Health plans are feeling the pressure as they face rising medical costs, intensifying competition, and rising regulatory scrutiny around the quality of care. In 2026, these factors are reshaping how plans approach care delivery. Nowhere is this shift more urgent than in musculoskeletal (MSK) care.
Musculoskeletal (MSK) conditions remain among the leading cost drivers for health plans; nearly 40% of members experience MSK conditions (UnitedHealthcare, 2025). Yet MSK care remains one of the least efficiently managed categories. The combination of high claim volume, fragmented provider networks, and inconsistent clinical decision-making creates unpredictable outcomes and uncontrolled spend—exactly what value-based contracts are designed to solve.
The clinical and financial risk of unmanaged MSK
In most health plan networks, MSK care operates on a traditional fee-for-service model: more visits, more imaging, more procedures translate into more revenue, regardless of clinical outcomes. With these financial incentives, surgery can become the default solution rather than the last resort.
Now, evidence suggests that a striking portion of these procedures are avoidable. Recent analyses show that up to 50% or more of some MSK-related surgeries are unnecessary, with one "low-value" back surgery occurring every eight minutes in the US (Lown Institute Hospital Index). These are often driven by overuse of procedures, poor adherence to clinical guidelines, and lack of conservative care before operating.
For health plans, every unnecessary surgery creates compounding exposure. You bear the direct cost of the procedure and post-acute care, plus indirect costs: higher disability claims, delayed returns to work, and member dissatisfaction that erodes retention. When MSK is managed poorly, it shows up in your medical loss ratios, star ratings, and member churn.
Three MSK trends reshaping health plan strategy in 2026
Three trends are forcing health plans to take action:
- Cost pressures are acute and accelerating. Rising provider consolidation, labor cost inflation, and member medical complexity are squeezing margins.
- Digital and hybrid care models have matured. Integrated, physician-led, data-driven MSK platforms can help manage MSK care from early triage to complex case reviews. These programs combine virtual and in-person care; they represent value-based models that are both operational and scalable.
- Quality is at the center of rising regulatory and competitive pressure. HEDIS, STAR ratings, and member experience scores now directly impact plan reputation and revenue. Plans that can demonstrate measurable improvements in MSK outcomes while reducing unnecessary utilization have a competitive advantage.
The key takeaway? Moving to a value-based, physician-led MSK model offers a credible path to all factors for plan success in 2026: predictable outcomes, controlled spend, and better member experiences.
How value-based MSK care works
Commercial health plan participation in value-based arrangements is growing: it increased from 34.6% in 2022 to 39.2% in 2023 (AHIP, 2024), and continues to rise. Here's what effective MSK value-based care delivers:
- Earlier, smarter risk identification. Rather than waiting for high-cost events to surface in claims data, value-based MSK programs use predictive analytics to identify members at risk of surgery, imaging overuse, or long-term disability. When signals are detected, high-risk members are directed to a physician-led MSK team as their first stop. This prevents unnecessary downstream utilization before it occurs.
- Conservative-first, whole-person care. Care begins with a comprehensive evaluation by a board-certified specialty physician who can rule out red flags, order appropriate imaging only when necessary, and build a personalized plan that may include physical therapy, exercise, behavioral support, and nutrition counseling. This MD+PT model ensures that both the medical "why" and the functional "how" of pain are addressed together, keeping members out of the operating room.
- Objective measurement and accountability. Because the model is value-based, outcomes are tracked and tied to financial performance. Programs monitor changes in pain, function, return to work, and downstream utilization. Independent validation drives ROI by preventing unnecessary procedures and resolving pain earlier, directly improving your medical loss ratio.
Why this matters for your network and your members
The financial case for value-based MSK care is compelling for health plans. But the clinical and member experience case is equally important.
Members dealing with persistent back or joint pain often experience fragmented care. They bounce between primary care, imaging centers, surgeons, and physical therapy. This leads to wasted time, wasted spend, and frustration. When you partner with a physician-led, integrated MSK model, you're offering members something fundamentally different: a single trusted clinical team, evidence-based care that prioritizes non-operative solutions, and transparent access to specialist expertise without unnecessary referral barriers.
This kind of experience drives member satisfaction and retention. In a competitive market, demonstrating that you offer smarter, safer, more coordinated care for something as common and costly as MSK pain can be a real differentiator.
Your next step
When health plan leaders build physician-led, value-based MSK care into their strategic roadmap, they're addressing one of the top drivers of medical costs with a proven, clinically sound model. Done well, this approach demonstrates to employers and members that your plan is committed to evidence-based care, cost containment, and measurable outcomes.
Vori Health is the only nationwide specialty MSK practice led by board-certified physicians and structured around value-based care from the ground up. Our hybrid virtual and in-person model combines physician oversight, integrated physical therapy, and whole-person support—designed to optimize both clinical outcomes and financial performance for health plans.
The best way to evaluate how value-based MSK care could work for your plan is to see the outcomes and cost data firsthand. Download our report to learn more, and connect with our team to discuss how other plans are using MSK VBC to drive competitive advantage.
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