Simplifying Musculoskeletal Care: A Tailored Approach for Patients, Providers and Payers

Roughly half of adults in the U.S. live with joint, back or muscle pain caused by a musculoskeletal, or MSK, condition. Treatments cost a staggering $380 billion annually, which we might consider reasonable if it yielded great results.

Sadly, that’s far from the case.

To pick just three data points: 1 out of every 3 people who undergo joint replacement surgery regret it a year later; 8 of the 10 most performed elective orthopedic procedures lack strong evidence showing they’re more effective than non-operative alternatives; and based on our experience with primary care, over 50% of patients referred to orthopedic specialists are more appropriate for physical therapy or physiatry.

Simply put, the nation’s healthcare system often fails not only patients, but doctors and payers, as well.

At TailorCare, we’ve found a better approach. We’ve created an effective decision-support framework for MSK conditions — one that engages and educates patients throughout their care journey. We deliver guidance about the various treatment options so patients and their providers can align more effectively to achieve the best possible outcomes.

This approach solves the common biases and blindspots among patients, practitioners, and payers, which too often nudge patients toward simple mismatches, whether with treatment method, timing, or practitioner. The result is better outcomes for all involved, but especially patients. I’m happy to report that our early data supports this claim.

It’s important to note what we are not — a blunt-force surgical avoidance tool. As a nation, we’ve spent decades seeking ways to rationalize our healthcare spending, and many solutions boil down to diverting patients from surgeries that might actually help them. Instead, there’s ground gain from determining treatment appropriateness, helping patients make better choices about surgery and finding the best possible provider for the specific patient no matter what treatment path they choose.

How It Works

TailorCare partners with primary care providers and orthopedic specialists to engage patients whenever they identify an MSK-related issue that’s not appropriate for their practice.

We educate patients about their treatment options and help them choose an appropriate treatment option, match them to the right specialists, and then actively engage them and their PCPs throughout the care journey to track results and maximize outcomes. This operating model empowers patients to manage their own health.

• Our initial patient consultation gathers information about their symptoms, goals, health history and preferences. It is clinically designed and backed by evidence-based guidelines.
• This data produces the most optimal treatment for the patient’s unique condition. Through shared decision making, we help patients make educated and thoughtful treatment decisions.
• Once aligned on treatment, our provider-related technology matches patients with appropriate specialists, which considers outcomes, location, language, and other factors.
• We frequently communicate with patients and providers. We follow up with patients to ensure they progress appropriately and share detailed status reports with providers.
• This comprehensive model positions us as key members of the care team—a trusted and privileged role we continuously earn through timely recommendations and follow-ups with all parties until the patient’s MSK issue resolves.

How does this framework serve the interests of everyone involved, particularly when different parties have competing interests? Let’s look at the various players one at a time.

Patients

• MSK expertise when they need it. Patients and PCPs rarely troubleshoot MSK issues in a routine visit. We know the right questions to ask and have time to listen.
• Better recommendations. We’ve gathered data on physical therapy, physiatry, and orthopedic specialists to recommend the right specialist at the right time confidently.

• Ongoing support and communication. Our clinical navigators walk arm-in-arm with patients until they achieve their goals.
• Better results. Many people, including me, can attest that effective MSK treatments can be life-changing. That’s our goal with every patient.

Primary Care Physicians

• Help with highly complex issues. PCPs rarely have enough time to address patients’ MSK issues during a routine visit, and even those who have such time typically lack enough MSK training to make the best recommendations. We help PCPs do better by patients.
• Better economics for risk-bearing PCPs, whose finances suffer when patients are inappropriately referred to specialty care.
• Healthier patients. People who are free of MSK symptoms are more physically active.

Orthopedic Specialists

• The right patients. When we make a referral, orthopedists are confident they’re seeing someone they can help. This avoids wasted appointments and maximizes their practices’ clinical and operational efficiency.

Payers

• Highly-satisfied patients. Health insurers have long sought to help patients achieve better MSK results. Higher patient satisfaction scores translate to improved member retention rates and potentially higher reimbursement from funding sources, among other critical business-related outcomes.
• Cost savings. MSK patients are, for payers, among the most costly and complex to support. We alleviate the administrative burden payers face by supplementing and extending existing programs adopted to support MSK-related claims. Such measures – and better health outcomes for members – can greatly improve their bottom line.

Perhaps more than anything else, that’s the point: while improving MSK patient outcomes, we also enable providers and payers to work more effectively across the board. We’re a force multiplier for our patients’ health and, we believe, the health of the industry broadly.

We’re proud to point our healthcare system toward a better state, and we welcome providers, payers and patients to join us on that quest.