Why wellness should be a part of value-based plan design

According to RAND corporation, about 80% of large employers in U.S. offer wellness programs. Despite a significant spend (over $8 billion annually) by employers on these programs for over 20 years, participation by employees as well as the program’s ROI remains poor.  We can think of three possible reasons:

  1. Lack of targeting
  2. Lack of evidence
  3. Lack of accountability

Lack of targeting

Wellness programs typically are not geared towards demographics of specific employee population. Plans based on VBID (value-based insurance design) are targeted for specific populations affected by specific conditions.

For example, free gym-membership is great for employees who are motivated to stay healthy and can take out time to exercise, not so much for someone who is struggling with chronic conditions, commuting for hours to get to work and feels the pressure of higher out of pocket costs. For such individuals, a plan that offers a lower out of pocket costs for certain evidence based services (and medications) goes a long way in reducing barriers to better health.

Lack of evidence

Karen Pollitz at Kaiser  summarizes it well –  “For a lot of things companies do, it’s all about being evidence-based. But with workplace wellness programs, it’s faith-based: A telling finding from our survey is that most employers who offer wellness programs don’t collect data on whether they work.”

On the other hand, VBID design is based on reducing barriers for high value services offered by providers who follow evidence based guidelines.

Lack of accountability

There are so many factors that go into helping an employee or dependent get “healthier”. Most wellness programs act like silos and provide a very nichy service, which makes it hard to determine if any improvements are a result of a specific program or something else.

VBID plans on the other hand are outcomes based that use clear metrics, incentives and payments design for enhancing access to preventive services as well as improving health outcomes by reducing barriers to effective treatments.

We believe that the impact of workplace wellness programs can be significantly improved if these are incorporated into an overall value-based plan design.

 

Narrow network and value-based-care are not the same thing for employers

Narrow networks have been in the news for the last few years. A number of carriers have started to offer this to employer-sponsored health plans as well as to individual marketplace. This concept is marketed differently than what it really is.

Narrow network is essentially a higher discounting method based on an assumption that a provider will offer more concessions when their competitors are excluded from the network. The higher discount is supposed to bring down the overall cost of the care for self-funded employers. Typically layered in tiers, narrow network becomes Tier 1 and broad PPO network is offered at a higher cost.

This is no more than a short term fix because it does not address the basic problem of accountability. By becoming part of a narrow network, a health system is not declaring that they will be accountable for the care they provide to your employees, that they will report on the outcomes that are important to you, that they will align their payments to meeting your quality measures or they will provide more visibility and better experience to your employees and their families. None of that. All they are promising is a better discount. Given the lack of transparency and huge variability in healthcare costs today, that does not mean much.

Even if the agreement between the carrier and network is value-based, employer don’t gain much from that. If the provider delivers on the promise of reducing costs in a risk-reward model, provider and carrier split the savings, employers not so much. If that does not happen, providers don’t make more in incentives, but the employers still pay for the higher costs.

In other words – Heads I win, tails you lose.

This approach will work only if the employers themselves are part of the equation, have full control over what benefits they require from the ‘narrow network’, what outcomes are important for them and what contractual arrangements will make sense to get value for the care.

Health Benefits Engagement vs. Experience: know the difference

The term “employee benefits engagement” has become one of the most talked-about topic today in HR today. But what exactly is benefits engagement? How does it differ from benefits experience? And to what extent should benefit leaders be focused on or concerned about it?

Employees’ experience with their health benefits is rooted in emotion, and they own it. They formulate the image of their experience as a result of all the interactions they have with the benefits provided by their employer. It is the cumulative impact of all touch points that determines the overall experience.

Benefits engagement, on the other hand, is each direct interaction that an employee has with the benefits. Contacting a call center for understanding coverage, visiting a doctor, receiving a claim statement are all interactions. All it takes is one negative interaction to damage the memory of the entire experience and the association with their benefits, which ultimately leads to a disengaged employee.

Companies need to think beyond individual interactions and focus on the ongoing journey to improve the ROI of their benefits spend.

Just like a customer’s journey does not start when the customer buys something -it starts when a customer wants something or has a need. The same concept is true for health benefits. The employee’s benefit journey should be an integrated and enduring experience that evolves as the employee interacts with her benefits at every touch point.

Traditionally companies have left benefit interactions to multiple providers, each narrowly focused on their own service or a program. The result – most programs are unused, employees are unaware, and benefits teams are constantly looking for answers.

It is time to take charge. Benefit leaders must recognize and define all aspects of their benefit strategy around delivering great employee experiences across multiple benefits. They need to ensure that every touch point (both physical and digital) is optimized and working to deliver engaging and satisfying experience. They should deploy new technologies to deliver integrated, consistent, contextual, and personalized engagement often to achieve better business outcomes.

While many companies recognize the importance of engaging employees with their benefits, they may find it difficult to know where to start, what to prioritize, and when to act.

At Sprite Health, we work hard every day to help self-funded employers design simpler, lower-cost, higher-value musculoskeletal benefits. Sprite empowers your people with simple, transparent, upfront pricing for services and treatments that address their specific needs. With hands-on support by our concierge, your people get a seamless, personalized experience that makes accessing, understanding, navigating and paying for care effortless.

Leverage mobility to drive employee engagement in health programs

We’re entering an era, where everyone likes their experiences to be immediate and catered to their preferences. That’s why your benefits communication should evolve from intranet-based links to human-centered, year-round mobile interactions to engage employees.

Even though many benefit plans and providers currently offer their own mobile apps and websites – most of these apps are rarely used by employees. Multiple logins, inconsistent, incoherent experience are big barriers to utilization.

It is time for you to have your own fully integrated benefits mobile app. An app that integrates all benefits into a single place and provides a simple, unified, consistent experience to your employees and families.

The goals of your mobile app should be global availability, simplicity, personalization, and a one-stop shop for all benefits.

With your benefits experience mobile app, your employees can access and utilize all benefits in a way that works best for their family. To further the impact, you can provide them a simple way to check coverage, view medical records, tests, Rx history, claims and even make payments using integrated HSA account.

The personalized digital experiences delivered through your mobile app can make benefits’ support immediately accessible to any employee, anywhere, and at any time. This will increase utilization of your programs and improve employee engagement and satisfaction.

Leverage these touchpoints to improve outcomes & employee engagement

When most benefit administrators focus on employee engagement, they think about open enrollment. Of course choosing the right coverage is an important step, but it’s only one piece of the puzzle. It is equally important for employees to know how to find and use care included in their coverage.

Why? Because care and coverage go together and when employees are engaged to improve their health and wellness, they are more likely to take positive action and change behaviors.

Employee engagement can be improved by creating a positive and consistent experience across her journey. This requires a systematic approach of orchestrating touchpoints — a touchpoint being any interaction between the employee and her health plan.

The key is coordinating and integrating the touchpoints so that they seamlessly meld together.

Here are some touch points longitudinally mapped throughout the employee journey, and you can leverage each touchpoint to support the others in the journey.

Open Enrollment

Reaching out to members during enrollment is a great way to start the communication. This opportunity should be used for explaining plan design, options and answering coverage specific questions for each member.

New Member Welcome

Post enrollment (after the member has signed up) is an opportunity to determine satisfaction and understanding of the plan collateral, design and customer service for future improvements. During this interaction, be sure to track responses that require timely follow up for members needing additional assistance.

Health Risk Assessment

Many employers provide incentive to employees for completing assessments. Use this touch point to engage members, enhance wellness programs, segment your population for better targeting and determine the appropriate follow-up plan for each segment.

Preventive Care Outreach

Employees aren’t used to seeking preventive care – they may be confused about which tests to ask for, may view preventive care as costly and aren’t aware of the free benefits provided under the ACA. This issue leads to members avoiding care until the last minute or using the most expensive option available. Use the right timing to reach members for preventive care.  Calls scheduled on the employee’s birthday can be very effective.

Care Gaps

If your plan design include VBID elements, and it reduces the out of pocket costs for members to use high quality services, you can use this as an opportunity to not only explain the gaps in care , the impact of this gap on member’s health, but also what services are needed to close the gap, the costs and the right providers to help close the gap.

Care Plan Adherence

The adherence to the plan of care is important in improving health outcomes and reducing overall cost of care. Start with a proactive reminder, and follow-up with calls to determine root causes and identify reasons for non-adherence. The overall approach should be to inform, educate, and assist members with adherence challenges.

ER Over-utilization

ER is expensive. A number of visits to ER are unnecessary or avoidable, and majority of such visits are taken  by a small segment of members. Identifying such members and helping them locate in-network providers in alternative cost-effective setting can reduce costs for employers as well as employees. You can use this touch point to educate them on appointment scheduling, video visits, nurse line etc.

Care Transition

Appropriate care transition from one setting to another can have a significant impact on employee’s understanding and compliance, readmission status, and overall satisfaction. It should however be done in a  timely manner (within 48 hours of discharge) to ensure the continuity of care.

We understand that most benefit teams are simply not naturally wired to think about the member’s journey through out the year.  For teams that master it, the reward is cost reduction, better outcomes, higher employee satisfaction and loyalty. It is well worth it.

At Sprite Health, we work hard every day to help self-funded employers design simpler, lower-cost, higher-value musculoskeletal benefits. Sprite empowers your people with simple, transparent, upfront pricing for services and treatments that address their specific needs. With hands-on support by our concierge, your people get a seamless, personalized experience that makes accessing, understanding, navigating and paying for care effortless.

Member Segmentation for better outcomes in self-funded plans

The health care delivery model is changing.  New models like ACO, PCMH, COE have evolved in the last few years. The payment structure in these models is typically aligned to quality measures, but the metrics and the operational processes required to achieve them are driven by large carriers (and CMS) or health systems or both. Even though self-funded employers contribute significantly into their revenue, they have largely been left out from the discussion.

Member segmentation is one such example – Large health systems and carriers serving diverse populations are trying to follow different risk stratification models including ACG, HCC, ERA, CCC, Charlson Comorbidity Index, MN Tiering etc. While these models may serve their interests, not necessarily yours. For example, Medicare uses HCC (Hierarchical Condition Category) model that assigns a risk score based on chronic or serious condition and demographics, which works for 65+ population they cater to. HCC model may not be suitable for your population.

Similar to large health systems, PCMH providing primary care to your employee populations are also trying different methods for their risk stratification including primary , secondary, tertiary prevention and terminal care. Again, these models may not exactly work for your employee population.

The employee and dependents population in mid-large employers is typically spread out in multiple geographies often served by multiple health systems. If the metrics and processes are not defined by the employer and left out to the systems or carriers, employers will end up facing the same issue that they currently face with PPO models: Data inconsistency and limited insights into overall plan performance.

As you start thinking about about benefit design, start looking at segmenting your employee population. For each segment, you can define the right care models, incentives and discounts on copayments for your employee population and align the payments to your provider partners to meeting those metrics.

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How to deliver high-quality musculoskeletal (MSK) benefits at lower cost?

In the COVID-19 era, benefit leaders are struggling to find the right composition of their 2021 benefits package amongst complex, unknown, and ever-changing workforce challenges. Despite the challenges, there has never been a better time to rethink the benefit design that would meet the evolving needs of future. A future where the workforce will likely spend a considerable amount of time online, at home.

The pragmatic employers and health plans are looking inside their black box of benefits and picking areas of potential opportunity, where they are getting poor value for their investments. Musculoskeletal (MSK) is one of those benefits for most of them. Musculoskeletal (MSK) conditions are highly pervasive (1 in 2 adults have it in a year), highly expensive (15 – 20% of annual spend) and highly wasteful (50% of total spend is waste).

Employers and health plans need a fresh approach. An approach built on first principles that addresses two things – a) provide high quality musculoskeletal (MSK) care to ALL of their people, anywhere and anytime and b) reduce the cost by eliminating waste.

This approach is digital-first, meaning it provides the care quickly, uses virtual models to deliver care in the safety of people’s home. This approach is integrated, and provides support for all MSK conditions, at any stage (acute, chronic, surgical or post-surgical) across the continuum. This approach is tech-enabled and data-driven. It uses dashboards and predictive analytics to inform benefit operations and infrastructure; and uses this data to design high impact strategies to produce high-quality outcomes at lower costs.

This systematic approach to optimizing musculoskeletal (MSK) benefits can be divided into 10 steps.

STEP 1: WASTE ANALYSIS

No one likes to waste money. In this environment where a number of businesses have lost customers and revenue, wasting money should be considered a sin. Yet, over 50% of musculoskeletal (MSK) spend is wasted, which can be attributed to a number of factors including inappropriate tests and procedures and price variation.

The musculoskeletal (MSK) health system is United States is highly fragmented and interventional. People with MSK conditions have varied needs (based on severity of their issue, co-morbidities etc.), and they face a system which is highly medicalized. For example, even though it is widely known that physical therapy should be the first-line treatment for most MSK conditions, its utilization is under 15%. Most specialists in pain medicine, orthopedics don’t encourage patients to explore conservative treatments even when it can be in their best interest.

To optimize spend, an effective digital MSK system provides deep insights into where you are wasting money. It evaluates every test and procedure for appropriateness to ensure it contributes to advancing the people’s health. In addition, it highlights high-value providers and services who provide quality services at lower costs.

STEP 2: FORECASTING & TARGETS

Health benefits is probably the only function in businesses which does not use a proactive approach to cost management. The next year’s cost projection is essentially based on past claims and medical trend. Underlying condition profile and cost-driving factors are not often considered at renewal.

Having targets aligns everyone (benefit leaders, consultants and vendors) to a common goal and brings the necessary discipline required to systematically improve cost and quality outcomes.

To optimize spend, a digital MSK solution enables benefit leaders to set cost, quality and outcomes targets. It includes a forecasting feature to guide them where the cost is heading for the remainder of the plan year. The visual dashboards in the system provides real-time visibility into how actuals are lining up against the forecast and flag specific areas that should be addressed to hit the targets.

The more precise and real-time understanding of musculoskeletal benefits performance makes it possible to fine-tune your strategies in accordance with the new and evolving needs of your population anytime of  the year.

STEP 3: POPULATION SEGMENTATION, RISK STRATIFICATION

20 percent of the member population accounts for over 80% of overall musculoskeletal spend for an employer. To control cost, it is important to find the best ways to meet these members’ needs. While some of these high-cost, high-needs members are easy to find from data (4% of members contribute to 35% spend over two years, persistent high-cost members), majority of high-cost, high-need members are difficult to spot in time in any given year.

A data-driven musculoskeletal care solution uses predictive modeling and analytics for segmentation and risk stratification. Both concepts together help understand the musculoskeletal needs of each sub-segment, so interventions and services can be better planned.

Segmentation is grouping people by what kind of musculoskeletal care they may need as well as how often they might need it. The digital MSK health solution analyzes past claims to understand what services were used by members in each segment, and the main combinations of care that people might need in future. It supports prioritization and a phased approach to implementation. The segmentation can be done by age/gender, acuity (acute, chronic, rehab), office (location x vs. location y), conditions among other options. Grouping people by MSK health conditions (state and stage) distinctly identify each group’s needs from another.

In addition to segmentation, a digital MSK health solution enables risk stratification to provide an understanding of members who have the greatest risk of utilization of expensive services such as surgeries, injections etc.

STEP 4: MUSCULOSKELETAL (MSK) TREATMENT PATHWAYS

The outcome of population segmentation is a set of needs per segment.

To optimize benefit composition, an effective musculoskeletal solution uses a pathway approach to each need. These pathways define predictable course, in which the different tasks or interventions are defined in a sequential manner. Pathways can be measured for cost and quality, and optimized over time.

Both virtual and in-person high-value services are considered, for each intervention. For example, while the initial MSK evaluation be done virtually, both in-person and digital therapy options are considered for treatment.

For each intervention, the digital MSK care solution identifies providers based on cost, quality and access. For example, in the surgery pathway, the surgery centers of excellence (COE) are identified based on highest quality, lowest cost and proximity to the target population.

STEP 5: MUSCULOSKELETAL (MSK) NETWORKS

Employer centric health networks

Most provider networks are designed from the carrier’s perspective (cost and network adequacy goals) and are not flexible to meet the needs of employers and their member population. A digital MSK care solution takes the data-driven approach to design musculoskeletal network around the specific needs of employer’s member population in each segment, as manifested in the care pathways.

It is not scalable to build network partnerships for each single service. The digital MSK care system consolidates providers across multiple interventions based on the volume of ‘high-value’ needed services. Consolidating providers helps in clinical integration as well as care coordination. The goal here is to find the highest quality, lowest cost, most accessible, clinically integrated providers who provide high-value services that meet the needs of your people. One underlying assumption in the musculoskeletal (MSK) network design is that all selected providers can electronically interface with each other across the MSK continuum to exchange utilization and quality data.

STEP 6: PAY FOR VALUE

Unlike traditional PPO networks that pay providers based on fee for service models, an effective digital MSK health solution aligns provider payments to performance and value (quality/cost).

Threshold Fee for Clinical Network

The numerator ‘quality’ is built on expected outcomes, response time, member experience relevant to your employees’ needs & clinical conditions.

It utilizes machine learning models to assess which value based payment models best meet the company’s budget and address the quality and cost expectations.

These models includes P4P, risk-adjusted primary care, severity-adjusted bundles, shared savings, etc that reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low value care.

STEP 7: BENEFIT AND INCENTIVE DESIGNS

A digital musculoskeletal (MSK) solution promises a high-value musculoskeletal care, which delivers better outcomes and lower costs. Since it is often offered as an add-on option, the employers and health plans create benefit and incentive designs to incentivize members to use these high-value services. Some organization waive the copay, some others provide rewards when members these services.

The digital MSK health solution provides maximum flexibility in experimenting with benefit designs to align member incentives.  This enables companies to implement new approaches such as value-based-insurance design (V-BID), reference based pricing to align member’s out-of-pocket costs with the value of the health services. This leads to a win-win situation for plan sponsor and the member.

STEP 8: MEMBER ENGAGEMENT

An effective digital musculoskeletal (MSK) therapeutics solution enables benefit leaders to market and communicate the solution benefits in a timely, personal and meaningful way to their people. It provides an intuitive user experience for employees to quickly sign-up and start using the services.

The system uses behavioral health science, along with rewards and member incentives, to motivate members to actively engage with their health. It leverages intelligence tools to proactively identify members who need recommended care and initiate customizable notifications regarding follow-up therapy sessions or behavioral health support. By engaging the member with the right message and the right incentives, it motivates members to complete high-value activities – leading to higher adherence.

In addition, the solution improves health outcomes with a proactive, collaborative and continuous care coordination approach that creates a personalized care journey for each member to address their specific needs.

STEP 9: DATA STREAMING AND COLLECTION

The technology architecture of a digital musculoskeletal (MSK) system is centered with the member at the center. It ensures that all stakeholders are connected with data that is accurate and timely.

A digital MSK therapeutics uses video chat and messaging, interactive education using videos, motion detection (and capture) using camera to better support members in their recovery and improve adherence and ultimately, clinical outcome. The therapists gain a lot of actionable data that assists in their management of each case and shift to a more proactive approach to health care.

Digital MSK therapeutics also changes the way care is provided, with the member completing regular outcome scores online, and an increase in pain flagged to the therapist remotely, giving the clinician an opportunity to make an informed decision at the right time.

STEP 10: REPORTING AND ANALYTICS

Data-driven decisions are smarter decisions. A digital MSK solution does the heavy lifting to infuse intelligence into your everyday workflow, and provides empirical evidence to truly understand the impact of your musculoskeletal investments. Easy-to-use reporting and advanced analytics provides actionable insights and savings recommendations to benefit leaders to help them make informed decisions. The dashboards provide real-time understanding of enrollment, engagement, utilization, spend and outcomes.

In addition, the analytics assesses the effectiveness of care management interventions, identify compliance with evidence-based care standards and compare the utilization and financial results of people participating in digital MSK health programs with those who are not.

Sprite health helps employers and health plans get the most out of their musculoskeletal benefits. Our digital MSK HUB 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. MSK triage ensures that members get help and advice to pick the right treatment at the right time. 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. 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.

5 ways a digital MSK solution can boost engagement & adherence

COVID-19 has not only changed where we work; it has also changed how we work. Hunching over a small laptop screen for a full working day, for days on end, is very different from doing a bit of work from home over a weekend. In a recent survey, 92 percent of chiropractors said that patients are reporting more neck pain, back pain or other musculoskeletal issues since the stay-at-home guidance began.

A majority of them are not looking to go to physical therapists or chiropractors to fix their problems. Reason – it is expensive and cost every time you go, only available in ‘office hours’ (not an option with kids at home) and risky because the virus is still out there.

It is not like it was much fun to go the clinic anyway. Traditional, in-person appointments are always difficult to fit into a normal workday schedule. For many people, it means an afternoon appointment. If you account for travel time and an hour-long visit, that person could lose two hours of his/her work day. Avoiding that scenario means scheduling an appointment before or after work hours, an option most clinics do not provide. Even when you are able to see the physical therapist or a chiropractor, most of them in traditional clinic setting are still following an outdated process. The therapist shows what exercises will help, give a printout of the exercise program. As soon as you get home, you forget most of it and those sticky figures on a photocopy of a photocopy is hard to understand.

It’s not surprising that up to 65% of people don’t fully adhere to their plans of care.

What is adherence to musculoskeletal (MSK) plan of care?

According to WHO definition, an exercise adherence is “the extent to which an individual corresponds with the quantity and quality of exercise, as prescribed by their healthcare professional.”

To be adherent

  1. The individuals should be exercising
  2. They should be completing the right # of reps and sets
  3. They should be following the correct techniques.

Why is adherence important?

Let’s start with the obvious. The exercise is beneficial for key clinical outcomes such as pain, physical function, and quality of life.

People who adhere to their prescribed exercises are significantly better at achieving their goals and demonstrate a greater increase in physical function. The prescribed exercises for musculoskeletal conditions are targeted specifically at certain joints or muscle groups (depending upon the injury or surgery) and both options (not doing it at all or doing it incorrectly) lead to suboptimal clinical outcomes.

It does not help if the only way to get help is for you to drive to the clinic and see the therapist in-person.

What affects engagement and adherence?

Generally members are faulted for non-adherence, with reasons such as low motivation, pain, poor self-efficacy, and reduced social support. This is not entirely correct. Businesses don’t fault customers if customers are not getting value from their products. The same rationale applies to musculoskeletal care delivery. Lack of access, personalization, adequate guidance, motivation, reminders, reinforcement, psychological therapy and support from therapists are also big factors responsible for poor engagement and adherence to MSK plan of care. The traditional method of providing written information and activity monitoring in physical therapy is regularly completed via a paper handouts, which are often illegible, lost, forgotten about or generally confusing for members to understand.

In addition, outdated plan designs with deductibles and copays per visit create barriers for members when they want to get help.

An effective digital Musculoskeletal (MSK) solution fixes this problem.

A paradigm shift

An effective digital musculoskeletal (MSK) program shifts the control of the treatment from the therapist to the member, making them accountable as their own “therapist,” with the clinician acting as coach. This doesn’t mean that members are being left to get on with things on your own. Rather, the starting point is the individual member, their needs, ideas, goals and the premise that members can and do already have skills and resources to get better. The therapist’s role is to address beliefs that may hinder recovery and provide the member with the skills to successfully manage their musculoskeletal condition.

An effective digital musculoskeletal (MSK) solution is available anytime and anywhere. It assumes home environment as the default therapy setting, and builds the treatment framework that is member driven.

The knowledge, guidance, measurement and monitoring typically addressed in therapist’s clinic is brought to the member’s home. Instead of relying on physical interaction, the program promotes an active, non-invasive management approach involving the use of education, exercise, functional activity training, and behavioral and lifestyle changes. The member is considered an active participant in the recovery process and develops greater control in managing their condition.

An effective digital MSK solution uses a data-driven approach that incorporates features to increase engagement & adherence by using self-monitoring, guided problem solving, education & remotely monitoring adherence rates more objectively. This technology-enabled solution provides a collaborative environment in which the member and therapist work together to develop a member-preferred approach, including feedback and adjustment of the plan of care.

There are 5 adherence-boosting elements of an effective digital musculoskeletal solution, that delivers on better engagement and adherence. These elements are:

  1. Self monitoring and positive reinforcement
  2. Guided problem solving
  3. Tailored Education
  4. Remote Monitoring
  5. Provider Accountability

Self-monitoring and positive reinforcement

A data-driven digital musculoskeletal (MSK) system enables the therapists to provide virtual exercise prescription in a rich, engaging application instead of static paper handouts. Its intuitive app interface helps the member through her prescribed exercises, providing feedback and encouragement in real time.

The members are able to record the completion of their daily exercises, as well as provide their input to the coach. Activity monitors are provided to members that gives them real-time insights on their physical activity and exercise frequency. This helps them take control and become more accountable.

It has been demonstrated in multiple studies that members are more compliant when their therapist provides them with regular and positive feedback. Members who know they are performing the task correctly are more likely to be more engaged. The digital MSK system enables continuous feedback by the coach during the episode, instead of routine 1:1 virtual physical therapy sessions. This is delivered via asynchronous channels such as messaging in between sessions. Not only does it improve exercise techniques, it also act as a reinforcement to complete the exercises.

Guided problem solving

Various studies have demonstrated that members when prescribed 4 or more exercises had a lower rate of compliance than those prescribed 2 or fewer. This is common sense. Anyone who works a full time job or looks after a family does not have time for 8 exercises a day. More importantly is this actually necessary in order for them to get better?

An effective digital musculoskeletal (MSK) program is built on shared decision-making and guided problem-solving. It tailors physical therapy exercise program demands to the member. The goals are specific, measurable, action based, realistic and time framed.

The exercise plans involve gradual exposure to movements, positions, and activities that were once difficult to achieve. Members are introduced to regular exercises in small steps that they feel comfortable to manage, and guided to perform self-mobilization techniques and active exercise sequences to help manage symptoms. For example, in post-surgical rehab, the therapy is divided into multiple phases. The first phase starts immediately after surgery when the body part may be immobilized while pain and swelling subside. Then comes a series of progressively challenging exercises to restore range of motion, stability, and strength. The final goal is to return the patient to a pre-injury activity level. When therapists and members come together during 1:1 video sessions to reassess the symptoms, this approach providers member with evidence and reinforcement that a self-management approach is effective.

Tailored education

Tailored education is a core intervention for people with musculoskeletal (MSK) conditions. Members who are informed have more confidence in self-management practices, more likely to be active participants in their care and adhere to treatment.

Much more so than with traditional care, virtual models of care (supported in digital MSK solution) include a larger educational component. Because the therapist is not physically present to assist with movements or joint stabilization, the onus is much more on the member to learn these techniques and practice them continually.

Virtual physical therapy models place emphasis on the interaction between therapist and member. The live video environment on a smaller screen limits the distraction that members encounter and fosters communication and education between member and provider.

The education component includes a thorough explanation of the musculoskeletal condition, symptoms, mechanism, and management plan and involves teaching and counseling to modify behavior. Effective techniques include repetition, spacing of new information over multiple sessions, and limiting the quantity of material to important points.

Done properly, education bolster confidence and improves self-management, which leads to higher adherence to plan of care.

Remote monitoring

In the traditional in-person setting, the self-assessment of daily activity by members own assessment can be highly variable and subjective. An effective digital musculoskeletal (MSK) system uses an automatic monitoring system that provides an objective measure for adherence.

The virtual musculoskeletal system collects range of motion and other clinical measures and provides an intuitive dashboard to therapists for remote clinical review. If a member is off balance or moving incorrectly, the system provides feedback to the member and flag the issue for their therapist.

An oversight by therapists helps to ensure that members adhere to their prescribed physical therapy programs and complete their exercises safely and accurately. An effective digital MSK program enables both member and her therapist to see if the member performed physical therapy exercises correctly, how often exercises were performed, and how the member is responding to therapy. The therapist has the flexibility to customize exercises and help reinforce that prescription through an engaging experience.

Provider accountability

In the current system, the providers are not held accountable for quality, outcomes or cost. For example, despite demonstrated benefits of guideline-based care, only 54% of physical therapists provide care that aligns with recommendations. After the member visit, the provider provides a service, bill for that service and collect money for that service – regardless of the impact the service had on the member’s well-being.

Since the providers are paid irrespective of the result, they are not always motivated to increase member engagement and adherence to the plan of care. Most of them don’t have systems to track outcomes, nor are they equipped to track what happens outside their clinic.

An effective digital MSK program is accountable for cost and outcomes. It follows evidence-based guidelines to deliver care and measure the effectiveness of the program. It checks the compliance of all the interventions included in the program, care standards and introduce clinical audits as a part of the process, to identify areas in these standardized care processes for continuous quality improvement.

By offering transparent, bundled pricing for different treatments, an effective digital MSK provider is aligned to members and plan sponsors and work collaboratively with them to improve engagement and adherence.

Summary

A digital MSK solution is built to deliver care that truly address the specific needs of the member, while equipping them with the knowledge and skills they need to achieve long-­term success. To achieve higher engagement and adherence levels, an effective solution leverages self monitoring and positive reinforcement, guided problem solving, tailored education, remote monitoring and provider accountability.

Sprite health helps employers and health plans get the most out of their musculoskeletal benefits. Our digital MSK HUB 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. MSK triage ensures that members get help and advice to pick the right treatment at the right time. 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. 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.

How to help employees find the correct path to musculoskeletal (MSK) treatment?

Imagine waking up with an acute back pain. Ask yourself what will you do, where will you go?

Some of us will turn to Dr. Google, some will call their Telehealth service, the lucky ones may be able to see their primary care physician on the same day. Not so lucky will go to ER.

Most recently available data suggests 37% visits for musculoskeletal (MSK) issues are made to primary care offices, compared with 31% to surgical specialists and 16.5% to medical specialists.

Essentially – the answer is all over the place. The pandemic is likely to have a big impact as well.

COVID-19 has not only changed where we work, but also how we work. In a recent survey, a significant percent of workers reported increased inactivity, insomnia, and alcohol consumption. People are hunching over their laptops in repurposed bedrooms and kitchen, which is causing a lot of them experience neck, shoulder or back pain. 3 out of 4 people with back pain stated that they have used internet to look for health information for themselves or their loved ones. We all know that online information is highly general and lacks context, creates more doubt and confusion over symptoms. This can lead to inaccurate self-diagnosis, inadequate advice and a prolonged treatment path.

MSK assessment and triage ensures that people with musculoskeletal (MSK) problems are directed to the right treatment in the right place at the right time. It provides clear, consistent and personalized information on prognosis, treatment options and self-management strategies to people with MSK conditions.

Fast access to right treatment options

Delays can be harmful to the member’s wellbeing whilst also adversely affecting the quality of care. Digital MSK assessment and triage reduces the timeline between someone deciding they need help and the time they receive clinical advice. It provides an online approach to finding the right care, and is accessible 24-hours a day; anytime, anywhere.

Digital MSK assessment uses a smart questionnaire which asks member specific questions related to their symptoms in an interactive discovery session. The tool picks up any worrying signs and symptoms more quickly and algorithmically analyze answers to identify the correct path to evidence-based treatments, in-app or in-person.

Because cost of treatment is a significant barrier to care in the US, it is important to combine suggested clinical pathway endpoints with cost-sharing data. This allows members get a side-by-side comparison of cost by providers for each suggested treatment. In some cases, where a self-management approach is appropriate it provides members access to tailored education resources and app-guided exercises, saving time and money.

Standardization of referrals to high-value care

Many muscle and joint problems can be successfully and safely self-managed without the need to see a health professional. The treatment guidelines for members at the initial stage of most musculoskeletal (MSK) conditions advocate that the diagnosis is based on history and physical examination rather than scans. Digital musculoskeletal (MSK) assessment helps in collecting information about patient history, needs and current symptoms to help clinicians perform better diagnosis and triage.

Digital approach to finding a correct path to treatment leads to standardized assessments and more consistent outcomes. When combined with network quality data, the triage helps in consistent treatment referrals to the recommended high-quality providers.

Cost Reduction

Getting members involved in their health results in best improvements in outcomes and cost savings. Members are often confused navigating multiple types of treatments before reaching the right course of action.

Where you start in the episode of care affects your outcome. The sub-optimal first-line treatment can be up to 25 times more expensive than the optimal option.

By guiding them to the right treatment options, digital MSK triage reduces waste on un-necessary, expensive imaging and treatments such as MRI, CT, Injections, surgeries etc.

Sprite health helps employers and health plans get the most out of their musculoskeletal benefits. Our digital MSK HUB 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. MSK triage ensures that members get help and advice to pick the right treatment at the right time. 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. 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.