Musculoskeletal care spending up 65%; more preventive care needed to reduce costs
The fastest-growing area of spending came from emergency room visits, which rose 155% from 2010 to 2019.
A new report finds that treatment of musculoskeletal (MSK) issues has doubled in recent years—with no improvement in patient outcomes.
The “State of MSK Report, 2021” was released by Hinge Health, a digital health company that specializes in MSK treatment. The report noted that MSK issues are a top health care cost for many employers, and that the new trend toward remote work may result in an increase in claims in this area, since many home workspaces are not set up to be ergonomically sound.
Related: 2021 benefit predictions: Where will utilization, costs increase the most?
The report said that despite the increased spending on MSK therapies between 2010 and 2019, many MSK treatments simply aren’t providing a long-term solution, instead relying on “quick fix” injections or costly surgeries that have questionable efficacy.
“Rising costs of MSK care means employers and health plans should expect MSK to continue to be their top cost driver,’ the report said. “Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years. Studies have shown that, despite a 65% increase in health care expenditures for patients with back and neck problems between 1997-2006, there has not been a corresponding improvement in patient clinical outcomes data.”
A broken system
“The reality is that the current system is broken,” the report said, pointing to studies that show common therapies such as surgery, injections, and opioids have not effectively resolved common back and join pain issues.
The Hinge Health report looked at claims data associated with MSK care, and found that the fastest-growing area of MSK spending came from emergency room visits, which rose 155% from 2010 to 2019. This was followed by outpatient hospital care (which grew by 149%); inpatient care that included overnight stays (which grew at 100%); and care at Ambulatory Surgery Centers (ASCs), defined as outpatient care at specialty centers (95% spending growth). The Hinge Health report noted that while plan membership grew 42% during this time period, MSK costs grew 155% during those years.
“This hefty price tag is largely driven by per-member cost increases in the types of treatment and services provided, not an increase in demand,” the report said.
There is some good news: more plan enrollees are using lower-cost outpatient facilities such as ASCs, rather than opting for procedures that require overnight stays in hospitals. But the report said there continue to be questions about over-utilization of things like MRIs, injections (which sometimes offer only short-term relief), and surgery.
Focusing on upstream care
The report said that upstream care, featuring more preventive measures, is preferable to downstream care that comes after an injury.
“While some of these medical claims are likely traumatic incidents like car accidents, other acute MSK injuries might have been avoided through better prevention programs earlier in a member’s journey,” the report said. “Benefit leaders and health plans should focus their efforts upstream or earlier in a patient’s MSK journey with prevention programs and conservative care before they lead to expensive surgeries and ER visits downstream. “
That preventive care can take a number of forms, including regular exercise therapy and lifestyle changes. The report discourages early use of MRIs, since these have been linked to earlier surgeries, starting a cascade of MSK issues. Advice and exercise therapies based on job type can also be an important preventive strategy.
The data showed that traditional treatments for MSK dropped significantly in 2020 due to the pandemic, allowing health plans and benefit leaders a kind of reset in how they think about these treatments going forward.
“Employer benefit leaders and health plans have a unique opportunity to wean their members off these expensive treatments,” the report said. “Studies have shown time and time again the ineffectiveness of treatments like surgery and injections over the more effective route of exercise therapy and lifestyle change for resolving back and joint pain. 2021 opens the door for benefit leaders and health plans to redefine MSK care away from an overreliance on these expensive and unnecessary treatments.”
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