Road to recovery: Patient advocacy, pain management critical for MSK

Part 4 in an ongoing series about MSK conditions and how advisers are changing their approach to treatment with new benefit solutions.

Benefit advisers know all too well how musculoskeletal (MSK) conditions can drive up claim costs. They secured the No. 4 spot among 19 of the highest stop-loss claim reimbursements in a 2024 report by Sun Life.  

That point hit particularly close to home for several industry leaders who learned valuable lessons from their respective MSK challenges. While three of the four who were interviewed eventually agreed to go under the knife, an elective procedure that often is considered a last resort, one decided to use his own company's service as a non-surgical option. 

Mark Testa, executive vice president of Regenex who's also a benefits adviser, chiropractor and licensed acupuncturist, received two rounds of platelet-rich plasma (PRP) injections. Nurse case managers and payers alike favor PRP as an alternative to surgery, he mentions.

Read the rest of the series here: 

• Part 1: Road to recovery: How MSK conditions transformed advisers' approach to benefits and care
• Part 2: Road to recovery: Are non-surgical remedies the solution to MSK?
• Part 3: Road to recovery: Self-funded care cuts through the noise
  

Since then, Testa has been extolling the virtues of this approach. "I try to educate other brokers because they might not know the clinical side of things like I do, like just paying for a less expensive surgery if you can avoid it, which is of no value to the member," he says, noting that surgery isn't always the best solution. 

The most likely outcome of back surgery in the U.S. is a second back surgery, explains David Contorno, founder and president of E Powered Benefits. Several years ago, he posted on LinkedIn a chart of 20 nations with the largest economies that compared two key metrics. The U.S. had not only the lowest life expectancy, but also spent the most amount of money by far. 

"Someone from another country commented on my post and said, 'Your healthcare costs are so high because Americans are so unhealthy,'" he recalls. "I disagree with that — I think it's the other way around: Americans are so unhealthy because healthcare costs are so high, and we don't have the money left over to buy healthy foods." 

Read more: How dieticians can improve health and lower benefits costs 

Promoting the importance of patient advocacy in combination with embracing a cash-pay model were key takeaways for Paul "Joey" Stone, VP of business development with Apta Health, which makes available to health plan members an expert they refer to as a "guardian" who ensures they they're admitted to the right facility and negotiates the best possible price on their behalf. 

The arrangement saves enough money for employers to eliminate out-of-pocket costs if they choose to do so by paying about 120% to 130% of Medicare vs. 250% to 300% or higher under most traditional health insurance coverages. "Our systems are designed to give the member the type of support from people who know how to navigate healthcare," Stone says.

Stay tuned for the final installment of this series, live Monday, on how this experience changed advisers' approach to practice management.