According to research published by the United States Bone and Joint Initiative, musculoskeletal disorders such as arthritis and back pain affect more than 50% of adults in the United States and are often the largest clinical cost driver for commercial employers, accounting for upwards of 20% of annual medical spend.
To put this in perspective, most employers spend twice as much on musculoskeletal conditions as they do on cardiovascular disease. Yet, employers often focus less attention and resources on musculoskeletal conditions, making it challenging to control costs and improve outcomes for employees with these disorders.
The high cost of musculoskeletal conditions is driven primarily by procedures and surgical interventions, but other areas of significant spend include diagnostic imaging and medications. Pain medications used for therapy are typically among the top five pharmacy cost and utilization drivers for employers. High rates of narcotic prescriptions are particularly concerning given increasing rates of substance abuse disorders involving opiates.
Musculoskeletal conditions and their associated economic and social costs pose a significant challenge for the U.S. healthcare system, particularly for employers focused on managing population health and ensuring their employees are healthy, happy and engaged.
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More spending, questionable improvement in outcomes
Population-wide studies show that spending on back and joint pain increased significantly over the past two decades, despite stable prevalence of these conditions.
A 2009 paper published in the Journal of the American Board of Family Medicine showed that in the decade leading up to 2005, rates of spine imaging (MRI) increased 307%, steroid injections increased 271%, opioid analgesic prescriptions increased 108%, and spine surgery increased 220%. This has resulted in a 62% increase in per capita spending on musculoskeletal treatments over the last decade based on research done by the United States Bone and Joint Initiative.
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In addition to medical cost, treatments for musculoskeletal conditions can have a significant impact on employee productivity, absenteeism, mental health and overall well-being. Recovery times for the most invasive surgeries can last several months. Depression, psychiatric disorders and increased risk of prescription pain medication abuse are also common.
In addition to higher treatment costs and risk, research shows that many invasive musculoskeletal interventions provide little or no long-term benefit. For example, a study published in the New England Journal of Medicine randomly assigned patients with sciatic back pain to either surgery or conservative treatment and found no difference in pain or perceived recovery one year later.
Prices are soaring for specialty drugs used to treat critical illnesses such as cancer, Hepatitis C and multiple sclerosis, as well as more common conditions like high cholesterol. Right now, employers are largely bearing the brunt of the cost, and health care experts and leading employer organizations like the Minnesota Health Action Group are looking for collaborative, sustainable, solutions to this challenging situation.
Employers need to understand the clinical characteristics and risk drivers of musculoskeletal disorders in populations so they can implement strategies to manage these conditions. Musculoskeletal conditions can impact employees in every demographic and are not isolated to a specific job type, making effective identification and management even more critical.
5 strategies to tackle musculoskeletal population health management
With the right analytical tools and knowledge, employers can follow a data-driven approach for effective condition management. Here are five strategies to get started:
1. Know your data and your population.
Healthcare claims data provides a comprehensive window into the cost and utilization trends of an employee population. Analyze claims data to understand the most prevalent musculoskeletal conditions in your population, as well as patient demographics and key cost drivers. Back pain is often the most significant medical cost for employers, and spouses often account for a disproportionate amount of spend, sometimes driven by elective surgeries. Analysis of pharmacy data can also help identify pain medication usage and potential abuse patterns.
2. Encourage alternative therapies.
Multiple studies have shown non-surgical therapies to be equally effective as surgery for certain musculoskeletal conditions. Design benefits to encourage use of physical therapy, medications, and complementary therapy. Further, provide employees and family members with access to behavioral management programs and counseling support to help manage stress and temporary discomfort.
3. Provide treatment decision support and care management services.
Equip employees and family members with services and tools to help them navigate the healthcare system and make informed treatment decisions. There are numerous services and tools that provide expert advice to help employees weigh the pros and cons of surgical intervention. Further, implement care management programs to help patients more effectively manage pain, medication use, physical therapy and workplace absence.
4. Guide patients toward high performance networks and providers.
The cost and quality of musculoskeletal treatments and surgeries can vary widely. Consider developing value-based care programs and benefit designs to more appropriately align cost, quality and outcomes. For example, several large retailers have partnered with leading medical facilities to develop Centers of Excellence for joint replacement and spine surgery, including bundled payments, waived out-of-pocket costs and covered travel expenses.
5. Help employees appropriately manage pain medications.
Pain medications are often an important component of a broader treatment plan for musculoskeletal disorders. Due to the risk of opiate addiction and the link between pain and mental health disorders (e.g., stress and anxiety), employers should work with medical carriers to ensure physicians monitor medication usage and provide employees access to Employee Assistance Programs and community-based support.
Taking action on a major healthcare cost driver
Musculoskeletal disorders are challenging to manage due to the breadth of conditions, variety of treatment protocols, and lack of predictable, long-term outcomes. With the right data-driven approach, employers can understand the prevalence and cost of musculoskeletal disorders across their eligible populations, and implement focused initiatives to help employees navigate treatment options, manage pain and return safely to work.
