3 ways holistic MSK care improves all avenues of care

MSK disorders affect about half of all Americans and nearly three-fourths of those 65 and older.¹ Beyond being more common than cardiovascular and respiratory diseases combined,¹ MSK problems are also incredibly expensive. In the United States, costs to treat these disorders exceed $380 billion annually, a figure that stands to grow as the U.S. population ages.² What’s more, MSK’s financial implications extend well beyond direct treatment costs, as these conditions also introduce an increased risk of comorbidities including cardiovascular disease and mental health issues.³

A holistic approach to MSK care, therefore, can significantly mitigate not only these persistent and costly conditions but also their ripple effects. By uniting conservative, evidence-based care and high-quality providers with a digital self-service platform and careful claims review, payers can create an MSK program that boosts engagement, reduces comorbidities and improves outcomes — all while bending the cost curve.

1. Keep pain in check

MSK conditions tread a well-worn path from acute to chronic pain, potentially harming patients’ mental health and increasing the risk of opioid misuse.⁴ Research shows that patients with newly diagnosed MSK pain are prescribed opioids more often than clinically recommended — and more often than physical therapy, counseling and other nonpharmacologic approaches.⁵ In many cases, access to a robust MSK care program that includes personal rehab plans and coaching support can be a more beneficial, lower-risk approach to short- and long-term pain management.

Case in point: Multiple studies demonstrate the benefits of participation in a digital MSK care program that includes exercise, education and coaching. One observational study of 10,000 participants in a 12-week digital care program found that nearly 80% of those who completed the program achieved improvement in pain, with the degree of improvement positively associated with the level of engagement.⁶ Additionally, completing the program — which included 1:1 remote health coaching and exercise therapy — was associated with a decrease in depression and anxiety, as well as an increase in work productivity. Meanwhile, other research suggests these results may be long-lasting: A 2022 study found higher levels of meaningful pain improvement in program participants versus nonparticipants at 3 months, 6 months and a full year out.⁷

Other research suggests that digital MSK care can go even further, to reduce the likelihood of acute or subacute MSK pain from developing into chronic pain.⁸ After 3 months, the probability of developing chronic pain was 77.7% for nonparticipants, compared with 46.5% for participants.

2. Serve mind and body

Chronic pain and impaired mental health often go hand-in-hand. Last year, the University of Arizona found that nearly 1 in 20 U.S. adults — some 12 million people — experience comorbidity between chronic pain and anxiety or depression.⁹ People with chronic pain were 5 times more likely to report symptoms of anxiety or depression than those living pain-free. What’s more, the combination of chronic pain and anxiety or depression had a greater negative impact on daily activities — things like working, socializing and performing errands — than either condition on its own.

The interplay between mental health challenges and musculoskeletal pain is a particularly slippery slope. Both physical and mental fatigue are significantly more common among people with MSK pain, and they are 8 times more likely than the general population to experience clinical insomnia.¹⁰

More than ever before, mental health is on employers’ minds, too. Some 77% of large employers report an increase in mental health issues among their workforce in the last year, up from 44% in 2022.¹¹

The good news? A holistic MSK care program can have trickle-down effects on mental health. A 2022 study examining the impact of digital MSK care on mental health and work-related outcomes found significant improvements in depression and anxiety levels among people with mild to moderate depression.¹² Multimodal digital MSK care programs, the study concluded, have the potential to maximize productivity recovery, facilitate access, ensure continuity of care and enhance patient engagement.

3. Break through engagement inertia

It’s clear that early, appropriate intervention is critical to avoiding poor MSK outcomes and complications. But care deferral can be all too common, whether due to confusion over health benefits, a lack of transportation or a flexible work schedule, or assumptions that MSK pain represents a natural part of aging. And when patients don’t get the right care at the right time and right place, treatment may suffer.

In fact, a large-scale study found that patients with lower back pain who first seek care in an emergency room are far more likely to undergo expensive imaging and steroid injections, while those who initially seek out physical therapy or chiropractic care have better outcomes and lower costs.¹³

Beyond connecting patients with the care they need, easy-to-use MSK programs can also foster a sense of motivation and momentum among members that creates a virtuous cycle of proactive health ownership and improved outcomes. In fact, recent research demonstrates that digital MSK care can create active engagement and long-term behavioral change in addition to effective pain management.¹⁴ Study participants who attended weekly physical therapy workouts reported consistent improvement in pain and function, which led to increased satisfaction. Virtual follow-up visits and personalized messages amplified that satisfaction and further increased participation in both the weekly workouts and the program as a whole. By increasing patient engagement and adherence, digital care tools fuel positive outcomes and lasting lifestyle change, ultimately reducing the impact of MSK conditions.

The power of the right approach

Given their prevalence and complexity, MSK conditions represent a major challenge to payers and employers trying to contain medical costs. To effectively respond, health plans need an integrated approach that supports patients in taking the crucial first step of seeking care, as well as every next step along the way.

By dismantling common barriers to care, effectively managing pain and providing access to resources that manage both the physical and mental aspects of MSK ailments, the best MSK solutions offer a holistic approach to deliver safe, successful and cost-effective treatments.

For further reading, learn about the high cost of care deferral and how connecting members with the care they need is more urgent than ever. Find out how integrated MSK Solutions from Optum for health plans and employers can deliver the right solutions at the right time.

Footnotes

1. United States Bone and Joint Initiative. Prevalence of select medical conditions. March 2024.
   
2. Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996-2016. JAMA. 2020;323(9):863–884.
3. World Health Organization. Musculoskeletal health. July 14, 2022.
4. Brummett C, Waljee J, Goesling J. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surgery. 2017;152(6).
5. Feldman DE, Carlesso LC, Nahin RL. Management of patients with a musculoskeletal pain condition that is likely chronic: Results from a national cross sectional survey. J Pain. 2020;21(7-8):869–880.
6. Bailey J, Agarwal V, Zheng P, et al. Digital care for chronic musculoskeletal pain: 10,000 participant longitudinal cohort study. J. Med. Internet Res. 2020; 22(5):e18250.
7. Wang G, Yang M, Hong M, et al. Clinical outcomes one year after a digital musculoskeletal (MSK) program: an observational, longitudinal study with nonparticipant comparison group. BMC Musculoskeletal Disorders. 2022;23,237.
8. Hong M, Topete M, Yang M, Bailey JF. Effects of a digital musculoskeletal acute care program on chronic pain prevention: An observational study with nonparticipant comparison group. J. Pain Res. 2022;15:3605-3613.
9. De La Rosa JS, Brady BR, Ibrahim MM, et al. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities. PAIN. 2024;165(3): 666–673.
10. Garnæs KK, Mørkved S, Tønne T, et al. Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients. BMC Musculoskeletal Disorders. 2022;23,1115.
11. Business Group on Health. 2024 large employer health care strategy survey: Executive summary. Aug. 22, 2023.
12. Costa F, Janela D, Molinos M, et al. Impacts of digital care programs for musculoskeletal conditions on depression and work productivity: Longitudinal cohort study. J. Med. Internet Res. 2022;24(7).
13. Bise CG, Schneider M, Freburger J, et al. First provider seen for an acute episode of low back pain influences subsequent health care utilization. Physical Therapy. 2023;103(9).
14. Beresford L, Norwood T. The effect of mobile care delivery on clinically meaningful outcomes, satisfaction, and engagement among physical therapy patients: observational retrospective study. JRAT. 2022;9(1).