Addressing the high cost of musculoskeletal care deferral

Musculoskeletal (MSK) conditions are a pricey and pervasive problem that seems to be growing. Already, more than half of American adults are affected by an MSK condition, and it regularly ranks among the top 2 conditions driving employer health care costs.¹ But an aging population, remote work (along with its associated poor ergonomics and reduced physical activity) and growing rates of obesity and diabetes are all contributing to a worrisome rise.

Low back pain, for instance, is the leading cause of disability worldwide, and researchers expect its prevalence to increase by 36% by 2050.² Scientists forecast that the incidence rates of some MSK disorders could more than double by the year 2050.

While prevention can and should be a clear priority, there’s also a need to ensure members experiencing MSK-related concerns seek timely care. Because deferred care doesn’t only impact a member’s current mobility and quality of life, it can also have a dramatic effect on the treatment, health care costs and health outcomes they experience later. With 41% of employers expecting to see higher chronic condition management needs in the future, including for MSK and diabetes, the Business Group on Health noted “the urgency felt by companies to avoid deferred care and the associated late-stage conditions and costs” as a top trend for 2024.³

The danger in delay

Care deferral was a default during the early pandemic, with roughly 40% of Americans putting off medical appointments and procedures. Four years on, that instinct to delay has persisted. Nearly 40% of Americans reported postponing treatment due to medical costs in 2022, a 12% jump from the year before.⁴ Lack of transportation, occupational inflexibility and cultural assumptions that MSK pain and aches are simply part of aging are all common contributors. But so, too, is the presence of chronic conditions.

Of course, not addressing an MSK issue doesn’t simply cause that first symptom to persist. Rather, care deferral can lead to a cascade of negative consequences, from severe and worsening symptoms to reduced treatment options once care is secured to the exacerbation of other health issues. If low back pain interferes with a member’s ability to ride a bike, for instance, they may abandon that healthy habit — and the weight-controlling, blood-pressure-lowering, cholesterol-improving benefits that biking provides. That behavior shift could ultimately put the person at higher risk of developing additional MSK disorders, as people with higher cardiovascular risk are 17 times more likely to develop 4 or more MSK conditions.⁵

Research shows that people with chronic MSK pain experience significantly more symptoms of anxiety, depression, fatigue and insomnia.⁶ And here, too, the deferral of care can lead to a vicious cycle of negative impacts. If joint pain forces someone with depression to miss work or have a harder time playing with their grandkids, for instance, that can make their depression harder to manage. This can make it even harder to seek treatment or maintain healthy behaviors. In a 2022 survey of physicians, 55% noted an increase in self-medicating among those who defer care.⁷

The power of appropriate timing

Connecting members to the care they need — as soon as they need it — can send them down a more effective, efficient treatment path. They may be more receptive and responsive to conservative interventions, such as physical therapy and lifestyle changes, which can effectively treat many MSK conditions without the need for more invasive options. At least one-third of the disability burden association with back pain, for instance, is attributed to factors such as smoking and being overweight.⁸ Engaging members early also enables health plans to steer them away from dubious, high-cost procedures and unnecessary surgeries.

Take lower back pain, for example. A large-scale study found that patients who first seek MSK care through an emergency room are far more likely to have high-cost imaging and steroid injections, while those who first seek out physical therapy or chiropractic care have better outcomes and lower costs.⁹ The power of early care is also enduring: A separate study of people with lower back pain found that early utilization of physical therapy was associated with lower costs and lower health care utilization, including fewer ER visits, at both 30 days and one year after acute pain was first reported.¹⁰

The benefits of well-timed MSK care are resounding, but how does a health plan get members to take that first crucial step of seeking care? By offering an integrated benefit that spans across the entire continuum of MSK care while addressing the common barriers that contribute to care deferral.

Imagine a benefit that privileged a member’s ability to self-direct their care while also serving as a source of support and encouragement as members progress through their health care journey. Members could have access to the clinical and therapeutic expertise they need, such as physical therapists, and also receive person-to-person support from specially trained nurses conversant in MSK ailments. These nurses can offer additional care and encouragement from the earliest onset of muscle pain to the ultimate end of the member’s treatment pathway. With this kind of wind at their sails, and with many common impediments to care effectively solved, members would be far more likely to address issues as they arise rather than delaying the care they need.

Find out how our integrated approach supports members with Optum® MSK Solutions for health plans and employers.