Addressing Musculoskeletal Health In The Workplace: Strategies For 2023 And Beyond

A comprehensive approach to prevention and treatment strategies

By Zack Papalia and Louise J. Short, Brown & Brown

Musculoskeletal Well-Being: Considerations for Employers and Employees

Musculoskeletal (MSK) health is a top cost driver for employers across the United States. Over one-half of the US adults report MSK pain annually, contributing to over $420 billion in annual spend (Joseph L. Dieleman, 2020). Furthermore, low-back pain has been identified as the leading cause of disability in over 160 countries worldwide as of 2022 (World Health Organization, 2022).

For employers, the impact of MSK disorders extends beyond direct medical expense, significantly impacting productivity, absenteeism, and presenteeism. Low back pain, for instance, accounts for more than 264 million lost workdays per year.

Developing a comprehensive treatment and prevention strategy is key to mitigating the direct and indirect costs of these conditions. Merging traditional treatment options with innovative solutions such as virtual MSK treatment, centers of excellence (COE), and medical second opinion services can generate significant cost avoidance for organizations while dramatically improving employee health outcomes.

Evolving the Intervention Mindset

MSK disorders have traditionally been seen as a risk for physical, labor-intensive occupations. However, the actual impact and risk of MSK disorders extend across demographics and industries and cover a broad range of conditions such as low-back pain and carpal tunnel in more sedentary, white-collar environments.

While occupational risk factors can, and do, play a role in the development of MSK disorders, lifestyle factors - physical activity, diet, body weight, and more - can also significantly impact the risk of MSK disorders.

Because of this, MSK health should not be addressed in a silo. For example, individuals experiencing chronic pain are at significantly increased risk for developing behavioral health disorders. In addition, those with MSK disorders and behavioral health conditions report a more than 60% increase in missed days of work annually compared to peers with no behavioral health comorbidity (Business Group on Health, 2022).

Furthermore, the National Institutes of Health has shown a direct link between chronic pain from MSK conditions and the risk for substance abuse (National Institute on Drug Abuse, 2020). Employers interested in helping to mitigate the impact of MSK conditions on employees are strongly encouraged to develop a comprehensive, holistic approach incorporating behavioral health resources.

Evaluating & Optimizing Your Ecosystem

From the most basic access-to-care standpoint, employers must ensure that plan designs reduce access barriers while making treatment convenient and affordable—which is critical to helping members engage proactively. Considerations should be made for local and regional differences in provider networks, referral requirements for physical therapy, COE, and direct cost to members.

The more barriers to care that exist, the more likely it is that members will avoid care until the issue has developed into a more chronic, severe state.

There are a few key pieces to the prevention puzzle to consider when crafting a plan design for MSK disorders:

● Physical Therapy and Chiropractic Care

Help employees understand the difference between physical therapy – administered in the United States by Doctors of Physical Therapy (DPT) – and chiropractic care – administered in the US by Doctors of Chiropractic (DC). While there are exceptions, DCs are often more focused on holistic treatment, addressing patient MSK needs while also evaluating lifestyle and other related risk factors. DPTs are typically more involved in the traditional treatment path for orthopedic pain and injury.

● Alternative Treatment Solutions

The Covid-19 pandemic forced the evolution to virtual approaches to treat many conditions, MSK included. As a result, virtual physical therapy and non-pharmaceutical pain management solutions have now emerged, offering high-quality MSK treatment without geographic or time barriers.

● Utilization-Based Billing

Employers should pursue virtual solutions that offer utilization-based billing rather than a subscription model to minimize financial risk, essentially incorporating virtual providers as any other in-network provider for MSK treatment.

● Second Opinion Services

These are helpful in plans as additional layers of quality assurance are shown to significantly improve outcomes and control spending, particularly for high-cost claimants. A knee replacement, for example, can cost over $30,000 on average (BCBS, 2019). Yet, despite the invasiveness of the procedure and associated cost, there is strong evidence that it is often over-utilized. Second-opinion services can add another layer of guidance to a member’s prognosis and proposed treatment.

● COEs

Shown to address the variations in cost and quality of care, COEs are groups of providers with proven track records of quality outcomes selected to perform specialized services with favorable financial arrangements for employers. There are several strategies employers can use to implement COEs, including carrier networks, independent COE networks, and direct-to-provider contracting.

Finally, organizations truly invested in preventing the long-term development of MSK disorders must also evaluate workplace culture and the promotion of healthy lifestyles. Flexible schedules, hybrid work opportunities, integrating workplace ergonomics, fitness, and nutrition programming, and providing paid time to seek treatment are just some ways employers can promote a culture of well-being beyond just acute MSK health.

Employer Strategy in 2023 and Beyond

Employers interested in advancing their MSK health strategy in 2023 should begin by evaluating their current population risk, demographics, and solution ecosystem. Comprehensive data analysis should be conducted to identify top risk drivers within MSK. Not only will this inform the severity and incidence of MSK disorders across a population, but it will also aid in developing a comprehensive strategy, including prevention, early intervention, and treatment options (e.g., virtual MSK, surgical COE, non-surgical COE).

Additionally, understanding population demographics and solution delivery modalities (digital vs. in-person engagement) will further increase the likelihood of success and impact.

Once these questions are answered, and gaps and opportunities in the existing network are identified, a roll-out of solutions over time will likely make targeting, communicating, and engaging with the solutions easier for all involved. Before implementing interventions and solutions, it is also vital to have a measurement strategy and decide on key metrics in advance. These metrics should, at a minimum, include engagement, health outcomes, patientreported outcomes, and financial impact.

As with many chronic conditions, there is no single solution to address MSK disorders. However, understanding your goal as an employer, the full spectrum of MSK conditions, and the ever-evolving landscape of prevention and treatment options will provide a foundation to develop a comprehensive strategy for workforce well-being and safety as well as management of employer-sponsored health plans in 2023 and beyond.

References

BCBS. (2019, January 23). Planned knee and hip replacement surgeries are on the rise in the U.S. Retrieved from Blue Cross Blue Shield: The Health of America: https://www.bcbs.com/the-health-of-america/reports/ planned-knee-and-hip-replacement-surgeries-are-the-rise-the-us

Business Group on Health. (2022, September 28). Addressing Musculoskeletal Conditions and Physical Therapy Needs with Virtual Solutions: Key Trends and Employer Considerations. Retrieved from Business Group on Health: https://businessgrouphealth.org/ resources/addressing-musculoskeletal-conditions-and-physicaltherapy-needs-with-virtual-solutions

Joseph L. Dieleman, J. C. (2020). US Health Care Spending by Payer and Health Condition, 1996-2016. Journal of the American Medical Association.

National Institute on Drug Abuse. (2020, April). Common Comorbidities with Substance Use Disorders Research Report. Retrieved from https://nida.nih.gov/publications/researchreports/common-comorbidities-substance-use-disorders/ part-2-co-occurring-substance-use-disorder-physical-comorbidities

World Health Organization. (2022, July 14). Musculoskeletal Health. Retrieved from World Health Organization: https://www. who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

Zack Papalia , Ph.D., MPH, is a Senior Population Health Consultant for Brown & Brown and leads the Musculoskeletal Health committee. With a background in education, public health, health promotion, and lifestyle well-being, his current work focuses on optimizing employee well-being programming and developing strategies to ensure broad access to high-quality care.

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Dr. Louise Short , MD, MSc, Partner, is the National Clinical Leader for Brown & Brown . She has a focus on making the healthcare system work better and has in-depth knowledge of many of the innovative health companies in the marketplace trying to solve key issues facing employers and workers. She is a member of the Business Group on Health’s Cost & Delivery Institute and Global Health Institute.