2024 is fast approaching, meaning it’s time to look back and reflect on the wins, losses, and emerging trends that defined 2023 and will shape the musculoskeletal (MSK) industry in the coming year. With overall healthcare costs expected to spike again, Vori Health co-founders Ryan Grant, MD, and Mary O’Connor, MD are sharing the strategies they are focused on to drive more value in MSK care for patients, employers, and payers alike.
Are GLP-1 medications here to stay?
GLP-1 medications like Ozempic and Wegovy continue to dominate the headlines with promises of rapid weight loss for overweight or obese individuals. The recent explosion of costly GLP-1 medications, marked by a 300 percent increase in prescription volume between Q1 of 2020 and Q4 of 2022, will undoubtedly top the list of healthcare trends in 2024 (Trilliant Health, 2023). Recent surveys show that almost 2 out of 3 large employers are either covering these drugs for obesity or considering it.
“I do not see any signs that the demand for GLP-1s will abate,” said Dr. O’Connor. “After all, we are an overweight and obese nation.” As prices start to come down, Dr. O’Connor predicts the popularity of GLP-1s will only continue to grow. “Health plans will continue to expand GLP-1 coverage. As a nation we cover all the downstream medical conditions that arise from obesity, so covering a drug that can help prevent subsequent health problems makes sense.”
But Dr. O’ Connor cautions that GLP-1s are not a total solution for obesity, nor its many comorbid conditions like MSK pain. “Many patients will regain the weight if they have not improved their underlying health behaviors,” explains Dr. O’Connor. “It is critical for individuals dealing with both obesity and MSK pain to have access to GLP-1s as part of an integrated treatment plan that includes physician-led medical care, physical therapy, and behavior change support. All of these elements are needed to sustain the benefits of these expensive drugs.”
Moving beyond digital-only care
After soaring during the pandemic, digital-only care companies are now trying to find a new cruising altitude. Many are looking to the future with a keen eye on hybrid modalities and marketplaces, with a primary objective of meeting client needs without causing point solution fatigue.
For some, like TytoCare’s virtual primary care clinic, the solution is to expand digital-only care via new partnerships that allow for face-to-face visits with clinicians in the same network. Other companies are transplanting their offerings to broader digital health marketplaces, such as Digital Square or Teladoc, to continue providing virtual-only care alongside other specialized telehealth services. With different expansion options on the horizon for digital health, many stakeholders are now asking the question: Which modality will prevail in 2024?
“It will be a mixture,” said Dr. Grant. “Virtual-first companies are solving a variety of pain points that include improving access, care coordination, and chronic condition management. The market is not looking for a duplication of services, so virtual-first companies will need to figure out how to integrate and enable in-person quality networks to best meet patients where they are. Hybrid care is the new norm.”
“People have gotten a taste of virtual care and love the convenience factor,” adds Dr. Grant. “But what people really value is choice. And a person’s desire to be able to go either online or in-person to get the care they want will shape the healthcare landscape for years to come.”
On the horizon: More value-based models for specialty care
Value-based care moves are top of mind for healthcare leaders, yet many are unsure of how this new payment structure will tangibly affect reimbursement distribution in specialty care. While value-based primary care networks, like Aledade, have successfully implemented these programs, the industry must next look to higher-cost specialties such as MSK and cancer care to truly make a difference.
At the heart of this challenge lies uncertainty around carving out risk for specialty spend—specifically, how to assign real risk on MSK care that extends beyond typical return on investment (ROI) guarantees. The lack of clinical systems that can handle different payment structures, in addition to an unstandardized approach to attribution of outcomes, complicates the equation and leaves multiple stakeholders taking on risk with unclear returns and downstream impact.
But, despite its challenges, Dr. Grant projects that value-based specialty care will take hold—so long as the right care model is in place. “Musculoskeletal care and orthopedics are primed for disruption in this arena,” Dr. Grant says. “But thus far these specialties have entered the value-based arena heavily focused on the surgical episode and procedure locations. To really move the value needle as described in a recent McKinsey report, the spine and orthopedic care model needs to be nonoperative and focused on a condition rather than a procedure (McKinsey, 2023). The secret to effective value-based care is making sure the care model is appropriate and mixed with the right economic incentives.”
The next iterations of surgical centers of excellence
To help slash healthcare costs, some companies have turned to surgical centers of excellence (COEs) to optimize outcomes for the most common procedures utilized by their employees and member populations. Leveraging outcomes-based care, COEs can reduce the cost per procedure for all stakeholders. One financial analysis found that a large COE generated over 76 percent net savings per spinal surgery (BridgeHealth, 2021).
However, reducing cost per unit has not yet translated into lower surgical volumes—especially for MSK conditions which go hand-in-hand with high rates of unnecessary surgery. “Even in our most elite hospitals, too many individuals go to the operating room unnecessarily or without the proper preparation. Those are risk factors we can and should change,” says Dr. O’Connor.
To unlock more value for payers and employers in 2024, COEs like Contigo Health are shifting their focus further upstream in the care journey to offer non-operative options for members. Contigo Health recently partnered with Vori Health to create a highly-integrated program for self-funded employers. Combining Contigo’s orthopedic and spine surgical COE program with Vori’s award-winning virtual non-operative MSK care model, the program creates a single, evidence-based benefit solution to improve outcomes and lower costs for millions of employees struggling with back and joint pain nationwide. “Giving patients access to the right care at the right time—whether that’s surgery or not—is the key to driving value in this space,” says Dr. Grant.
As a leader in multidisciplinary hybrid MSK care, Vori Health is positioned to provide the 360º access to care that members and employees need in 2024 and beyond.
Learn more about how value-based, virtually-enabled care can elevate your MSK program in 2024.
REFERENCES
- Trilliant Health, 2023: 2023 Trends Shaping the Health Economy.
- BridgeHealth, 2021: National study shows BridgeHealth model saves Plan Sponsors 50%. (2021, April 14).
- McKinsey, 2023: Improving US orthopedic care via patient-centric pathways.
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