People with pain are not productive. Employers concerned about making their employees productive have realized that status quo of just handing over member Id card for insurance is not going to be enough. Their employees are routinely experiencing complexity and multiple handoffs across different providers. Without any health advocate on their side, they have to figure things out on their own. Progressive employers have started to look beyond their medical plans and are considering digital musculoskeletal (MSK) solutions that can reduce pain, improve function and address the underlying pain conditions.
Not all musculoskeletal benefit solutions are created equal, which makes the task of finding a good and effective solution a bit difficult. We have put together a checklist for you to facilitate your decision making process. The guide below assists in the evaluation of both the strategic and tactical components of an offering to help you evaluate the partners who will provide the most effective digital musculoskeletal solution that meets your organization’s needs.
Question for providers:
What are the components of your solution suite, and what’s the lifetime journey for the members?
Given the explosion of new ‘point’ digital health apps (in diabetes, nutrition, maternity, physical health, mental health etc.), plan sponsors are having a hard time selecting best-of-breed solution for each major condition impacting their member population. Each solution has its own way to enroll and engage – leaving members confused with tons of emails and messages coming from all directions.
Majority of the existing offerings in MSK/Pain category are simple apps that provide physical therapy over a video platform. These solutions serve an important but ‘narrow’ purpose, something that employers and health plans are trying to avoid due to extra administrative burden.
An effective digital MSK solution is comprehensive and provides a single point of access for musculoskeletal care at every stage of their pain journey, from prevention, acute, chronic to post operative rehab.
It meets people where they are and makes it frictionless for them to access both digital and in-person care, based on their specific needs.
How engaged are members to their treatment plans?
70% of the treatment plans are not followed through by members, which leads to ineffective outcomes. Engagement is key for adoption of digital MSK solution. The engagement is not downloads of the app, and it is about members following up on their treatment plans.
An effective musculoskeletal system is built on a data-driven infrastructure to measure and report the engagement correctly. It uses performance analytics to identify the members most likely to engage at the lowest possible cost. By engaging the right member with the right message—and the right incentive—it motivates members to complete high-value activities.
Do you provide access to both digital and in-person care?
2020 has been a monumental year for telehealth adoption. After getting to 80% to total visits in Q2 of 2020, we are now seeing it leveling off at around 15-20%, which is a very healthy range. But this also means that majority of the musculoskeletal (MSK) care delivery remains (and will likely to be) in-person.
At the end of the day employees are looking for omni-channel experiences in musculoskeletal healthcare. They want to be cared for the way they want to be cared for in that moment, and that may mean going into a clinic and getting care or maybe it means talking to a physical therapist through a video call. Or maybe it means engaging with a digital app in which there is no provider involved, all AI-driven and technology-driven.
A good musculoskeletal solution takes a digital-first strategy to use digital services as an anchor that improves quality and cost outcomes in the entire musculoskeletal continuum of care. This approach also makes sure 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.
How does this solution uses data and what insights does it provide?
The digital MSK solution should provide empirical evidence to plan sponsors to truly understand the impact of their healthcare investments. It should analyze musculoskeletal medical and drug claims and other related data sources to highlight waste, gaps in access and improvement opportunities .
The analytics should also provide clarity into how members use healthcare services, who high-risk members are and how to intervene effectively to lower costs, improve quality and outcomes.
An effective musculoskeletal benefit solution puts the right information in front of the right people, at the right time. It enables users to get at the information that they need to make informed data-driven decisions.
In addition, the analytical tools in the musculoskeletal benefit solution routinely check data against key quality measures, identify gaps in care and generate appropriate alerts for members, caregivers and administrators.
How does this solution reduces cost by addressing supply-side waste?
50% of musculoskeletal spend is waste. This waste is attributed to over-diagnosis, over-treatment, pricing variation and inappropriate utilization.
Contrary to a common belief, over-diagnosis is not confined just to traditional medical field, it also spans to physical therapy, podiatry and chiropractic – where the treatments are primarily driven by assessment of factors such as posture, range of motion, alignment, weakness, balance and coordination.
The good news is that 80% of the waste is recoverable, by executing multiple pragmatic strategies on the back of a solid technology foundation.
To identify inappropriate utilization, an effective digital solution for MSK monitors the utilization intensity and identity specific patterns and root causes. Through evaluation and predictive modeling, it identifies the population segments that have the potential to become high cost claimants before claims even begin to accrue. Once identified, it addresses the unique needs of high-need high-cost (HNHC) members in the most efficient manner.
To address variability in pricing, an effective musculoskeletal solution uses value-based payment models like reference pricing, bundled payments and COE contracting. These payment models reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low value care.
How do you segment member population with musculoskeletal conditions in risk categories and address their specific needs?
Like most health conditions, musculoskeletal pain is also not monolithic. People with musculoskeletal pain have varied needs, which can’t be addressed with a one-size-fit-all point application.
80% of musculoskeletal (MSK) spend is concentrated among 15% – 20% of members. A small percentage of these members are persistent utilizers of musculoskeletal services, but most of these members are ‘new’ high cost claimants in a given year.
Our medicalized and interventional care system is designed around an acute care paradigm, where the focus is to address (rather than prevent) pain. This system of care is not incentivized to find issues early to reduce downstream costs.
An effective musculoskeletal benefit solution takes a proactive approach to pain management by mitigating the risk factors that causes the injuries or onset of acute musculoskeletal pain. 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.
In addition, it predicts expensive surgical events in future and have system in place to intervene with the right care pathways, at the right time.
Flexible benefit designs
Does your solution support smart benefit designs including member cost-sharing? If so, does it align the cost-sharing to value?
A musculoskeletal benefit solution is no good without the tools that allows for benefit customization. Ever since digital health solutions were first introduced a decade ago, employers have been asked to subsidize 100% of the cost. With an explosion of digital care solutions in each category, this is unsustainable for most employers.
A good musculoskeletal benefit solution provides customized cost-sharing options to employers that fit their specific needs.
Instead of one-size-fits-all approach to benefit design, it provides maximum flexibility in experimenting with benefit designs, for example, waiving co-pays and deductible for preventive, chronic care with demonstrated value. This enables plan sponsors to implement new approaches such as value-based-insurance design (V-BID), reference based pricing, transparency tools to align employee’s out-of-pocket costs with the value of the health services.
Does your solution support integration with other partners and benefits in the ecosystem?
The benefits ecosystem is getting complex every year. No digital solutions including the ones for pain management should exist in vacuum. To reduce administrative hassles for benefit leaders and navigation nightmare for members, the musculoskeletal benefit solution must integrate with other benefits and resources in the ecosystem.
An effective musculoskeletal benefit solution provides simplified experience that reduces the amount of effort required on the part of the members to access pain management programs and information. Starting with registration, the benefit solution provides members a simplified experience to better understand all of the musculoskeletal benefits available to them; understand what their choices are, and what questions to ask to make the right choice for their family.
In addition, the top musculoskeletal benefit solution providers train their care teams on employer’s specific suite of benefits, allowing them to guide their employees to available resources and in-network providers.
Sprite Health provides a digital-first destination to employees and their family members for all of their pain management needs. In addition, our cost-containment analytical tools and services eliminate waste to drive better financial outcomes. 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 quick access to on-demand virtual care, evidence-based digital care programs for pain management, supported by our white-glove concierge service.