The 2024 healthcare industry is primed for rising costs across the board, making high-value care for chronic conditions even more critical for employer and payer bottom lines. According to a recent global medical trends survey, the cost of medical benefits is expected to increase by almost nine percent this year—even after record-setting highs in 2023 (WTW, 2023). The study also reported that musculoskeletal (MSK) and connective tissue disorders are the fastest-growing class of conditions in 2024 and one of the top three cost-driving conditions on a global scale (WTW, 2023).
With healthcare costs continuing to balloon into the new year, employers and plans should challenge their vendors and solutions to determine the true value of their programs. While improvements in program satisfaction and qualitative outcomes are helpful indicators, the only way to perform a concrete analysis is by tracking your return on investment (ROI). But some ROIs–especially in the MSK space–are fuzzier than others. Uncovering real savings requires a deep dive into how the math is done.
The good news about MSK ROI
In many areas of healthcare, like preventive cancer care, assessing the true impact of an intervention on a population can be hard to do. Even with multiple data points (such as program cost, medical and pharmacy claims utilization rates, rates of re-intervention, etc) it can be challenging to accurately evaluate the impact of an intervention and the actual cost of care against projected costs.
Fortunately in MSK care–where elective surgeries account for the largest portion of spend–the equations are more clear cut. In fact, you can start measuring ROI immediately and calculate accurate numbers in year one–so long as your vendors are using actual claims to validate savings.
Not all MSK ROIs are created equal
Vendors in the MSK space often use subjective metrics, such as a patient’s perceived level of pain, as analogs to claims-based savings. The lack of standardization with this approach can make it difficult to compare ROI values across multiple programs, and also lead to inaccurate and even inflated numbers that steer program sponsors in the wrong direction. Below is a breakdown of different ways to calculate ROI in the MSK space, and why these nuances matter when evaluating new or current solutions.
Pain scale-based (Low correlation to actual MSK spend)
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This method assigns a dollar value to each point decrease in pain scores and calculates savings based on overall reductions in pain for a given population. While pain scales, such as the visual analog scale (VAS), are relatively straightforward and simple to analyze, they don’t tell the whole story of each individual’s condition. Pain is a highly personal experience that can vary greatly from person to person—one person’s seven out of ten could be another’s four out of ten. Likewise, individuals can experience varying levels of pain in different parts of their body—savings tied to a reduction in elbow pain doesn’t necessarily equate to savings from a reduction in back pain. All told, it’s nearly impossible to accurately and consistently tie the right dollar amount to each pain score, even for a specific condition.
Member intent-based (Medium correlation to actual MSK spend)
Another common way to measure ROI in this space is to assess a member’s intent to have an orthopedic surgery (for low back pain, a knee replacement, etc). With this method, the vendor asks the member: Are you considering a surgery for your condition in the upcoming year? All of the 'no’s' get tallied and translated into automatic savings that show up in client reporting. This method is flawed for many reasons. For one, members often come to a vendor for the purpose of post-surgical rehab—they already had the surgery and are not considering another at that moment in time; savings get attributed to these cases, yet no actual savings occurred.
Additionally, with chronic cases of MSK pain, setbacks can commonly occur, especially if the root causes of the condition were not adequately addressed during the intervention. Members experiencing this kind of ongoing frustration can quickly change their minds about surgery, or end up resorting to other costly options such as opioids. The only way to clearly see savings is to follow a member to see what they really do and compare claims data pre- and post-intervention.
Claims-based (Direct correlation to actual MSK spend)
At Vori Health, we validate savings by calculating a client’s MSK spend by condition type in a baseline year (e.g. 2023) and comparing it to the actual spend for the program year (e.g. 2024). We use pain scales, too, but not as a stand-in for savings. Instead, pain scales show up in reporting as they were designed to be used—to show how members are doing clinically. By using claims data to calculate ROI and clinical metrics to demonstrate outcomes, clients can quickly assess the value of a physician-led, non-operative care model–one that addresses the root causes of each individual’s pain without resorting to inappropriate imaging, injections, or surgery. This approach to ROI calculations not only ensures accuracy but also identifies real, bottom-line savings, evidenced by up to a 4:1 ROI.
Ready to learn more? Discover how Vori Health can help you achieve a greater ROI while delivering positive MSK outcomes for your member population.
REFERENCES
- WTW, 2023: 2024 Global Medical Trends Survey. (November 28, 2023). Willis Towers Watson.
- Bailey, 2020: Bailey JF, Agarwal V, Zheng P, et al. Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study. J Med Internet Res. 2020;22(5):e18250.
