Why Managed Care Organizations Must Consider the Effect of COVID-19 on MSK Care

All across the country, and in fact globally, musculoskeletal (MSK) care has become difficult if not impossible for most patients to access because of the COVID-19 pandemic. These injuries may be piling up on couches and porches across America as many go without help. Many hospital-based physical therapy (PT) centers and private PT practices have paused providing in-person assessments and care to avoid close personal contact that increases the risk of spreading the virus.

Although access to MSK care has contracted, the urgent need for these services has not. MSK disorders affect half of all American adults, with more than 126 million Americans over the age of 18 reporting being diagnosed with one of these conditions. These disorders have a significant impact on the health and quality of life of those affected, with approximately 18 million reporting an MSK disorder prevents them from performing daily activities, including walking unaided, bathing, and using the bathroom.

Beyond the pain and limitations experienced by individuals, MSK disorders also exact a high economic cost, affecting employers in every industry as well as insurers:
• MSK disorders account for $213 billion in direct and indirect costs, according to a CDC survey. 
• Back and neck pain alone are responsible for 290.8 million lost workdays, according to one study.
• Employers spend $20 billion a year on MSK disorders, accounting for 17% of their total healthcare budgets.
• Direct medical expenses cost payers a total of $130 billion.

Related: Could the US, World Benefit From "Whole Person Care" Program?

These numbers are projected to continue to grow substantially as the number of older Americans increases.

Even before the COVID-19 pandemic, there was a large unmet need for PT and other MSK care in the U.S. Lack of access to that care can not only lead to poorer outcomes and greater need for surgical intervention, but also to higher healthcare costs. Fortunately, these issues can be successfully addressed by redefining how this care is delivered to those who need it.

The short-term impact of COVID-19

The first challenge is meeting short-term MSK needs during the COVID-19 pandemic; although, in the case of this pandemic, short-term is a relative concept. With the number of cases still increasing across the country, no definitive treatment protocol, and a vaccine projected to take 12 to 18 months to develop and test, patients will continue to have significant difficulty accessing care for the foreseeable future. In addition, vulnerable patients - including people over 65 and those with underlying health conditions that put them at higher risk for COVID-19 - are unlikely to quickly return to crowded settings like healthcare facilities.

The medium-term impact of COVID-19

When hospitals begin to perform elective MSK-related surgeries again in the medium-term, a flood of patients will require pre and post-op PT and recovery care. It’s unlikely that traditional PT practices will be able to handle this sudden increase as they ramp their operations back up. In addition, many smaller practices may not be able to reopen, creating further pressure as demand far outpaces supply.

Beyond its impact on healthcare delivery supply, that pent-up demand likely will negatively impact workplace productivity and medical loss ratios (MLRs) and rebates later this year, as those with unmet medical needs begin to seek care for conditions that have exacerbated during the crisis. Further, the opiate crisis is likely to exacerbate as people self-medicate to deal with the isolation resulting from weeks and months of social distancing.

An innovative model for MSK care

The solution to these short- and medium-term challenges is a new model for MSK care that incorporates both technology and individually tailored care created and guided by clinical experts, experienced PTs, and behavior-change coaches. This new approach should harness the power of telemedicine via a website and mobile phone app, while ensuring that the care each patient receives is carefully tailored to her or his specific needs, whether focusing on a single or multiple MSK problems.

Key elements of an effective model for MSK care during the pandemic and beyond include:

• A hybrid model that combines the convenience of technology with the personalization of human guidance. Users should be able to access on-demand video exercise and recovery sessions tailored to their needs, pain severity, and fitness level. The model should also include access to skilled PTs and coaches who can provide guidance, answer questions, and troubleshoot problems users encounter when performing the recommended therapy.

• Easy access with multiple entry points. People should be able to access care via an online portal or an app on their phone or any other device, from the convenience of home or other locations.

• An easy-to-use digital assessment tool. This tool should collect the right information to guide people along a path to recovery using an individualized, evidence-based approach. It should triage users and recommend outside medical care where appropriate.

• Live behavior-change coaches to help motivate users to stick with their recovery program through completion, with the goal of achieving a significantly higher adherence rate than is achieved with a traditional approach. Constant progress tracking and feedback for the patient should be included and will also encourage adherence.

• Continuing care and support until the condition improves and the user can return to performing self-care, work, and leisure activities. In place of a limited number of in-person PT visits and expensive medical and surgical interventions, users can get as much or as little support as they need.

• Lower costs. This model can lower the high costs of our current approach to MSK care by reducing expensive medications, imaging tests and surgical interventions.

This redefined model is the innovation we need now to ensure that those suffering from MSK disorders can access the care they need during and beyond the crisis. Even when medical offices are closed, people can easily seek the guided intervention they need to regain mobility, reduce pain, avoid worsening symptoms, and reduce the high costs associated with surgery and medication.

The good news is that this new model already exists, and the current crisis is heightening demand from insurers and employers. It represents the future of MSK care, opening access for hundreds of thousands of those who will want to mitigate pain so they can get back to their work and life again long after the pandemic ends.

Mark Luck Olson is CEO of RecoveryOne, formerly known as Trainer Rx. A 30-year healthcare veteran, Olson is known as a health tech strategist who can accelerate performance and top line growth. His areas of expertise include government healthcare markets, market development, consumer engagement, and health management and delivery models.