As national healthcare expenditures balloon into the trillions, a closer look reveals musculoskeletal (MSK) care to be a leading contributor to skyrocketing costs.1,2 In 2019 alone, MSK care totaled almost $253 billion nationwide, pushing employers to contribute even more to employee health plans.2 That same year, MSK care accounted for approximately 31 percent of total employer medical expenses, according to a National Business Group on Health report.
Based on increasing cost projections, employers can expect to continue allocating more space in their healthcare budgets to MSK care. In fact, a recent survey found that 44 percent of employers reported that MSK conditions were the most expensive health concerns among plan enrollees.3
MSK treatment costs may be on the rise, but positive results are not. A longitudinal analysis of healthcare spending for back and neck pain showed that the 65 percent budget increase did not lead to an improvement in patient outcomes.4 Now more than ever, healthcare leaders must find new treatment options that deliver favorable results while reducing expenses. This requires a deep dive into the many trends pushing MSK costs to unprecedented levels.
A look at root causes
From a 10,000 foot view of the traditional healthcare system, there are multiple forces at play inflating the costs of MSK care.
For one, primary care physicians and surgeons–the clinicians recognized as the go-to experts for MSK care–often lack training in evidence-based, non-operative care. As a result, unnecessary tests and procedures often get recommended to patients when non-invasive and less costly alternatives could have had more success.
Reimbursement models also play a role. With fee-for-service revenue models, for example, providers are paid more to do more—meaning greater reimbursements for full diagnostic workups and costly surgeries. If patient outcomes are left out of the equation, MSK clinicians will likely continue to provide inadequate care while consuming employer and enrollee budgets.
Many other factors shape the costly landscape of MSK care including societal demand for a quick fix. Muscle and joint pain–especially when chronic–can be a confusing and overwhelming experience for individuals. Medical providers are often expected to provide concrete answers and relief right away. However, band-aid solutions come at a cost.
MSK: A specialty rife with unnecessary steps
These underlying trends lead to inefficiencies in the traditional MSK treatment process that not only prolong patient discomfort but increase the financial burden for everyone involved. Unnecessary steps fill the specialty including:
- Inappropriate steerage — The current model of MSK care begins at the primary or urgent care level and moves into a continuous cycle of inappropriate steerage towards unnecessary diagnostic imaging, opioid prescriptions, procedures, and surgeries. These steps are not only unnecessary but also often fail to provide lasting relief due to a lack of treatment personalization—meaning a lack of treating all the factors underlying an individual’s MSK pain.
- Inappropriate imaging — The rise in unnecessary imaging — particularly MRI scans — is a signpost of non-evidence-based medicine. Primary care physicians wish to diagnose their patients quickly to improve the patient experience and clinician satisfaction. This drives many to order scans that typically fail to provide a clear reason for the patient’s symptoms or further insights into the problem. In fact, one study found that 76 percent of pre-consultation knee MRIs were not useful in helping orthopedic surgeons decide next steps.5
- Inappropriate procedures & surgeries — MSK surgery is both expensive and physically traumatic, and the risk of surgical failure should motivate clinicians to see invasive procedures as a last resort. “Failed Back Surgery Syndrome” is a recognized medical condition affecting up to 40 percent of patients who continue to experience back pain years after their procedures.6 Non-surgical alternatives not only have a higher chance of providing better outcomes, but they also have the potential to save an estimated $14,000 per patient.7
- Inappropriate opioid use — Opioid overuse for MSK pain has become a common challenge for patients with chronic pain. Nationwide, 18.8 percent of medications for lower back pain were opioids, and 76.9 percent of these were intended for long-term use.8 Given the addictive nature of these medications, even one patient can generate thousands of dollars of unnecessary medical costs.9
An unsustainable net result for employers
MSK pain is a leading cause of disability that produces dramatic demand for treatment. When combined with inefficiencies in the traditional care model, MSK conditions place employers in an unsustainable situation.
- Employers face rising healthcare costs for MSK care with no end in sight — A recent survey found that MSK care is second only to cancer in driving employer healthcare costs, and the employers surveyed expected to cover a larger portion of enrollee health expenses moving forward.10
- Poor employee outcomes — Long absences for illness and disability reduce workplace productivity, and employees left with long recoveries are often less productive and become frustrated with their quality of life. With 216 million missed workdays for costly MSK conditions, employers face shrinking profit margins that leave them with difficult decisions to make.11
Enter personalized, doctor-led care
The need for change in MSK care could not be greater, and Vori Health is taking the steps necessary to lower costs and prioritize patient outcomes over all other agendas.
Evidence-based & non-operative
Vori Health is the only nationwide specialty medicine practice with care teams led by board-certified doctors trained in evidence-based, non-invasive MSK care. The care process starts with a comprehensive evaluation by a specialty medical doctor, physical therapist, and certified health coach who work together to find a holistic diagnosis and devise a treatment protocol centered around non-operative therapies.
Within 24 hours of their initial visits, patients begin a care plan to manage pain, regain strength, and get back to their lives without unnecessary steps or delays. Vori Health’s integrated MSK solutions have helped countless patients get relief with non-operative care. In fact, less than three percent of Vori Health patients are referred for surgery.
Personalized for individual health & goals
Vori Health’s care teams work with each patient in a shared decision-making process to build a treatment plan centered around each individual’s goals. Due to the multifactorial nature of muscle and joint pain, MSK care must be approached with a flexible and patient-centered mindset in order to get to the root of the problem as soon as possible. This reduces the pressure for a ‘quick fix’ and helps each individual feel supported through every step of their recovery journey.
Once a care plan has been created, patients have open access to the most appropriate care for their unique needs all in one place — including physical therapy, health coaching, and nutritional guidance. The virtual-based care delivery system is highly convenient and meets patients where they are, reducing any barriers that may have prevented access to traditional care.
With no incentives for surgery and a complete focus on patient outcomes, Vori Health's care teams craft value-based treatment plans that most often successfully relieve pain and discomfort without invasive operations. This means faster recoveries and fewer unnecessary procedures and medications. As a result, patients and employers see a large reduction in cost of care. The average 4:1 ROI demonstrates Vori Health’s commitment to delivering the highest quality of care without financial incentives.
Working together to improve outcomes and lower costs
Vori Health partners with self-funded employers, forward-thinking health plans in value-based arrangements, as well as primary care and surgical practices to drive appropriate, evidence-based care and faster, cost-effective recoveries. These partnerships bring more patients closer to the standard of care they deserve—all while bringing down the total cost of care.
To learn how Vori Health’s MSK solutions can strengthen both your team and bottom line, schedule a demo today.
- NHE Fact Sheet. (2022, December 14). Centers for Medicare and Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=NHE%20grew%202.7%25%20to%20%244.3,17%20percent%20of%20total%20NHE.
- Bureau of Economic Analysis. (2022). Blended Account, 2000-2019. https://www.bea.gov/data/special-topics/health-care
- Business Group on Health. (2019, August 13). Large Employers Double Down on Efforts to Stem Rising U.S. Health Benefit Costs which are Expected to Top $15,000 per Employee in 2020 [Press Release]. https://www.businessgrouphealth.org/en/who%20we%20are/newsroom/press%20releases/large%20employers%20double%20down%20on%20efforts%20to%20stem%20rising%20us
- Martin, B.I., Deyo, R.A., Mira, S.K., Turner, J.A., Comstock B.A. Hollingworth, W., Sullivan, S.D. (2008). Expenditures and health status among adults with back and neck problems. JAMA 299(6), 656-664.
- Mohammed, H.T., Yoon, S., Hupel, T., Payson, L.A. (2020). Unnecessary ordering of magnetic resonance imaging of the knee: A retrospective chart review of referrals to orthopedic surgeons. PLoS One 15(11), e0241645.
- Christelis, N., Simpson, B., Russo, M., Stanton-Hicks, M., Barolat, G., Thomson, S., Schug, S., Baron, R., Buchser, E., Carr, D.B., Deer, T.R., Dones, I., Eldabe, S., Gallagher, R., Huygen, F., Kloth, D., Levy, R., North, R., Perruchoud, C., Petersen, E., Rigoard, P., Slavin, K., Turk, D., Wetzel, T., Loeser, J. (2021). Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11. Pain Medicine 22(4), 807–818.
- Tosteson, A.N.A., Skinner, J.S., Tosteson, T.D., Lurie, J.D., Andersson, G.B., Berven, S., Grove, M.R., Hanscom, B., Blood, E.A., Weinstein, J.N. (2008). The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine 33(19), 2108-2115.
- George, S.Z. & Goode, A.P. (2020). Physical therapy and opioid use for musculoskeletal pain management: competitors or companions? PAIN Reports 5(5), e827.
- Chang, H.Y., Kharrazi, H., Bodycombe, D., Weiner, J.P., Alexander, G.C. (2018). Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study. BMC Medicine 16(69).
- Business Group on Health. (2022, August 23). Cancer Now Top Drive of Employer Health Care Costs, Says Business Group’s 2023 Health Care Strategy and Plan Design Survey [Press Release]. https://www.businessgrouphealth.org/en/who%20we%20are/newsroom/press%20releases/2023%20lehcspds
- Weinstein, S.I., Yelin, E.H., Watkins-Castillo, S.I. (2014). Lost Work Days. https://www.boneandjointburden.org/2014-report/id2/lost-work-days
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