Reconsidering Our Nation’s Costly Knee-Jerk Response to MSK Care

Oct 28, 2024 | Blog

Two years ago, osteoarthritis crippled Cheryl Morgan’s daily life, leaving the once-active 66-year-old homebound. Her orthopedic specialist delivered what was, to her, devastating news. “He said there’s nothing that will get you back to your normal activities except surgery,” she recalled.

“I felt scared. I felt hopeless. I didn’t even trust what I was told,” she added. “There’s always options.”

Soon after, she connected with a TailorCare Clinical Navigator who conducted a comprehensive intake over the phone, talked her through treatment options, and helped her select a physical therapist. With therapy, her pain dramatically decreased from a nine to a two on the pain scale, allowing her to return to the activities she loves, like cooking and spending time with her grandchildren. “So much has changed for the better,” Cheryl said, reflecting on her renewed hope and quality of life.

The Current State of MSK Care in the United States

For far too long in the U.S., this is the experience of those with musculoskeletal (MSK) pain. Patients are referred to orthopedists, and too often, their treatment options quickly shrink to one: surgery. And patients are paying the price, given the high rate of avoidable surgeries and studies showing that conservative treatment may be just as effective as surgical procedures.

This premature move to surgery provides no favor to orthopedists who want to see patients who can most benefit from surgeries and other interventions. But it’s also one reason why MSK care represents 10% of the nation’s healthcare spending — far more as a percentage of GDP than other industrialized nations, resulting in a $420 billion total price tag annually. The bigger problem is that U.S. outcomes are often no better than those of other nations who spend far less. 

Why is this? I’d argue that the industry isn’t leveraging the other great clinical solutions, like physical therapy, in addition to our nation’s highly skilled orthopedic specialists.

In recent decades, as orthopedists have advanced their expertise—for example, introducing surgical technology shifting total joint replacement surgeries from an in-patient hospital stay to an outpatient procedure, —our health system has not equally prioritized other disciplines that have also made significant progress in treating MSK conditions through less costly and less invasive methods. This includes rehabilitation physicians and other non-surgical practitioners, but it applies especially to physical therapists (PTs), whose role has expanded beyond traditional responsibilities. Over the past decades, physical therapy has evolved into a doctorate-level profession, and its rigorous training combines anatomy, physiology, biomechanics, and neuroscience with extensive research and clinical experience.

Given such expertise and advancements in technology, health systems are increasingly recognizing PTs’ ability to improve patient outcomes cost-effectively via in-patient services as well as through telehealth. Indeed, according to a comprehensive report published last year by the American Physical Therapy Association, the cost of successfully treating patients across eight major MSK categories drops significantly when a physical therapist treats them.

According to the report, the most significant savings per care episode are:

  • Osteoarthritis of the knee: $14,000
  • Carpal tunnel syndrome: $39,000
  • Tennis elbow: $10,700
  • Vascular claudication (muscle pain due to poor blood flow): $24,100
  • Lower back pain: $4,100

TailorCare’s Answer: A PT-Centric MSK Model

TailorCare keenly understands the value of PT interventions, and we’ve purpose-built a model that combines evidence-based physical interventions with personalized care to improve outcomes and reduce the need for invasive procedures. While we are not the first healthcare organization to leverage PTs for MSK care, we firmly believe we’ve designed the most effective care model by far — one that drives substantial cost savings. 

TailorCare has referred more than 50 percent of patients to PTs. Many of these patients, like Cheryl, might have otherwise been treated by orthopedists—or avoided treatment altogether, continuing to suffer from a declining quality of life. Instead, overall patients have thrived under this more conservative care approach, avoiding costly surgeries and achieving better outcomes.

At the core of our model are Clinical Navigators, who are licensed physical therapists providing in-depth consultations early in a patient’s care journey. They are key to consistently matching patients with the right clinicians for their MSK issues. That often includes not just clinicians who specialize in a patient’s specific disorder, but also those who have experience treating patients with other comorbidities — for instance, MSK patients with complications from cancer care.

It’s worth noting, too, that our model isn’t engineered to steer patients to PTs exclusively. While that’s often an appropriate pathway for a patient, our Clinical Navigators frequently refer patients to physical medicine and rehabilitation physicians — and to orthopedic surgeons when surgical care is necessary. In these cases, we ensure patients are matched with the effective and appropriate surgeons for their condition, leading to better outcomes.

Our approach yields financial benefits for healthcare delivery systems and payers alike, given that their reimbursements are often tied to patient satisfaction scores.

TailorCare’s recent NPS score sits at +94, an almost unheard-of figure in healthcare circles.

Even more meaningful to us, we’ve consistently witnessed the life-changing impact our model has on patients. As Cheryl said: “It makes me feel better to go out and do more. I don’t believe that I’d be in this spirit, or frame of mind, or even just physically feeling good if it wasn’t for TailorCare. I feel 100% better than I did a year ago today.” 

I know — as does the entire TailorCare team — that our model is making tremendous inroads in our nation’s battle to lower healthcare costs while improving outcomes and the patient experience. And as important and motivating as that mission is, stories like Cheryl’s are the ones that keep us coming back to work, day in and day out.

 

Rachel Winokur

By Rachel Winokur, Chief Executive Officer

Rachel Winokur is a seasoned executive with an unwavering passion for transforming healthcare through value-based models. Thriving at the intersection of payers and providers, she understands how to build programs that improve clinical and financial outcomes.

As CEO and founder, Rachel launched TailorCare to find a better musculoskeletal (MSK) care solution. She oversees a strategic vision that closes the gap between patients and providers and creates a better experience for everyone.

Before founding TailorCare, Rachel launched Bright Health Group, where she was Chief Business Officer before founding and serving as the CEO of NeueHealth, the risk-based primary care business at Bright. She has also worked in executive roles at Aetna, The Carlyle Group, Bertelsmann and Goldman Sachs.