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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.

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.