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 these touchpoints to improve employee engagement with musculoskeletal benefits

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 benefit.

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 employees during enrollment is a great way to start the communication. This opportunity should be used for explaining musculoskeletal benefit design, options and answering coverage specific questions for each employee.

New Member Welcome

Post enrollment (after the employee has signed up) is an opportunity to determine satisfaction and understanding of the musculoskeletal benefit 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.

Risk Assessment

Many digital musculoskeletal programs use assessments at time of sign up. Use this touch point to engage members, 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. 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.

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. Lower back pain alone results in 2.6 million ER visits a year. Identifying such members and helping them locate in-network providers in alternative cost-effective setting such as remote physical therapy 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.

Sprite Health’s corporate musculoskeletal program 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.

Member Segmentation for better outcomes in musculoskeletal (MSK) care

Musculoskeletal spend for employers and health plans has grown steadily over the years, and a large percentage of this spend can be attributed to members with multiple, complex health care needs.  These “high-need, high-cost” (HNHC) members make up to 5-10 percent of all members in any given population group, but they account for nearly 60 – 75% of  musculoskeletal care spending in a given year. 

In addition, there is high level of persistent utilization in musculoskeletal spend.  When analyzed over a ‘longer’ period of time, about 4-5% of members contribute 35% of the spend.

Leading health plans and employers are now looking inside their claims data and turning their attention to high-cost sub-population, with common musculoskeletal conditions such as back, neck, knee, hip and shoulder pain.  Through member segmentation by conditions, different needs can be identified, and tailored policies and budgets can be set for homogeneous member groups. For example, by segmenting high- and medium-risk members based on chronic back pain, members can be offered tailored digital interventions for managing back pain, such as specific exercises, education, self-care and biometric devices for remote monitoring.

In conclusion, member segmentation by musculoskeletal condition provides a range of benefits to employers  and health plans who are aiming to provide high-quality health benefits for their people.  The segmentation data analysis helps in selecting a homogeneous target population and tailor an intervention to different member types within a population. As health care continues to move toward a person-centered approach, and big data and analytics become even more ingrained, employers and health plans should consider the significant benefits of member segmentation analysis for integrated care and support its use.

We are happy to help.

Sprite Health’s corporate musculoskeletal program 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.

 

Request a free demo

We’ll get back to you promptly.

Digital Musculoskeletal (MSK) platform for employees: Why now?

Musculoskeletal (MSK) conditions such as back, shoulder, neck, hip or knee pain affect 1 in 2 employees every year. The cost to treat MSK conditions is greater than treatment of many other chronic health conditions.combined and makes up about 15-20% of spend for most health plans. In 2016, Americans spent an estimated $380 billion on MSK conditions. That’s far more than diabetes ($111.2 billion) and ischemic heart disease ($89.3 billion). Besides the huge cost impact, MSK conditions are also the leading cause of disability and absenteeism. Back and neck pain alone impacts 1 in 3 employees, and leads to the loss of 12 working days per year.

Despite the high prevalence of musculoskeletal conditions, most employees don’t know the right place or pathway to start when they experience muscular pain or injury. A number of the visits are made to suboptimal settings that either delay the treatment or add unnecessary cost to treatment. For example, people presenting to ER with minor musculoskeletal conditions such as tendinopathy, back pain or sprains etc. represent more than 35% of all ER visits. Our fragmented musculoskeletal system of care is getting bigger every year with no change in quality or outcomes.

More than 80% of MSK spend is attributed to surgeries, related imaging and drugs. Employers and health plans can avoid these costly surgeries by offering conservative care options like physical therapy to address back and joint pain. Unfortunately going to physical therapy twice a week in-person is not realistic and now with COVID-19, it is not even an option.

Permanent shift in working

Musculoskeletal (MSK) pain is most often caused by an injury to the bones, joints, muscles, tendons, ligaments, or nerves. However, for most employees working in service industry, MSK pain is caused by overuse, poor posture or prolonged immobilization.

The duration of the pandemic has already exceeded the early predictions of many analysts; now eight months into COVID-19 and with rising cases (again) around the world, it appears that telecommuting trend will continue for the remainder of the year and well into 2021. While this is somewhat of a good news for employees from work flexibility standpoint, unfortunately the change in our working environment is resulting in exacerbation of all three risk factors that lead to MSK pain. Additional factors such as lack of sleep and increased stress due to the pandemic are also contributing to work-from-home injuries.

What does it mean for employers who want to assist employees with physical pain? A number of them had already made huge investments in making workplace safer for employees, with optimal comfort and ergonomics. With so many people working from home hunching over their laptops in repurposed kitchens & bedrooms, the remote work environment requires that the health benefits must evolve to supporting employees’ physical and mental health needs at home.

Making help available

In this period of extreme uncertainty, organizations can support their people and foster a physically safe environment at home with a digital musculoskeletal (MSK) platform.

The digital therapy platform for MSK conditions provides employees a single point of access for virtual musculoskeletal care, from the safety of their home. Whether it is acute or chronic MSK pain, the platform makes it easy to access help, ensuring that everything from self-help tools to high-quality providers are visible, affordable, and available virtually as well as in person. In addition, the digital MSK platform provides tools and resources that helps employees choose the right treatment options and care settings for their situation and condition.

The investment in the right digital musculoskeletal solution can reduce your health spend significantly and provides your people an elevated, integrated experience with a single point of access for MSK conditions across the continuum – from preventive to postoperative rehabilitation. One place to go, one app for all musculoskeletal care, from the safety of their home.

Like any other condition, MSK conditions are not monolithic. People with musculoskeletal pain have varied needs, which can’t be addressed with a one-size-fit-all point application. An effective digital care solution for employees with musculoskeletal pain provides multiple pathways, each designed to support the specific needs of employees for their unique situation and stage of their journey. These pathways range from preventive care (a good option for healthy people who want to prevent MSK pain or injury), to acute, chronic as well as pre-surgery, surgery and post-surgery rehabilitation.

MSK Preventive care pathway

MSK preventive care pathway proactively identifies ergonomic, behavioral and bio-mechanical risks for potential pain or injury and translates them into effective corrective actions through job role specific, ergonomic and mobility education.

MSK Acute care pathway

Acute care pathway is triggered when you experience minor injury, aches and pain. Digital MSK platform provides quick access to diagnosis and early management advice from MSK specialists using a phone or a video call; get a tailored plan specifically designed for you that includes at-home exercises, education, advice, and direction towards self management.

MSK Chronic pain management pathway

Acute pain, if not properly addressed, can progress to chronic pain if not addressed correctly. Employees living with chronic pain have a higher risk of developing depression. The digital care pathway for employees with chronic musculoskeletal pain provides a multimodal personalized approach that combines the right interventions (physical, psychological, and educational) for maximum impact.

MSK Pre/Post Surgical Rehab Pathway

Most important component of successful surgical outcome is what a member does when they are not in the surgery. The digital MSK platform optimizes the musculoskeletal surgical pathway, by integrating prehab and rehab into the surgery support process. Prehab provides members with the right physical and psychological conditioning to best prepare them for successful surgical outcomes and faster recovery time. The postoperative rehab gets members back on their feet, so they can continue living a healthy and productive life.

Summary

Instead of instilling the artificial belief that life will get back to the way it was, progressive benefit leaders are confronting the reality that working may never be ‘normal’ again. They are focusing on developing individual, team, and organizational resilience, and are continuously sensing, learning and exploring new solutions for their people. The digital musculoskeletal (MSK) platform is one of these solutions that can provide the employees an affordable, safe and more convenient way to prevent and treat pain.

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.

5 pitfalls to avoid when selecting a digital musculoskeletal program

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.

Transforming musculoskeletal care: Shifting from reactive to proactive, prognostic and connected care

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.