Building a More Rational MSK Care Delivery System: A Case for Specialty Value-Based Care

Musculoskeletal, or MSK, care has frustrated and puzzled policymakers and healthcare leaders for decades, given its inconsistent quality and the massive, and rising, cost it imposes on society. Time and again, we’ve heard how the U.S. spends 20% of its healthcare dollars on MSK care – vastly more than other industrialized nations – and yet patients see little, if any, incremental benefit.

As with most healthcare investors, our approach at Valtruis has been to scour the startup community for ideas that, with the right backing, could solve problems like this one at scale. We were especially keen to find startups that were taking a holistic approach and could work with patients through the entire continuum of MSK care. We strongly believed in collaborating with local clinical resources to help patients navigate to the right MSK treatments at the right time. We also felt strongly that this entity needed to take financial risk for the patients’ health outcomes in the process.

What we found were solutions that were unwilling to take full accountability for MSK care, or were too narrow to do so responsibly. 

Instead, we pulled together an incredible management team and some strategic partners to launch our own effort to tackle this intractable problem.  

The company’s name is TailorCare, and we’re proud to report that its successful launch is proving our thesis—namely, that MSK care can indeed be made more rational for patients, healthcare providers, and payers alike if it is approached with an elegant solution and the right leadership team.

MSK Care Through TailorCare

TailorCare targets the dysfunction of MSK care at its source: the moment when patients and clinicians choose the first treatment option to address an MSK complaint beyond a PCP’s scope of expertise. Until now, we have not seen a mechanism to support patients and clinicians in navigating to the best possible choice.

Too often, this leads to:

• Orthopedists seeing patients that would be more appropriate for physical therapy or physiatry, thereby diminishing the orthopedist’s clinical impact and efficiency and wasting the patient’s time and resources.
• Patients seeking surgical solutions that may not provide the best outcome and long-term improvements. To cite one example: of ten highly common elective orthopedic surgeries analyzed in this study, just two outperformed non-surgical treatments in addressing patient symptoms. Notably, both back surgeries studied – lumbar spine decompression and lumbar spine fusion – failed to outperform non-surgical treatments.
• Health insurers assuming the role of treatment gatekeeper do not decrease their costs via prior authorization processes. This approach engages clinicians more than patients, frequently frustrates both parties, and compromises the payer’s ability to focus on delivering great insurance-related services. The kicker: even with the rise of prior authorization, MSK costs continue to increase, driving payers’ medical-loss ratios even higher.

Any company that seeks to address these problems, we felt, would need four key elements to succeed:

• Objective, longitudinal care navigation for patients. Patients need a trusted and deeply knowledgeable partner, working initially in collaboration with the PCP, helping choose and coordinate the best solution for their symptoms. While some existing companies purport to offer MSK care-navigation services, they’re often financially biased toward specific care categories (like PT) or don’t engage deeply enough with patients to recommend the best clinical pathways.
  
• An appetite for value-based care. At Valtruis, we believe that true financial alignment gets all parties to focus on what really matters – engaging the right patients at the right time and helping them achieve the best clinical outcome in the most efficient way.
• Data science skills are baked into the company’s DNA to match patients with the right treatment pathways and to continually refine those recommendations with every subsequent byte of data generated by providers and patients.
• An exceptional leadership team, with experience in complex care delivery and value-based contracting.

Together, these ingredients formed the blueprint for TailorCare.

Building an MSK Framework for TailorCare

Starting in early 2022, we created the first scalable, truly effective decision-support framework to help MSK patients identify and follow the clinical pathway that’s right for them. We partner with PCPs, orthopedists, and health plans to engage patients at the beginning of their MSK-related issue, and then we match patients to the right specialists and stay with them until their issue is resolved.

In the process, we take on the financial risk to only reap benefits when our patients thrive. TailorCare’s world-class leadership team includes healthcare veterans with long track records of patient-driven innovation and data-driven strategies.

As we designed TailorCare, we sought to partner with an aligned orthopedic specialty group. We found an ideal partner in United Musculoskeletal Partners (UMP).  UMP is committed to providing high-quality orthopedic care in the communities it operates and is attracted to partnering with TailorCare to align with value-based models. With UMP as a key launch partner, we’ve pressure-tested TailorCare’s ability to support patients in selecting surgery when it is the right clinical pathway and helping them find an orthopedic specialist right for them.  

We’re pleased to report that patient engagement has exceeded our bullish expectations, and payers are similarly well-engaged. We’ve helped them better understand their members, drive a better care experience, and successfully address a significant driver of medical costs.

Looking Forward

This is a huge opportunity for everyone involved. We estimate that the right interventions could save $20 billion from the nation’s MSK spending. But more than that, TailorCare has the chance to improve everyone’s experience in the MSK ecosystem. 

We have the rare opportunity to take a largely broken system and rationalize it for everyone involved. We look forward to more conversations with prospective partners and, of course, patients to further improve on what we believe is a singularly impactful new model of care.