What are Musculoskeletal Conditions (MSKs) and Musculoskeletal Disorders (MSDs)?
- Back Pain;
- Carpal Tunnel Syndrome (CTS);
- Plantar Fasciitis;
- Sciatic Nerve Pain;
- Shoulder & Neck Pain;
- Migraines & Headaches;
- Sprains & Strains;
- Tennis & Golfers Elbow;
- Tendonitis; and
- Chronic Pain
Why Should Employers Make an MSK Program Their Top Priority in 2021?
The total costs of MSKs to individuals and on the U.S. economy are staggering at $781B or 24% of total healthcare annual spend.
Types of Costs:
- Direct costs include healthcare and workers’ compensation insurance premiums; deductibles/copays and other direct pay expenses; workers’ compensation claims payments; and costs of employer sponsored health and wellness programs.
- Indirect costs include quantitatively measurable costs such as employee turnover and productivity lost to lost workdays (absenteeism) as well as more qualitative cost drivers to include lost productivity due to presenteeism (being at work but distracted); culture and quality of life; and reputation as an employer
To best understand costs and their key drivers it is important to explore how and by who those costs are incurred.
MSK Costs to Employers:
U.S. employers have assumed the majority of the costs burden that MSKs cause.
- Over 1 million MSK-related workplace injuries every year in the U.S. costing $20 billion in workers’ compensation claims (S. Bureau of Labor Statistics (BLS))
- 408,000 overexertion workplace injuries in the U.S. every year (S. Bureau of Labor Statistics (BLS))
- 434,000 workplace sprains, strains, and muscle tear injuries occur in the U.S. every year (S. Bureau of Labor Statistics (BLS))
- 223,000 workplace soreness and pain injuries occur in the U.S. annually (S. Bureau of Labor Statistics (BLS))
- MSKs are responsible for $297 billion, or $2,397 per employee, in lost productivity annually (US National Library of Medicine National Institutes of Health (NIH))
- MSKs are responsible for 360 million lost workdays, or 2.9 per employee, annually in the U.S. (S. Occupational Safety and Health Administration (OSHA))
- $190 billion in MSK-related medical care costs annually = $1,533 per U.S. employee
- Average cost of one workplace MSK injury is $33,000 to the employer (S. Bureau of Labor Statistics (BLS))
- 35% of all outpatient visits are for MSKs = 558 million per year = 1.1 billion hours away from work (S. Bureau of Labor Statistics (BLS))
- 63% of workplace injuries/illnesses are not treated by medical professionals, thus increasing the risk of further harm (US National Library of Medicine National Institutes of Health (NIH))
- Presenteeism due to MSK pain commonly reduces individual productivity by 33% or more (Harvard Business Review (HBR))
- Pain conditions associated with sitting, like back pain, arthritis, and headaches, cost $47 billion a year in reduced employee performance (Harvard Medical School)
- 44%t of employers ranked musculoskeletal issues (MSKs) as the top condition impacting their costs while 85% ranked it among the top three conditions (National Business Group on Health)
- A Gallup Poll revealed that 70% of U.S. workers are not engaged at work leading to mistakes that cost U.S. companies 20-40% of sales (Gallup Poll)
- Employers project health plan costs will rise 5.3% for 2021 (Society for Human Resource Management (SHRM))
MSK Costs to Individual Employees:
While U.S. companies experience the side effects of MSKs through costs of their benefits spend and productivity, it is the individual employee who feels the physical and mental pain and reduced quality of life from MSKs.
- 50% of American workers suffer from chronic pain due to an MSKs (S. Bureau of Labor Statistics (BLS))
- Back pain is the #1 most common reason for surgery in the U.S. and accounts for 264 million lost workdays, and $50 billion in medical costs every year (National Library of Medicine National Center for Biotechnology Information)
- Carpal Tunnel Syndrome (CTS) is the second most common surgery in the U.S. and accounts for 30 lost days of work on average for every case (S. Bureau of Labor Statistics (BLS))
- Presenteeism due to MSK pain commonly reduces individual productivity (at home and work) by 33% or more (Harvard Business Review (HBR))
- On average every American will have 4.5 doctor’s office visits annually resulting in over 9 hours at those appointments (Harvard Medical School)
- MSKs are responsible for 360 million lost workdays, or 2.9 per employee, annually in the U.S.
- Back and neck pain affects nearly one in three, or 75.7 million adults (Science Daily Research News)
- The average annual out of pocket cost per person for treatment of a musculoskeletal condition is $7,800 (Science Daily Research News)
- And here are the really important ones to consider…people with an MSK condition are in pain, are much less happy, and less productive
The current system to address MSKs is broken. Studies show that costs continue to explode while patient (employee) outcomes are getting worse.
This means that you cannot depend on your healthcare premium dollar to take care of your employees with MSK conditions.
In order to put this paradox into perspective let’s take a closer look at the two most common MSK conditions affecting the most American workers and costing the most; back pain and carpal tunnel syndrome (CTS).
Back Pain: there are approximately 1.62 million instrumented spinal surgeries performed in the United States annually (iData Research). Patient outcomes are a bit challenging to measure as there are a wide variety of variables that can be considered to include age, severity and duration of injury, and rehabilitation compliance. Estimates are in the 50% range of success with at least 20-40% considered a complete failure requiring a second surgery or reduced quality of life (US National Library of Medicine National Institutes of Health (NIH)). Employees are prescribed an average of two months (60 days) of sick leave following a surgery and 10% are permanently disabled after surgery (US National Library of Medicine National Institutes of Health (NIH)).
Carpal Tunnel Syndrome (CTS): there are approximately 400,000 CTS surgeries every year and accounts for 30 lost days of work on average for every case (U.S. Bureau of Labor Statistics (BLS)). CTS cases are most commonly covered under a workers’ compensation claim averaging $33,000 per case totaling $7.4 billion in workers’ compensation annually (U.S. Occupational Safety and Health Administration (OSHA)). 8 million Americans suffer from CTS every year. The National Institute of Health conducted a long-term outcomes study and literature review suggesting that up to 57% of those receiving CTS (aka CTR) surgery have recurring long-term symptoms to include chronic pain, numbness, and loss of grip strength. The data is inconclusive as to the cause of the high failure rate; however, misdiagnosis is suspected as the primary contributing factor.
Anecdotally speaking, a specialty physician consultation for an MSK condition is most likely going to end up in a surgery, physical therapy, and pain medication. The order of these symptom treatments varies, but the majority of cases end up in surgery and less than half return the patient (employee) to a normal quality of life.
3. Access to MSK Care: there is good news and bad news related to access to the care described above. The basic economics of MSK surgery demand and profitability have led to an abundance of supply, especially in outpatient settings.
While outpatient surgeries are more cost effective than their inpatient counterparts, there is a general misconception as to the seriousness of the procedure and recovery required resulting in more patients opting for surgeries. Add to that a paradigm of overdiagnosis due to a bias related to MRI imaging whereas more perceived pain and disability comes from a negative MRI result (US National Library of Medicine National Institutes of Health (NIH)).
Although there are a lot of outpatient surgery centers ready to cut on your employees, Covid-19 has created a backlog for elective surgeries for MSK care as a result of many patients electing to wait. It is estimated that patients seeking an orthopedic surgery will wait up to sixteen (16) months to be scheduled (The Journal of Bone and Joint Surgery). In the second half of this paper, I will suggest that the wait for potentially lower quality care offers an opportunity to resolve MSK issues in your employees without ever needing a surgery.
The GREAT news is that there is a better way and has been made widely available and affordable to U.S. employers.
Prevention is most certainly the best medicine as it relates to MSKs
Unfortunately, this is not as simple as a one size fits all program. Prevention programs must be customized to the actively level and mobility health of the individual taking into consideration their specific risk factors at work, home, and extra curricular. We have witnessed many (well-intended) stretching programs lead to injuries if not purposefully designed and moderated. Unfortunately, the wellness industry is saturated with these types of one size fits all programs with lofty claims of preventing injuries.
What are the key elements of a well-designed MSK program starting with a prevention focus?:
1. Assessment is the keystone to success of an MSK wellness program.
This is the most critical phase of planning a prevention program. A proper assessment captures key data on employees through individual confidential surveys that allow for a program to meet them where they are at from a mobility health perspective. These surveys must also include self-reported functional movement assessments completed by the employee. Allow me to explain what a functional movement assessment looks like. An employee would complete a series of movements without any resistance or weight. These are common movements that indicate healthy mobility. Some examples include a squat, one-legged balance, and more. The assessment takes less than five minutes and does not pose a risk of injury. The results are used to design a program to meet anyone where their individual capabilities are and keeping the entire process private to assure there is no competition or shaming freeing up space for improving mobility health and preventing injuries. This really works and participation is nearly always enthusiastic as we see 99% adoption rates. Very few people have resigned to just accepting their pain and limited mobility and while the motivation for better mobility varies greatly it is almost universal across age, gender, nationality, race, etc. For this author I want to be able to run and play with my grandchildren someday. As my kids are eleven and nine, I have some time and regular self-assessments are going to assure that I am in my optimal mobility health.
2. Screening is another way that BHS differentiates us from the competition.
All other MSK programs that I know of are reactive in nature. When an individual is feeling pain or has had an obvious injury like a sprain, strain, slip/fall, etc. than the program starts to resolve the symptoms they are experiencing. This is usually focused on pain; however, can also include limitations in range of motion (mobility) and a reduction in strength. Those are the direct symptoms of an MSK and there are many more indirect symptoms that include depression, anxiety, fear, and of course a loss of productivity (presenteeism and absenteeism). That is why we use what we affectionately refer to as the “blood test” of mobility health with our patented Computer-Aided MSK Assessment (CAMA) system. This system is marker-less (meaning there are no sensors to attach to your body) and takes less than ten minutes to produce a mountain of OBJECTIVE data on your employee’s mobility health by looking at every joint in every motion they perform and analyzing their dynamic posture (as opposed to static posture when not moving) throughout. The system analyzes the range of motion health of each joint based on what the American Academy of Orthopedic Surgeons (AAOS) has determined as ideal based on age, weight, height, and gender. Range of motion limitations are the first indicator of an issue that will produce pain. Our brains are wired to protect our joints from further insult to tissues and injury and the first defense mechanism is to limit your ability to move or use that joint. These limitations might be slight and have been something that came on slowly and worsened over a long period of time making us unaware of the limitation.
Soft Tissue Injury Life Cycle
The 3D camera cannot lie and has been clinically proven to be accurate in identifying mobility and stability issues that are a result of or will lead to further injury if not resolved. The question I always get right now when discussing this is “how do you fix the problems the system finds?”. I will discuss that soon in the section following to include digital and hands-on treatments.
There are several applications/uses for screening that I would like to highlight.
Regular screening check-ups
this is why we call this the “blood test” for mobility health. When we get annual physicals the primary driver of care needed comes from objective test results from standardized tests. Specific disease screening for chronic conditions like diabetes and high cholesterol as well as organ function tests for the liver, kidneys, and heart enable doctors to identify issues before they become life threating in most cases if the patient is both regular about getting a health checkup and compliant with the prescribed remedies. We recommend a minimum of an annual mobility health screening to assure the same level of proactive care is applied to prevent chronic pain and permanent limitation in mobility as well as to prevent surgeries and lengthy physical therapy due to MSKs.
most of our visits are still driven due to an existing problem that is producing pain. This is episodic care and the importance of objectively measuring the problem is vital to assuring that you know when resolution has been achieved. If you have already had a prior check-up than you will also have an important data point to understand your personal baseline before the injury. This way you can focus on regaining that baseline as a milestone before moving on to improving mobility to the ultimate goal of healthy mobility as set by the American Academy of Orthopedic Surgeons. So what this looks like is screening before and after each treatment. The system is capable of isolating tests to certain affected areas to make this even more efficient and take less time. Again, range of motion is the first indication of an MSK and it is also the first to be resolved. Once your brain allows full range of motion your pain levels will soon diminish, and strength regained with proper rehabilitation. In short, you cannot effectively resolve MSKs without an objective measurement of success…that is mobility health. Unfortunately, this is where almost all MSK programs fall short. The screening process is also one that needs to be conducted by a highly trained medical professional in person to reach its highest efficacy potential. This is why BHS trains our registered nurses to administer our patented Computer-Aided MSK Assessments. Competitors offer remote/digital options using wearable sensors and some that use image mirroring via any camera; however, these are not accurate and simply cannot be. Unfortunately, the variance introduced by environmental factors like background, lighting, camera resolution (and many more) makes the image mirroring systems less accurate. The wearable sensors introduce a higher degree of user variance and rely on a heavy number of dimensional assumptions to make simulations appear useful. Both are very cool and I believe that there are benefits of using this kind of technology to engage employees in their preventative health measures. Their shortcomings do limit their use in resolving MSKs after they happen.
while employment laws vary greatly from state-to-state on what you can ask and require of employee candidates prior to employment, we have universally found that an initial mobility health screening is useful to both the candidate and prospective employer. How you use the information is something we help employers navigate. Simply put, every employer wants to know if they are hiring someone who is already broken and potentially moments away from a workers’ compensation claim and/or disability. Let us be honest that our employees are our most important asset and conversely can be our biggest liability if they are not healthy. This information is also valuable in a workers’ compensation claim. The employers’ responsibility is to assure that they return the employee back to their “normal”. The majority of disability and workers’ compensation claims are from MSKs and without an objective BASELINE MEASUREMENT of what an employee’s individual “normal” state was when you hired them or prior to an injury than there is no way of knowing if the employer has fulfilled their responsibility. That is looking at the application from a cost avoidance perspective and we prefer to look at the injury avoidance aspect of the baseline measurement. With a pre-employment screening you can prevent matching employees to jobs within your company that will lead them to physical failure. The employer may also consider offering the employee help through their MSK program to prepare them for the job and assure they are healthy. This is where our customers really shine and build loyalty with employees early in the relationship. Again, these are tools and treatments that professional athletes trust to stay competitive. I can assure you that these athletes are not rushing to their orthopedic surgeon to get surgery and taking a much less invasive route to resolving their injuries and pains.
3. Digital Solutions in MSK care are not new; however, have seen a great insurgence in market share due to the COVID-19 pandemic
There are the obvious advantages to being able to reach employees wherever they are without the need for an in-person interaction. These solutions can be highly effective in resolving minor acute MSK conditions and in a lot of cases in reducing chronic pain caused by older conditions.
The primary obstacles to obtaining results are 1. user acceptance/adoption and 2. accountability. We have experienced much higher adoption when digital solutions are paired with in-person provider treatments and follow-ups. There have been similar results for less serious MSKs with telehealth provider
consultations. Ultimately, there is a definite place for digital MSK solutions in the future landscape of MSK care and these will inevitably continue to improve as more employers start to realize the cost savings of these programs and the improved health and productivity of their employees that utilize them. A digital MSK solution is a valuable complement to a comprehensive MSK wellness program that also includes telehealth and in-person care.
BHS set out five years ago to develop the first MSK digital solution that is based on the same hands-on clinical treatment system used by professional athletic teams. In the simplest of terms, we have created a system, “YouMari”, that guides users (employees) through the MSK condition identification triage process and creating customized treatment plans to resolve those issues. These programs include the same hands-on treatments a provider would use, mobilization/stretching, exercises to strengthen the areas, and regular assessments to measure the effectiveness of the protocols and program. Tests have proven the system to be 80% effective in resolving acute MSKs without the need for a doctors’ office visit and over 90% reported a reduction in pain related to the reported issue.
4. Noninvasive hands-on treatments will never be replaced as the most effective, least invasive, and least costly way to resolve MSKs
The clinical term is palpation. This refers to the method of feeling with the fingers and hands during a physical examination. MSKs are soft tissue injuries that a lot of times cannot be diagnosed through imaging technology like X-rays, MRIs, ultrasounds, etc. You might know this if you ever had a serious sprain or strain that felt like a broken bone only to be cleared by imaging of a “more serious” problem. Then what?...treat the symptoms of inflammation, immobilize the affected area, ice, and maybe something for the pain. Nothing that addresses the root cause of the problem that you still have and that is insult and injury to the soft tissues. Our hands-on treatments identify and address the root cause of the MSK and our providers leverage the best treatment approach available to resolve the issue without surgeries or other care needed.
Our hands-on system, Functionally Optimized Massage (FOM), is the best available system which incorporates the best of all soft tissue techniques. BHS was started in 2007, because a Fortune 500 company approached our founder, Dr. Casey Hummel, to provide the same hands-on MSK care that he was applying to professional athletes and has trained thousands of providers to do the same in their clinics in the United States, Europe, Asia, and Australia.
I personally was introduced to this elite soft tissue healthcare while trying to rehab after a torn ACL reconstruction surgery. I was compliant with the 5-day onsite physical therapy sessions and quickly regained strength. Unfortunately, though I lost 15% of my range of motion in that knee due to scar tissue building up an the only answer my surgeon (the same the Denver Broncos use) had was another surgery or live with the limp I now had. At least before the surgery I did not limp. In a five-minute hands-on treatment, I was able to regain my range of motion and cancel the follow-up surgery. I was sold and almost immediately transitioned from the more traditional healthcare system executive roles I had been in to figuring out ways to deliver this elite care to more Americans.
That is why BHS exists today…to provide an elite level of care your employees will not have access to unless provided by their employer. There is very slow (almost zero) adoption of these treatments in the healthcare system although it appears intuitive that a low cost and noninvasive option would benefit so many. Our results are simply amazing with 98% of employees reporting more than a 50% reduction in pain associated with their MSKs. 79% of MSKs are resolved without the need to go to a doctors’ office for another type of treatment. That is not just a huge savings in medical and/or workers’ compensation costs, but also time savings. The employer and office become the solution for the employees’ pains resulting in an overall higher quality of life and more productive employees.
MSKs are resolved without the need to go to a doctors’ office for another type of treatment. That is not just a huge savings in medical and/or workers’ compensation costs, but also time savings. The employer and office become the solution for the employees’ pains resulting in an overall higher quality of life and more productive employees.
5. Care Management is what we do in the 21% of MSK cases that we cannot resolve.
Most of these cases we know immediately are beyond the scope of care that can be delivered in the onsite clinic, and we refer these out immediately. We do not just leave employees to fend for themselves in the overly complex healthcare delivery system. We manage each case to assure the best possible outcome for employees. We are experts and thought leaders in MSKs and will guide your employees to the fastest and most effective resolutions.
Here is why BHS added case management (aka care management) to our services portfolio:
According to the National Library of Medicine of the National Institute of Health (https://pubmed.ncbi.nlm.nih.gov/12762075/) :
- 366% more lost time from work without case management
- 73% decrease in frequency of lost time and medical claims rate with case management.
- 77% reduction in workers’ compensation costs as a result of case management programs
- 44% lower medical costs for employees with case management
This is a good time for me to explain why BHS utilizes licensed registered nurses to deliver our MSK care onsite and through our HIPAA compliant telehealth portal:
- Gallup Poll rated nurses the “MOST TRUSTED” profession 18 years running
- Nurses provide 3 times more healthcare than all other healthcare professions combined due to their extensive scope of practice (American Association of Colleges of Nursing (AACN))
- 100% of nurses are required to complete an accredited academic program, hospital-based clinicals, and pass a national certification board exam and hands-on skills tests
- There are 3.8 million nurses in the U.S. (the largest healthcare profession) covering our customers in even the most rural locations (American Association of Colleges of Nursing (AACN))
Why BHS is so much better than any other MSK solution available:
Scalable – our technology-enabled solutions can be anywhere you are and quickly. The average onsite implementation can be completed within 21 days of engagement. We are a national corporation founded and run by seasoned healthcare executives with a clinical oversight team to assure quality.
Affordable – designed to be affordable for small businesses with 10 or more employees. BHS wants to reach as many Americans as possible and with 61% (97 million) of employees working for companies of less than 100 employees we had to price ourselves right to reach them.
Digital and Onsite – the only complete MSK solution that has an onsite component. We do digital better than anyone else, because we are the first to bring medical grade self-treatments to individuals. However, we recognize the importance of a direct relationship and contact with employees to assure the best outcomes every time.
Elite – get the same care Fortune 500 companies and professional athletes want. Show your employees and perspective talent how much you care by providing them health and wellness otherwise only available to the most elite organizations.
Where can I find help with designing a benefit program for my business?
Contact BHS and speak to one of our experts by visiting us here (click here).
Want more information about our services?
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