How employers can help achieve more inclusive MSK care

Musculoskeletal (MSK) conditions affect roughly half of U.S. adults and more than 3 in 4 Americans over 65.¹ They’re also among the greatest sources of medical spend, outpacing diabetes and cardiovascular disease. These conditions affect both employees and employers since they can have a profound impact on an employee’s quality of life and career stability. For example, back pain is the most common diagnosis responsible for sick leave, long-term disability payments and early retirements.² Perhaps it’s not surprising, then, that one survey found that 81% of employees agree that employers could be doing more to support those who experience chronic pain,³ for which many of the top causes are musculoskeletal.⁴

With the U.S. population aging and risk factors such as obesity rising,^5,6 MSK care is an area ripe for attention. That urgency can’t be disentangled from the grim reality of certain health disparities. Like most corners of health care, these disparities tend to be complex and compounding.

Take hip and knee osteoarthritis, for example. Though research shows no significant difference in prevalence rates among different racial and ethnic groups,⁷ there are profound disparities in health care utilization and health outcomes.⁸ Black and Hispanic Americans are far less likely than white Americans to have total knee replacement — as much as 30% less likely.⁹ When BIPOC patients do undergo orthopedic procedures, they’re more prone to complications within the first 90 days.¹⁰ They also face higher failure rates after total joint arthroplasty yet are less likely to have revision surgery than white patients. Those who do have revision surgery are more likely to experience infection and poor surgical efficacy.¹¹

MSK patients in rural areas face similarly disparities, including more limited access to care and fewer specialists. Rural Americans also have higher rates of comorbidities, such as obesity and smoking, that can increase their risk of MSK conditions and amplify their symptoms.¹² As researchers have noted, “It is unrealistic to rely on the physician workforce alone to provide adequate musculoskeletal care in rural communities.”¹³

The good news is that impact is possible. By taking a holistic view of employees and their varying needs, employers can take aim at these persistent health inequities and drive better, more equitable outcomes for those they employ. Here are a few steps well worth taking.

Virtual solutions: Making space for employees to obtain appropriate care

When accessing MSK care depends on proximity to a provider and readily available transportation, childcare and time away from work, that care is out of reach for many Americans. Research shows that 73% of patients miss at least one in-person physical therapy appointment.¹⁴ This is a particular threat for shift workers who typically can’t afford to take unpaid time off to attend multiple in-person appointments. Another challenge may be travel time. The average American spends 34 minutes in the car (provided they have one, which many do not¹⁵) to obtain medical care,¹⁶ with those in rural areas often subjected to much farther distances.

Employer-sponsored virtual solutions help erode these common barriers, making MSK care more accessible for all.¹⁷ These solutions include telehealth appointments with a licensed provider or online resources such as video exercises employees can perform on their own time.

Virtual solutions can also help to mitigate shortcomings that employees may experience in their medical care. For instance, rates of chronic pain are higher in rural areas than urban, yet research shows rural patients are less likely to have a provider recommend nonmedication interventions, such as physical therapy.¹⁸ Similarly, Black patients suffering acute back pain are 63% more likely to receive opioid-only therapy from a provider than white patients, who tend to receive physical therapy referrals along with opioid therapies.¹⁹ That disparity may stem, in part, from the provider’s own resource limitations and access issues. Just 22% of physicians provide care for 80% of Black Americans, and these providers report limited access to health care resources such as specialists.²⁰ Virtual solutions can help expand a provider’s toolbox and better meet patient needs — and employers can play a valuable role in filling in these gaps.

To meet the needs of diverse patient populations with varied preferences, digital fluencies and MSK conditions, employers should cover a wide array of virtual offerings. That might mean telehealth appointments with a provider, asynchronous video consults or self-directed digital resources, such as lessons on musculoskeletal anatomy or guided meditations designed to ease pain-exacerbating stress.

Second opinion services: Increasing diagnostic confidence for employees

Sub-specialty second opinions within MSK medicine are often far more accurate than a patient’s initial radiology-based diagnosis conducted by a non-specialist.²¹ In fact, research has found that more than 4 in 5 of these second opinions were more accurate than the first diagnosis given.²²

Yet getting a second opinion remains the exception, rather than the norm, as initiating and navigating the process often require high health literacy, health care access and resources. Employers can reverse that stubborn reality by covering — and clearly promoting — a second opinion service to all employees. By making second opinions easily accessible, swift and reliably covered, employers can ensure that such offerings promote equitable utilization and outcomes. And employers are increasingly taking notice, partnering with these services at a rapid clip. In fact, the medical second opinion market is expected to reach upwards of $9 billion by 2027, driven in large part by partnerships like these.²³

Specialized nurses and care advocates: Improving health navigation for all

Primary care providers are often on the front lines when a patient has chronic back pain or other MSK condition. But even the best in-the-moment care may do little to ease barriers, like low health literacy or financial anxieties, that can threaten treatment adherence and make the right care at the right time more elusive.

For instance, Latino and Black older adults suffering from chronic low back pain are significantly more likely to use emergency department services than their white counterparts.²⁴ They also tend to manage a higher number of prescription medications and experience more medication-related challenges, such as non-adherence or inappropriate medication use.²⁵

One powerful antidote to the stubborn status quo? Offering employees access to a concierge service that makes it remarkably easy for them to access high-quality, affordable care. When an employee experiences a pain flare, where should they start their journey to seeking care? When an employee is seeking an MSK specialist but is fearful of medical bills, how can they figure out their options? In moments like these, their health plan’s web portal for browsing in-network providers and facilities simply won’t cut it.

Instead of a one-size-fits-some offering, a concierge service provides targeted resources and guidance, tailored to the individual’s needs, concerns and health literacy level. For instance, for MSK and orthopedic conditions, as well as 9 other subspecialties, Optum® Specialist Management Solutions (SMS) connects patients with local, in-network specialists who regularly use high-quality ambulatory surgery centers. Empowering an individual with specific guidance on the next best step to take can make it easier for them to follow through — while delivering potentially significant cost savings, compared with accessing care at a facility plucked from the web portal. In fact, our SMS program has been shown to reduce targeted medical expenses for MSK, along with lower readmissions and reduced complications. That can result in far fewer work absences — as well as the reassuring sense that their employer is looking out for their well-being.

With programs like these, employees also have access to a specialized orthopedic nurse, who can engage in shared decision-making, coaching and even pre- and post-surgery counseling. They might help employees access resources for their behavioral health needs, connect them with pharmacy discount programs to bolster medication adherence or talk through in detail what to expect from surgery recovery and how to prepare at home. The specifics are just that: specific to the individual.

Just as no single factor can fully explain the health disparities that dot the MSK care landscape, no stand-alone solution can fully address them. But solutions that leverage a holistic, whole-person approach can help turn the tide, allowing employers to fill in some of the gaps that can prevent employees from receiving the care they truly need.

Learn more about Optum MSK Solutions for employers.

Sources

1. United States Bone and Joint Health Initiative. Musculoskeletal diseases and the burden they cause in the United States. February 2023. Accessed May 24, 2023.
2. Solumsmoen S, Poulsen G, Kjellberg J, Melbye M, Munch TN. The impact of specialized treatment of low back pain on health care costs and productivity in a nationwide cohort. The Lancet Discovery Science. 2022; 43:101247.
3. Harvard Business Review Analytic Services. The future of digital care: Tackling the costs of physical and emotional pain in the workplace. 2021. Accessed May 24, 2023.
4. Johns Hopkins Medicine. Chronic pain. Accessed May 24, 2023.
5. The Urban Institute. The US population is aging. Accessed May 24, 2023.
6. Centers for Disease Control and Prevention. Consequences of obesity. Last reviewed July 15, 2022. Accessed May 24, 2023.
7. Xu Y, Wu Q. Trends and disparities in osteoarthritis prevalence among US adults, 2005-2018. Scientific Reports. 2021; 11:21845.
8. Patel M, Johnson AJ, Booker SQ, et al. Applying the NIA health disparities research framework to identify needs and opportunities in chronic musculoskeletal pain research. Clin J Pain. 2022; 23(1):25–44.
9. Spira B. The drive for health equity: the need to use technology to reduce healthcare disparities in orthopedics. J Orthop Exp Innov. 2022.
10. Ibid.
11. Ibid.
12. Bush C. New models for the delivery of musculoskeletal care in rural communities. J Nurse Pract. 2020; 16(1):41–43.
13. Ibid.
14. Bhavsar NA, Doerfler SM, Giczewska A, et al. Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions. PLoS ONE. 2021; 16(5): e0251336.
15. U.S. Department of Health and Human Services. Reliable transportation. Accessed May 24, 2023.
16. Altarum. Travel and wait times are longest for health care services and result in an annual opportunity cost of $89 billion. Accessed May 24, 2023.
17. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract. 2020; 48:102193.
18. Rafferty AP, Luo H, Egan KL, et al. Rural, suburban, and urban differences in chronic pain and coping among adults in North Carolina: 2018 behavioral risk factor surveillance system. Prev Chronic Dis. 2021; 18:200352.
19. Knoebel RW, Starck JV, Miller P. Treatment disparities among the Black population and their influence on the equitable management of chronic pain. Health Equity. 2021; 5(1):596–605.
20. Ibid.
21. Chalian M, Del Grande F, Thakkar R, et al. Second-opinion subspecialty consultations in musculoskeletal radiology. Am J Roentgenol. 2016; 206(6):1217–1221.
22. Ibid.
23. Globe Newswire. Medical second opinion market size worth USD 9751.58 million by 2027 at 15.8% CAGR - report by Market Research Future (MRFR). Accessed May 24, 2023.
24. Bazargan M, Loeza M, Ekwegh T, et al. Multi-dimensional impact of chronic low back pain among underserved African American and Latino older adults. Int J Environ Res Public Health. 2021; 18(14):7246.
25. Ibid.