If you have made the decision to implement a digital health program for your employees with musculoskeletal conditions, you might have found the process of selection a bit challenging. Multiple aspects have to be taken into account to get the outcomes you desire from the successful implementation of digital MSK program, including –
- convenient on-demand access to comprehensive care
- reduce musculoskeletal costs by eliminating waste
- reduce unnecessary surgeries, imaging and injections
- flexible benefit cost-sharing options to incentivize employees to engage with the program
- easy, turnkey implementation and communication
- integration with other solutions in your benefits ecosystem.
To derive real outcomes from a digital musculoskeletal (MSK) program, you need an effective selection strategy.
Don’t worry—we’ve got you covered with 5 pitfalls to avoid.
1. The “Less Is More” pitfall: Forcing employees to go to 5 places for musculoskeletal care
The musculoskeletal care delivery system in our country is very fragmented. Most of us can’t tell the difference between physiatrist, rheumatologist and pain medicine specialists and when and why one is better than other. The digital health alternative must be easier and provide a front door for all musculoskeletal care to make the lives of your people easier. Expecting them to go to one place to find virtual physical therapy, another for chronic pain, and 4 other places for centers of excellence (COE) surgery support, expert opinions and rehab just recreates another fragmented system of care that they despise.
Instead of ‘point’ disconnected solutions that you may have to stitch together, and often create confusion and clutter for their employees – our digital musculoskeletal solution uniquely covers the full continuum of MSK care to provide you the most complete solution, and your people a consistent experience for any MSK issue, from prevention to postoperative rehab.
By combining AI-enabled technology platform, clinical support and high-touch concierge – we provide a personalized care pathway for your people at any stage of their MSK journey.
2. The “hypothetical” savings pitfall: Self-serving metrics conundrum
MSK conditions (low back, shoulder, neck, hip or knee pain) make up about 15-20% of spend for most health plans and 50% of that is avoidable waste – attributed to price variation and unnecessary utilization. It is important to note than 10% of members cost 90% of spend and these high-need, high-cost (HNHC) members typically have varied needs, co-morbidities, require multiple pathways and most of these members typically DO NOT voluntarily participate in the chronic pain management point solutions. Further there is no established correlation of pain score reduction or reduced intent of surgery to actual reduction in overall spend.
This does not mean that the needs of members who either enroll themselves or are “approved” for these programs are not important. People in pain are not productive. It is super important to address acute, chronic or rehab needs of each member in a timely manner to get them more actively engaged in work. However most participants who voluntarily sign up for these programs have low to moderate risk, are motivated to exercise regularly and generally are open to surgery alternatives.
To save cost, health plans and employers must look at eliminating waste. The good news is that 80% of waste is recoverable. However this requires a pragmatic strategy build on a robust technology foundation. The strategy includes managing persistent high-cost utilizers, reducing price variation between providers, improving quality by optimizing process, value-based payment and value-based plan design.
Given that 90% of the health plan spend is concentrated in 10% of the population, our digital musculoskeletal solution goes beyond clinical care and uses analytical tools to predict high-need, high-cost (HNHC) members who are likely to have costly surgical events, and intervene at the right time to prevent unnecessary surgeries.
3. The “digital-only” pitfall: One-size fit all
Healthcare is going to the cloud. Consumer expectations have changed as more people were introduced to virtual care services during COVID-19 pandemic. Digital musculoskeletal (MSK) services provide the same or higher quality of care in the most convenient setting for them. The digital model of delivery is ideal for for complex conditions such as chronic pain, which requires both physical and behavioral health support, and that has been inadequately addressed in traditional physical settings.
Like everything else in life, many people prefer and will continue to use in-person care for their needs. Further, there are many services closely associated with musculoskeletal care such as imaging, injections and surgery which can’t be delivered digitally. The digital musculoskeletal service provider should not leave the hands of an employee just because her needs are better addressed in an in-person setting.
Instead of digital-only approach, our enterprise-grade digital MSK solution uses a hybrid digital-first approach that focuses on optimizing care utilization process by using digital services as an anchor that improves quality and cost outcomes in the entire musculoskeletal continuum of care. For example, even when post-surgical rehabilitation starts with one or more digital sessions, members may choose to do the follow-up online or in-person (where available) with their physical therapists.
Digital-first also means that if and when members are better served in an office or outpatient setting, the referral and care continuation process is made easy and seamless for them.
4. The “$0 copay or nothing” pitfall
For a number of years now, digital health vendors have been demanding $0 copay, while at the same time not aligning their own payments directly to value. The cost of 100% subsidy is often absorbed by employers or health plans based on the assumption that the utilization of these “high-value” services may reduce the cost of more expensive downstream services.
However, as long as the cost of any digital service is more than $0 and its utilization is not directly associated with direct savings (please see point 2), this additional cost will somehow make its way into premium (or higher deductible) in the future.
Digital services are in general lower cost than physical in-person services and that means that a percentage cost-sharing contribution of digital service will also be smaller than the alternative (for example, a cost share of 20% of $50 is smaller than 20% of $150). Most digital health providers ask for 100% subsidy because a) you can’t beat free and b) the vendors don’t have the right infrastructure in place to process complex cost-sharing structure.
Like most other benefits, employers and health plans should have the flexibility to define their cost-sharing in a way that leads to better decision making by the members. Our smart benefit design tools provide maximum flexibility to experiment with different cost-sharing models, including aligning employee’s out-of-pocket costs with the value of the digital health services. This approach improves utilization of high-value services and discourages the use of inappropriate, intensive surgical options.
5. The “Cherry-picked” evidence: Led by marketing
Cherry-picking subjects based on subjective criteria can bias the results and even invalidate the clinical study. Many digital health companies don’t follow the rigorous clinical trial study models that are required of biosciences and pharmaceutical companies. Some digital MSK solution providers make their selections based on an assessment form and often leave members out of their program based on their own subjective criteria such as ‘member activation’ – meaning members with no demonstrated history of self-management of their condition. With “flexible” eligibility criteria, the study’s population may not be representative, the results can be misleading, the study cannot be replicated, and the results could even be manipulated.
The other problem with clinical trials by digital health companies is related to outcome switching. Since these trials are not registered in advance, it is relatively easy to find a positive result by changing the main outcome measure after looking at the data or by using a different type of analysis to the one originally planned. With enough data dredging you are guaranteed to find something that can be published, even if that “something” is a false or ‘made up’ discovery.
We believe that digital health companies must not shrink from demanding proof of value of their products and services and all of us must continue to streamline and accelerate the process for collecting evidence. We also believe that a prospective randomized controlled trial provides the highest form of clinical and economic evidence — evidence that could help drive adoption. At Sprite Health, we use decentralized clinical trial (DCT) direct-to-member remote model to collect member data in the home or natural environment. This leads to more robust and accurate clinical study results.
Leading employers choose Sprite Health to get better outcomes at lower cost – over 30% cost savings, reduction in unnecessary surgeries, opioid dependence, and absenteeism. In addition they provide their people an elevated experience with a single point of access for all musculoskeletal conditions at every stage of their journey. From prevention to postoperative rehab – all in one app.