To Lower MSK Costs, First Drive Value to the Patient

As the healthcare system makes tremendous strides toward value-based care delivery, the industry as a whole should stay tuned into who we are actually driving value for. When implemented correctly, value-based care can and should drive value to bottom lines, but if the underlying care model does not drive value to the patient first, the gains are likely unsustainable.

As we put more and more solutions in place that drive “value,” we must continue to assess if and how much patients stand to gain. Only then will we see the cost of care begin to drop.
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Why putting patients first matters

It’s no secret that the traditional healthcare system is fundamentally broken. Under the fee-for-service model, clinicians are financially incentivized to generate charges, which are not always aligned with the most appropriate treatment. This climate inevitably generates a conflict of interest that can complicate the clinical decision-making process and put a patient’s outcomes at risk. 

At the height of the COVID-19 pandemic, for example, a recent claims analysis found that hospitals performed over 30,000 unnecessary and low-value back surgeries on older adults (Toleos, 2022). Despite the nationwide lockdowns and dangerous health risks (especially for the more vulnerable population included in this analysis), clinicians continued to send their patients to the operating room for surgeries that delivered little to no clinical benefit. Moreover, the dramatic overuse of low-value care—especially invasive procedures like back surgery—puts a substantial financial burden on members as well as the health system as a whole. Altogether, unnecessary care costs the U.S. healthcare system up to $101 billion each year (Chalmers, 2021).

In a perfect world, the only metric of success would be patient outcomes. When we zoom in on what actually drives value, we find that it’s not the care designed for bottom lines—it’s the care that prioritizes the patient above all else.

The essentials of patient-centered care

So, what does patient-centered care look like? It starts with meeting (and exceeding) patient needs and expectations, accounting for individual perspectives and preferences. This requires shared decision-making as well as meaningful connection and communication (Hutting, 2022). In fact, this is a must for clinicians in 2023 and beyond. A recent Accenture report found that members rank trust, access, ease of doing business, and digital engagement as the most important factors when choosing their clinicians (Accenture, 2022).

As patients take more of a front seat in driving their healthcare decisions, the most successful value-based programs leverage both current and emerging patient expectations to achieve the best outcomes. According to one study, the best value-based frameworks encompass seven core pillars (Juhnke, 2013):

1. Easy access to healthcare

2. High-quality infrastructure and services

3. Patient-friendly information and secure data

4. Effective, safe, and professional care

5. Continuity and coordination

6. Interpersonal and engaging care

7. Individualized and self-managed care
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What to look for in an MSK solution

With the total cost of musculoskeletal (MSK) care ballooning to well over $380 billion, high-value solutions are more crucial than ever in this industry (Dieleman, 2020). Applying the pillars of patient-centered care to the MSK space, the most effective care models encompass the following features:

• Convenient home-based and digitally-enabled care ‍
• Easy access to a non-operative MSK specialists 
• Multidisciplinary, whole-person evaluation and treatment
• Personalized care plans tailored to member preferences

At Vori Health, our doctor-led MSK program is founded on patient-centered care, which is proven to increase member adherence and drive higher value—as seen in our 85% plan adherence rate and up to 4 times return on investment. We provide the convenience of receiving care from the comfort of a member’s home as well as the flexibility to receive treatment in person–all tailored to a member’s preference.

By redirecting members from unnecessary imaging and surgery to non-operative care from Vori Health, clinicians and payers can reduce healthcare consumption and improve long-term outcomes, paving the way for healthier members and lower MSK spend.  

Looking for an innovative MSK care model that lowers the cost of care and puts patient needs first? Reach out to our team today.

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REFERENCES

• Toleos, 2022: Toleos, A. PRESS RELEASE: 100,000 older Americans got unnecessary surgeries during dangerous first year of COVID-19. Lown Institute. May 17, 2022. Accessed August 15, 2023.‍
• Chalmers, 2021: Chalmers, K, Smith P, Garber J, et al. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims. JAMA Netw Open. 2021;4(4):e218075. ‍
• Hutting, 2022: Hutting N, Caneiro JP, Ong'wen OM, Miciak M, Roberts L. Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person. Musculoskelet Sci Pract. 2022;57:102434. ‍
• Accenture, 2022: Healthcare experience: The difference between loyalty and leaving. Accenture
• Juhnke, 2013: Juhnke C, Mühlbacher AC. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems. Int J Integr Care. 2013;13:e051. ‍
• Dieleman, 2020: Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray CJL. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA 2020;323(9):863-884.

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