Wear and tear conditions are the leading driver of musculoskeletal-related care and costs in the United States.
Stress, strains, and even long hours of sitting have taken a toll on Americans’ health, affecting 1 in 2 adults. Musculoskeletal (MSK) conditions also cost the U.S. health care system $420 billion in 2018—more than any other chronic condition.
Chronic Conditions, by Cost to U.S. Health Care System, 2018 ($B)
By analyzing data, we can understand how to contain costs associated with certain MSK conditions and provide better care. The new Americans in Motion report, part of our Improving Outcomes Series, explains how.
Inside the costliest chronic condition: wear and tear
Wear and tear conditions account for about two-thirds (63.5%) of utilization cost among the three MSK subgroups, which also include major trauma (18.6%) and autoimmune conditions (16.9%).
Wear and tear conditions may be strains, sprains, or more serious tears of muscles, tendons, and ligaments; ruptured discs in the spine; or degenerative disease of the joints.
Pain in the back and neck, or spine, dominate wear and tear conditions, accounting for 42% of spending, with surgery and other services driving costs.
Back conditions alone account for 29% of costs, and present the greatest opportunity to change utilization and spending.
MSK conditions often accompany several medical and behavioral health comorbidities that impact the total cost of care. For instance, average spend on patients with both a wear and tear condition and obesity is 80% higher than for those without obesity. Similarly, 35% of patients with MSK wear and tear conditions have claims related to behavioral health, and the average spend for these patients is 66% higher than for those without behavioral health conditions.
Three options for caring for wear and tear conditions
When it comes to caring for wear and tear conditions, some of the most common treatments can be expensive and yet ineffective.
The report presents three options to improve care and reduce spend for patients with musculoskeletal pain:
- Create clinical profiles: Organizing patients into clinical profiles helps identify those at risk for surgery who may benefit from underutilized conservative measures such as physical therapy. Studies show that adherence to physical therapy, especially early during treatment for low back pain, reduces wear and tear utilization and costs.
- Identify high-performing providers: Selecting providers based on high performance ratings can make a positive impact on treatment.
- Explore behavioral health: Musculoskeletal conditions often go hand in hand with anxiety and depression. Seeking behavioral health treatment can decrease the need for surgery, saving approximately $460 per patient per month (PMPM).
A data-driven, holistic approach to MSK care is critical to reduce unexpected and unnecessary costs and drive healthy outcomes. After a dip during the COVID-19 pandemic, requests for advanced imaging for MSK diagnoses are on the rise, making actionable insights important to improve care and contain costs.
Download the Americans in Motion report to learn more.
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Evernorth Guided Musculoskeletal Care
Through predictive models and a digital first personalized experience, Evernorth Guided Musculoskeletal Care connects patients at high risk of MSK conditions to the right care, at the right in a seamless approach that supports the whole person. In addition to concierge-style guidance to providers and treatment options, the comprehensive offering also includes mental health support, physical therapy, coaching and wellness to deliver better health outcomes.