There is no shortage in reports about the rising incidence of musculoskeletal disorders and, likewise, the rising use of orthopedic interventions, like spine surgeries, joint replacement, and pain management.
Richard Valdesuso, MD, medical director of the AIM Musculoskeletal Solution, sat down to discuss the surge of this type of care, the value of “boots on the ground” provider engagement, and the “integrated” future of managing musculoskeletal care.
It’s really not a single reason, but many, driven by both members and physicians. Let’s start with members.
We’re seeing more joint surgeries largely because of “wear and tear” among certain populations. Baby boomers used to an active lifestyle are increasingly seeking out services, like surgery. “Weekend warriors” want to get back on the road as soon as possible after injuries. And youth are involved in more intensive, year-round sports and training, leading to arthritis at an earlier age.
And we can’t neglect obesity: The number of obese Americans is dangerously high, and research has told us for some time that obesity drives musculoskeletal pain and, consequently, musculoskeletal care.
Physicians are also driving some of the increase in cost. Many physicians coming out of training today are eager to try new technologies and minimally invasive techniques on patients whom in the past would not have been a candidate for surgery. As a result, the threshold for surgery, especially spine surgeries, is dropping. Providers are pushing to complete these cases in ambulatory settings, where it’s convenient, affordable, and, as a result, more attractive to health plan members.
Finally, the opioid crisis is playing a role. Providers are turning to interventional pain management procedures because in many cases, it’s a safer way to manage certain chronic pain syndromes.
What I hear most often from plans who end up choosing a partner like AIM is that they asked themselves a simple question: What would the quality and affordability of care for our members be like if managed more comprehensively?
They also typically want to know how they compare with their peers: Do our providers overprescribe this surgery and that surgery more than a plan in a similar region?
When the plan starts to ask itself those questions, it’s probably a sign that they’re ready.
In short, extensive planning with the health plan and ample collaboration and coordination with their providers.
And once the solution’s in place, benefits take on a domino effect. Members begin to receive more appropriate musculoskeletal care, which tends to be less expensive, so the plan more easily hits its medical loss ratio (MLR) goal. And by hitting its MLR objective, the plan can reduce members’ premiums and out-of-pocket spend, which are major factors in member satisfaction.
My experience with health plans would have been vastly different if I had the opportunity to collaborate with them the way that we’re working together now. The partnerships between us, plans, and providers are such an intuitive, meaningful part of the process. And I’m certainly biased, but the way AIM does it is just fantastic.
We take a “boots on the ground” approach, as we say at AIM. Before the solution goes live, our provider engagement team and I visit with providers and their office staff to lead training and offer the opportunity for providers to ask questions. We work diligently with the providers to make sure that these trainings accommodate their schedules rather than interfere with them.
For larger or complex provider groups, we can assign a member of our clinical team to help them navigate the solution and assist with onboarding. It’s an important part of our provider collaboration model.
[Laughs] Every doctor loves a good dinner, myself included. But, in my opinion, we can engage providers and their staff in a way that’s more convenient for them and more affordable for health plans.
Providers are very interested in our guidelines and the efficiency of our platform. For example, just recently, our provider engagement team and I visited a client. The providers that joined us that day asked a lot of insightful questions demonstrating how committed they are to the practice of evidence-based medicine and best practices. They wanted to know why we arrived at certain guidelines.
Ultimately, my responses are straight-forward, because, one, we base our clinical guidelines on clinical evidence, and, two, we have one of the most rigorous, if not the most rigorous, guideline development processes in the industry.
And the physicians that I’ve met appreciate that candidness. They recognize the shared commitment to clinically appropriate care, and they value the transparency, which they may not have with other partners.