Musculoskeletal spend for employers and health plans has grown steadily over the years, and a large percentage of this spend can be attributed to members with multiple, complex health care needs.  These “high-need, high-cost” (HNHC) members make up to 5-10 percent of all members in any given population group, but they account for nearly 60 – 75% of  musculoskeletal care spending in a given year. 

In addition, there is high level of persistent utilization in musculoskeletal spend.  When analyzed over a ‘longer’ period of time, about 4-5% of members contribute 35% of the spend.

Leading health plans and employers are now looking inside their claims data and turning their attention to high-cost sub-population, with common musculoskeletal conditions such as back, neck, knee, hip and shoulder pain.  Through member segmentation by conditions, different needs can be identified, and tailored policies and budgets can be set for homogeneous member groups. For example, by segmenting high- and medium-risk members based on chronic back pain, members can be offered tailored digital interventions for managing back pain, such as specific exercises, education, self-care and biometric devices for remote monitoring.

In conclusion, member segmentation by musculoskeletal condition provides a range of benefits to employers  and health plans who are aiming to provide high-quality health benefits for their people.  The segmentation data analysis helps in selecting a homogeneous target population and tailor an intervention to different member types within a population. As health care continues to move toward a person-centered approach, and big data and analytics become even more ingrained, employers and health plans should consider the significant benefits of member segmentation analysis for integrated care and support its use.

We are happy to help.

Sprite Health’s corporate musculoskeletal program provides a single point of access for all MSK conditions, across the entire MSK continuum. Our virtual physical therapy services provide a more affordable and convenient way to prevent and treat pain. Chronic pain management provides an evidence-based, PT-led digital program for chronic joint and back pain that includes personalized exercise therapy, behavioral health support, education & guidance. Bundled surgery provides access to high-quality musculoskeletal surgical care at a pre-negotiated bundled rate. MSK financial management leverages predictive analytics, clinical expertise and plan administration capabilities to eliminate waste – resulting in over 30% net savings in your MSK spend.


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