Musculoskeletal care delivery system in United States is highly reactive. That is, the system waits for one to have to significant back and joint pain before it kicks into reactive action. This highly medicalized and interventional system is designed around an acute care paradigm, where the focus is to address (rather than prevent) urgent issues and manage pain. Acute musculoskeletal pain tends to be short and fit the transactional doctor-centric model of care. However this model is plagued with lots of issues such as diagnostic errors (over 40%), expensive (15-20% of annual spend for employers and health plans) and wasteful (50% of the musculoskeletal spend is waste).

The archaic health benefit designs have contributed to the reactive model by paying for musculoskeletal care that happens inside the healthcare facilities such as visits, surgeries and rehab and not much for proactive outreach, education, self-management, asynchronous communications and connected evidence-based care models that put member at the center of care.

Digital care for people with musculoskeletal pain

The rapid adoption of telehealth during the pandemic has blown away any and all doubts about people’s acceptance to digital model of care. Despite easing of restrictions, the telehealth utilization remains quite strong.  However the traditional model of telehealth is designed to solve minor urgent care issues such as cold and flu, allergies, sore throat, UTIs etc.  This synchronous, transactional model of care is not suited for the varied needs of people with musculoskeletal pain, who often have comorbidities. Research suggests that 30 to 50% of people with chronic pain in the workplace also struggle with depression or anxiety. These two conditions often feed on each other – which often leads to loss of days at work.  

Digital musculoskeletal pain program takes a holistic, multifaceted approach for MSK pain, helping employers  and health plans target risk factors to prevent acute and chronic musculoskeletal pain and treat the physical and psychosocial causes that contribute to lost time and high treatment costs.

What causes MSK pain?

Musculoskeletal (MSK) pain affects the bones, muscles, ligaments, tendons, and nerves. It can be acute (having a rapid onset with severe symptoms) or chronic (long-lasting).

The  causes of musculoskeletal pain can be wide-ranging and pervasive.  For employees, musculoskeletal pain is most often caused by postural strain, repetitive movements, overuse, and prolonged immobilization. In addition, an injury to the bones, joints, muscles, tendons, ligaments, or nerves causes musculoskeletal pain.

Proactive

Digital musculoskeletal pain program takes a proactive approach to pain management by mitigating the risk factors that causes the injuries or onset of acute musculoskeletal pain.

For most workers, at the heart of most musculoskeletal injuries and pain lay three major factors: incorrect posture, high force and exposure time.

Incorrect postures involve positions that take the body out of its natural alignment, that allows an employee to exert force without placing harmful strain on tendons, ligaments, and joints. The poor body mechanics brings about spinal alignment problems and muscle shortening, therefore causing other muscles to be misused and become painful.

Prolonged periods of exertion, or overexertion is very common issue for workplaces, especially in factory or other production settings. Excessive or heavy force can cause significant pain and injuries. Oftentimes, an employee can experience two or even three of these risk factors at once, which compounds their risk of musculoskeletal pain or injury.

Each person in the workforce has their own strength, flexibility and range of motion. An effective digital care program for workers with musculoskeletal pain takes an holistic and personalized approach to ergonomics – to facilitate healthy joints and muscles so that the employees’ body is better prepared for their daily tasks. This includes education, training and when required 1:1 coaching, where an ergonomics coach can observe, monitor and encourage workers to maintain the right posture when performing repetitive tasks. In addition, the coaches can identify risks attributed to individual worker health factors, workstation design as well as work environment and provide best practices for completing tasks properly. This proactive approach facilitates a healthy and safe workplace in which musculoskeletal injuries and pain are much less common, chronic pain is reduced, and costs are dramatically lower. 

Prognostic

Unfortunately due to limited access and transactional nature of our primary care model, it is quite difficult to assess the severity, impact and prognosis of musculoskeletal conditions. This leads to high variability in treatments.

The digital musculoskeletal pain program focuses on early identification and improved management of employees with back and joint pain. This approach saves severe discomfort for members and significant downstream costs for employers and health plans. It uses a prognostic stratified model of care to predict the severity and stage of the musculoskeletal condition as well as define the right treatment pathway for each condition based on the progression. The implementation starts with a digital assessment that quickly, accurately and confidently assesses MSK problems, then matches employees with the recommended care.

The outcome of this process is a) risk categorization and b) suggestions for next step, an evidence-based care in-app or in-person based on risk category and c) clear explanation of costs for different treatment options.

The members at low risk are typically guided to self-management including education and advice to exercise, activity modification, weight loss. A review is recommended if the pain is not resolved after 6 weeks. For those at medium risk, besides education (same as low risk), they are encouraged to use virtual physical therapy, multimodal care (including psychosocial interventions such as behavioral health) for people with chronic musculoskeletal pain, and personalized exercise programs for back and joint pain. For those at high risk, this includes interventions recommended for both low and medium risk as well as referral to clinical services including rheumatology, orthopedics and pain clinics.

Connected

In-person appointments are time-consuming if clinics are far away and inconvenient if they interrupt work routines. Going to physical therapy twice a week in-person is not realistic and now with COVID-19, it is not even an option.

In addition, this episodic model is not working for people with chronic pain. With 40% of acute care members transitioning to chronic pain every year, the fact remains that the current treatment model is not able to adequately cope with musculoskeletal chronic pain.

Unlike the traditional in-person episodic care, connected musculoskeletal care is quality health care that is personalized, accessible from home rather than a hospital or the doctor’s office and centered around the person — their needs and goals. An effective digital musculoskeletal pain program pairs technology and clinical support to provide continuous, connected and on-demand care that aligns with the 24/7 demands of chronic pain.

This connected musculoskeletal care provides real-time, electronic communication between a member and her providers and includes video sessions, remote monitoring, and secure messaging in-between sessions. Connected musculoskeletal care improves access, helps members avoid costly injections and surgeries, and increases convenience.

Organizations that are adopting digital solutions for musculoskeletal (MSK) pain are taking a proactive approach to prevent and manage MSK conditions that impact 1 in 2 workers in any given year. They are seeing reduction in sickness absence and employee turnover but also an increase in performance, higher employee engagement and reduced healthcare costs.

Sprite Health’s digital program for musculoskeletal pain 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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