriate only for the smallest segment of an employee population but can drive employer cost significantly.

With an overwhelming number of treatment options available, employees are often left to their own devices and don’t have the time or resources available to become educated consumers.

Many times, employees rely on recommendations from friends and family, or even a simple Google search, when selecting a care provider. In fact, a 2017 analysis of patient intake trends from Airrosti Rehab Centers shows that patient populations are almost evenly split in their opinion of which type of care is the most appropriate first step. In response to the question “If this option did not exist, where would you have sought care for your injury/condition?”, patients indicated as follows:

  • Chiropractor – 20 percent
  • Physical Therapist – 20 percent
  • Orthopedic Specialist – 21 percent
  • Care Provider – 18 percent
  • Other – 21 percent

Cost and outcomes aren’t always taken into consideration when scheduling an initial consultation or appointment. And, too often this data isn’t made readily available to patients.

In a health plan environment where the general trend is toward narrowing networks, steering to high-value preferred providers or even offering on site care, many HR and benefits managers simply aren’t applying these tactics as a means to reduce musculoskeletal costs. Unfortunately, it’s showing in the bottom line.

A Solution in High-Value, Outcome-Based Triage

There is hope, however. HR departments are well-positioned to attack growing MSK costs through engagement and benefit design. Developing a strategic approach to dealing with MSK conditions can result in a more productive workforce and a lower claims experience. Implementing a wellness and prevention program that addresses MSK issues before they become claims, and steering employees away from wasteful, unnecessary procedures, has proved successful in lowering costs and absenteeism rates.

In 2015, Pflugerville Independent School District (PfISD) decided to help stem the tide of rapidly escalating claims. PfISD worked with their broker and carrier representatives to vet network providers who might provide an effective solution and, in doing so, found Airrosti to be the lowest episodic cost option accessible through their health plan. On average, these patients were only seen 3-4 times total, and the providers committed to referring any non-responsive cases to another high-value provider without unnecessary procedures and imaging.

Kenneth Adix, CFO of PfISD, and Kristin Baum, workers’ comp/leave & benefits coordinator at PfISD, decided to take an aggressive approach to making sure employees had a reason to choose Airrosti. For the first year of the partnership, any employee or family member on the district’s health plan could access treatment with no out-of-pocket cost. In addition, employees were provided monthly education and engagement programs at no cost, including on-site assessments, injury prevention classes, and benefit announcement emails and flyers.

Baum reported that one out of five plan members saw an approved provider during that first year. As a result of the high engagement and value-based benefit design, PfISD experienced:

  • An estimated annual savings of $300,000 (a 21 percent reduction in MSK costs while most employers were experiencing an increase of 4-7 percent annually)
  • 48.5 percent of all MSK cases sought care from an approved provider
  • On average, overall MSK episode treatment duration was 61 days shorter than the previous year

Making Healthcare Convenient, Engaging and Affordable

Get started down the path of lowered MSK costs:

  1. Identify providers within your network who are transparent in their costs and outcomes, who can show episodic claims reductions, and who are willing to interact with employees without adding cost to the wellness budget.
  2. Work with your broker or carrier to decide on the right benefit design to incentivize plan members to choose these providers.
  3. Design an engagement timeline that emphasizes consistency and clarity, creating smarter shoppers out of employees and family members.