As the U.S. healthcare system grapples with near-astronomical levels of medical spending, all eyes are turning to musculoskeletal (MSK) care as a top driver of these costs. While many concerted efforts have been made to decrease MSK spend, such as the shift to outpatient surgical facilities, reference-based pricing, centers for excellence, travel surgery programs, and in-home patient care, the best approach may be one that gets back to the basics. How do we accurately identify each key player contributing to the total cost of care and leverage that data to inform our cost-saving strategies?
Defining the total cost of MSK care
The total cost of care (TCOC) takes into account both direct and indirect costs of MSK conditions. Direct costs are those immediately related to the disorder itself, such as:
- Clinician visits
- Diagnostics
- Medical therapies
- Procedures
- Long-term care
Altogether, the grand total of MSK care now exceeds $380 billion (Dieleman, 2020).
On the other end of the spectrum, indirect costs are the result of living with a chronic condition as well as non-medical expenses related to treatment. These include:
- Transportation costs
- Lost wages
- Reduced productivity
- Additional childcare
- Administrative tasks
MSK costs are rapidly growing due to both the widespread prevalence of these debilitating conditions, as well as the alarming amount of inappropriate procedures, tests, and surgeries. More than 50 percent of American adults suffer from some form of MSK pain, meaning countless healthcare systems across the nation continually add to the MSK bill (USBJI, 2023). Recent data reveals that patients seeking treatment for an MSK condition comprise 27 percent of commercial health plan volume (Evernorth, 2022).
Compounding this high prevalence is the all-too-common story of inappropriate steerage for MSK conditions, resulting in unnecessary imaging for up to 30 percent of patients, as well as unnecessary and costly procedures and operations, many of which are also ineffective. The prevalence of failed surgery for back pain alone reaches 46 percent (Crowell, 2022; Orhurhu, 2022).
Of the top five problem areas, the back is the most expensive, consuming 29 percent of the nationwide MSK bill (Evernorth, 2022).
Altogether, the grand total of MSK care now exceeds $380 billion (Dieleman, 2020). There is little debate that the TCOC has far exceeded reasonable limits. Considering traditional MSK care is a top driver of these costs, health plans and clinicians must take the time to analyze all contributing factors and reevaluate what high-quality MSK care should look like.
Breaking down the MSK bill
MSK conditions come in a variety of shapes and sizes, but they generally fall into three categories:
1. Acute trauma
This type of MSK condition includes fractures, muscle and tendon tears, or any other injury sustained from an accident or traumatic incident. Common direct costs associated with acute MSK injuries include opioid prescriptions, emergency room visits, and orthopedic surgery for more severe cases. For some, additional rehabilitative therapy is needed to restore optimal function. In total, these injuries make up an estimated 19 percent of the total cost of MSK care (Evernorth, 2022).
2. Autoimmune diseases
MSK-related autoimmune diseases represent a long-term financial and clinical burden. The most common MSK autoimmune diseases are rheumatoid arthritis, multiple sclerosis, and polymyalgia rheumatica. As no cure is available, treatment for these conditions aims to manage symptoms, decrease the frequency of flare-ups, and improve overall quality of life. From a TCOC standpoint, these diseases total nearly 17 percent of MSK expenses (Evernorth, 2022).
3. General wear-and-tear
This category encompasses approximately two-thirds of all MSK treatment expenses (Evernorth, 2022). Wear-and-tear (or age-related) injuries are characterized by the gradual degeneration of healthy joints, muscles, bones, and other connective tissues. Common conditions include strains, sprains, osteoarthritis, and herniated spinal discs.
Wear-and-tear conditions rank first on the list of TCOC contributors, generating almost 64 percent of total MSK spend (Evernorth, 2022). Of the top five problem areas, the back is the most expensive, consuming 29 percent of the nationwide MSK bill (Evernorth, 2022). On top of medical expenses, the indirect costs of back pain are also substantial. From missed work days to productivity loss, the non-medical costs of back pain can total up to $40 billion (Zemedikun, 2021).
Wear-and-tear conditions rank first on the list of TCOC contributors, generating almost 64 percent of total MSK spend (Evernorth, 2022).
Fortunately, the majority of back pain is responsive to proper treatment; specifically, functional, non-invasive techniques meant to reduce inflammation, relieve pressure, and restore movement and function. There are several risk factors which may increase the occurrence of low back pain, including smoking, obesity, and low levels of physical activity (Hartvigsen, 2018). Fortunately, all of these factors can be modified through lifestyle changes, a fact that points to the importance of whole-person MSK care.
Sounding the TCOC alarm
From 1970 to 2020, healthcare spending increased 55-fold to more than $4 trillion (Kurani, 2022). In order to effectively combat these rising costs, the healthcare system as a whole must overhaul its approach to medical care—especially its management of chronic conditions.
From 1970 to 2020, healthcare spending increased 55-fold to more than $4 trillion (Kurani, 2022).
A critical oversight in the current medical system is the notion that the body is not a wholly integrated system. Traditional medicine often focuses on resolving individual ailments as quickly as possible instead of treating each symptom as a signpost to a larger issue. Rather than band-aid solutions such as costly medications, imaging, and surgeries, the focus should turn to a systems perspective. In the MSK specialty, this means taking a step back and identifying each factor contributing to an individual’s muscle or joint pain.
Treating the problem at its root
It is well-documented that the largest contributor to health is individual behavior (GoInvo, 2018). This is why, at Vori Health, our care teams include non-operative doctors, physical therapists, health coaches, and nutritionists. Working collaboratively, these clinicians not only support patients with evidence-based medical care but also address lifestyle habits and choices that may hold a patient back from fully healing. By choosing a holistic approach first, the team at Vori Health has had tremendous success helping patients heal before turning to more expensive and invasive methods. Our care pathway for low back pain, for example, has been certified by the Validation Institute to reduce surgeries, imaging, and injections while also improving pain.
Our care pathway for low back pain has been certified by the Validation Institute to reduce surgeries, imaging, and injections while also improving pain.
In addition to boosting outcomes with fewer interventions, the Vori team also strives to reduce healthcare spending wherever possible. Our unique virtual-first model gives patients the opportunity to connect with medical doctors, physical therapists, health coaches, and others in just one place—from the convenience and comfort of home. By leveraging the efficiencies of virtual care, the Vori model helps reduce transportation costs, time away from work, childcare needs, and other indirect costs of care. Our integrated care plans also treat each individual’s condition at the root, meaning reduced long-term healthcare utilization and holistically healthier patients.
From unlimited access to appropriate medical care to personalized digital care plans, Vori Health is a one-stop shop for patients looking to find relief without spending thousands on MSK care. Talk to us to learn how the Vori solution can drive significant value for your team.
REFERENCES
- USBJI, 2023: United States Bone and Joint Initiative. Musculoskeletal Diseases And the Burden They Cause in the United States, https://www.boneandjointburden.org/, accessed January 27, 2023.
- Evernorth, 2022: Evernorth Research Institute Report, https://www.evernorth.com/americans-in-motion-report, accessed January 27, 2023.
- Crowell, 2022: Crowell MS, Mason JS, McGinniss JH. Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study. Int J Sports Phys Ther 2022;17(2):237-246.
- Orhurhu, 2022: Orhurhu VJ, Chu R, Gill J. StatPearls [Internet]. (2022, May 8). Failed Back Surgery Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK539777/
- 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.
- Zemedikun, 2021: Zemedikun DT, Kigozi J, Wynne-Jones G, Guariglia A, Roberts T. Methodological considerations in the assessment of direct and indirect costs of back pain: A systematic scoping review. PLoS ONE 2021;16(5):e0251406.
- Hartvigsen, 2018: Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M. What low back pain is and why we need to pay attention. The Lancet 2018;391(10137):2356-2367.
- Kurani, 2022: Kurani N, Ortaliza J, Wager E, Fox L, Amin K. Health System Tracker. (2022, February 25). How has U.S. spending on healthcare changed over time? https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Total%20national%20health%20expenditures,%20US%20$%20Billions,%201970-2020
- GoInvo, 2018: Determinants of Health. (2020, April 14). GoInvo. https://www.goinvo.com/vision/determinants-of-health/
