Why Focus on Musculoskeletal Health
National Institute of Health's most recent available data is over 5-years old.
MSK (musculoskeletal) care is an under recognized component of the healthcare cost continuum that requires active management by plan sponsor decision-makers.
As humans age the body's MSK system changes and may be a contributing factor to onset of other chronic diseases receiving more attention in healthcare management systems(i.e., Type II Diabetes, Cardiovascular Diseases, Obesity).
MSK is second, only to primary medical care, as the most rapidly inflating healthcare expense for populations under the age of 65.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021174/
“Musculoskeletal health care over diagnosis is widespread, leads to unnecessary tests and treatments that do not benefit patients, may cause harm, and wastes health resources that could be better used elsewhere.”
Source: Maher, O’Keeffe, Buchbiner, Harris. Musculoskeletal healthcare: Have we over‐egged the pudding? 2019. Retrieve from https://doi.org/10.1111/1756-185X.13710
“…pouring major resources into one of healthcare’s most notorious money pits: musculoskeletal (MSK) procedures, based on no scientific evidence, which in most cases provide less value than physical therapy (PT).”
Source: https://www.cfo.com/health-benefits/2017/11/run-health-care-business-whether-like-not/
“Virginia Mason Hospital & Medical Center in Seattle, a forward-looking organization, has been candid in admitting that, at one time, 90% of its spinal procedures were of no help. While some worry about rationing care, the volume-driven reimbursement system has always rationed choices by pushing towards costly, invasive treatment options. Top-performing, value-based primary care organizations tell us that patients virtually always choose the least invasive treatment option first — but only if they’re told about sound alternatives to expensive and overused treatments and tests. Equipping patients to become active partners in their own care is the sign of an ethical organization.”
Source: https://www.cfo.com/health-benefits/2017/11/run-health-care-business-whether-like-not/
Ignoring the Cost of MSK care in an aging population
WILL COST!
Well informed decision-makers must be proactive in managing the cost of participant musculoskeletal care and what fiduciaries don't know, can hurt the plan today and into the future.
The difficulty for decision-makers is that the most recent data from the NIH (National Institute of Health) is 5-years old and relying on the network provider to manage MSK care in the plan's best interest is misguided.
Can a plan sponsor anticipate that the network provider, with a vested interest in making money from care delivery, but focused on MSK care that delivers results without redundancy or waste?
We would hope not but wasn't the issue that befell prescription drug cost management the reason retention of pharmacy benefit managers (PBM) became an integral component of healthcare system's delivery?
The best choice?
Analyze your plan participants' MSK care behaviors, utilizing actual claims data, to understand MSK healthcare spending and reduce future care cost inflation from an ever aging cohort.
Musculoskeletal Benefits Analytics, Inc.
MSK Benefits Analytics will help by delivering analytics that:
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Summarize current in-network MSK care.
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By Patient
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Specific Joint care
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Provider remediation costs
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Deliver participant specific MSK care expenditures from exams, injections, and surgeries.