Musculoskeletal conditions are a massive source of health spending—accounting for $420 billion in 2018—and a new report from Evernorth aims to pinpoint where health plans could cut down on costs.
The study tracked medical and pharmacy claims data on 6 million people aged 0 to 64 from 2020 as well as insights from a broader population in 2018 and 2019. More than half of American adults experience some kind of MSK condition, the analysis shows.
It found that more than a quarter (27%) of patients experience MSK conditions attributed to "wear and tear," with neck and back pain representing the largest opportunity for savings. Such injuries include strains and sprains of ligaments, ruptured discs and degenerative joint changes. These wear and tear issues account for nearly two-thirds of health plan spending on MSK overall, according to the study.
Among wear and tear injuries, back and neck issues account for 47% of claims, according to the report, and addressing these concerns represents a significant opportunity for plan savings. Twenty-nine percent of health plan spending on wear and tear injuries is related to back pain alone, the study found.
Back conditions were also the largest driver of care use among the MSK conditions studied, and patients with back pain had significantly higher physical therapy and interventional pain injection use compared to other site-specific conditions, according to the study.
"And there is limited long-term improvement for many individuals receiving spine-related injections for pain management," the researchers wrote.
So what can insurers do to mitigate these costs? For one, take steps to identify patients at risk sooner, according to the study. Predictive models can flag patients who may still benefit from lower acuity services like physical therapy, which could avert unnecessary surgical procedures.
Greater adherence to physical therapy programs early in the onset of wear and tear MSK conditions can reduce pricey, low-value services like spinal fusion, according to the study. The analysts found 60% lower costs for early adherents to physical therapy in a two-year follow-up.
In addition, insurers can track high-performing providers that deliver better patient outcomes at lower costs, Evernorth recommends. Using scoring models can help identify docs that guide patients to evidence-based, cost-effective care, according to the report, as there is significant variability in surgical costs.
The researchers also found that treating behavioral health needs in tandem with MSK conditions can drive savings. The analysts found that 17.8% of patients with such conditions also reported comorbid anxiety, and 11.5% reported depression.
Tackling these issues together can drive savings of $460 per member per month, according to the study.
"Regardless of the presence of underlying behavioral health conditions, using cognitive behavioral treatment for individuals with low back pain can help reduce the need for surgery," the researchers said.