How To Overcome Social Determinants of Health in MSK Care

February 24th, 2022  by  Dr. Ryan Sharkey, DPT – Doctor of Physical Therapy

In the 2001 landmark report Crossing the Quality Chasm, the Institute of Medicine outlined six key aims for healthcare to focus on in the twenty-first century: a prime healthcare experience that is safe, effective, patient-centered, timely, efficient, and equitable. Although many of these goals have been at least partly achieved, one is lagging – health equity.

Healthcare is no more equitable now than it was twenty years ago. The divide between rural and urban communities continues to show itself in average life expectancy. Research shows that 33 states have seen at least one rural hospital close in the last 10 years, and it’s estimated that just over 30 million Americans live more than an hour away from trauma care. In urban communities, like Milwaukee, San Francisco, and Los Angeles, physical disability, disease prevalence, and mortality rates are significantly higher in zip codes with lower median household incomes.

In this blog post, we’ll explore how virtual physical therapy solutions can address musculoskeletal (MSK) conditions and help close health equity gaps which we highlight in our recent white paper Addressing Disparities in Musculoskeletal Care: How Employers Can Narrow the Health Equity Gap.

Digital MSK care, social determinants of health, and improving health equity

When it comes to treating musculoskeletal (MSK) conditions, tremendous opportunities exist to improve the way care is delivered and coordinated throughout the healthcare system. Here are four social determinants of health that often affect members’ ability to get access to the treatment needed to resolve their MSK pain:

1. Access to Care & Transportation

As a physical therapy worker in rural Oregon, I have seen the lack of access to care firsthand in rural America. It wasn’t uncommon for patients to drive forty-five minutes each way to an appointment. I’ve also seen patients drive as long as four hours in a day just to get to a physical therapist. The time commitment required to access a thirty-minute physical therapy (PT) session creates significant barriers to care.

Access is also an issue for people for whom transportation is problematic, either because of physical distance or an inability to get rides to appointments. This has an impact on the overall cost of healthcare and correlates with poorer health outcomes. Some efforts have been made to improve access to transportation in both rural and urban communities, but no standard currently exists.

2. Income and Awareness

In-person physical therapy can be challenging for hourly shift workers in retail, manufacturing or distribution jobs. Many need to take unpaid time off of work to drive to appointments and physical therapy often requires visits multiple times a week over several months. In addition, lower-income workers may be less likely to afford the deductibles required to cover the cost of all in-person physical therapy appointments. If they drop out of physical therapy, their MSK conditions may worsen and they may turn to opioids or surgery as a last resort.

Awareness of MSK care options and income levels are also correlated. Lower income individuals report lower awareness that care even exists. Members living in underserved communities need both awareness about MSK care and access to low-cost care options.

3. Race and ethnicity

According to the National Academy of Medicine, ethnic minorities consistently receive lower-quality healthcare than whites even when insurance status, age, income, and severity of disease are taken into account.

In a survey of orthopedic surgeons regarding disparities in healthcare:

  • 12% of respondents believed that patients receive different healthcare based on race/ethnicity
  • 68% acknowledged evidence of disparities in orthopedics

People who are not proficient in the dominant language of their region also experience difficulty accessing healthcare and exhibit poorer health outcomes. Utilization of professional interpreters can improve health services and outcomes for this population.

4. Health literacy

Health literacy is a social determinant of health that cuts across income, race, and ethnicity. Education plays a critical role in MSK care. For example, most members do not seek second opinions for surgery in part because many members don’t know this option exists.

A 2019 study noted that doctors are less likely to inform patients to seek a second opinion if they are elderly or poorly educated. If members are aware of their treatment options and realize that surgery is not always the most effective course of action for MSK recovery, they can be guided to more appropriate conservative care.

How to overcome social determinants of health in MSK care

While social determinants of health can have a negative impact on MSK care, the good news is that tremendous opportunities exist to improve the way care is delivered and coordinated throughout the healthcare system. Employers can close health equity gaps in MSK care by:

- Improving access to care with comprehensive digital technology. By closing the logistics gap, Hinge Health’s Digital MSK Clinic brings care directly to the member’s home at zero out-of-pocket costs with a comprehensive suite of technology including computer vision, sensors, Enso wearable device for non-addictive pain relief, and an all-in-one app.

- Personalize care with a complete and diverse clinical care team of doctors of physical therapy, health coaches, physicians, and orthopedists. Understanding not just a patient’s logistical barriers to care, but also their social and familial beliefs about what optimal care looks like is crucial to creating a more equitable healthcare system.

- Enhance health literacy through education, real-time data, and expert medical opinion. The Hinge Health digital clinical care team is connected to participants’ electronic medical records across in-person providers and is flagged when a participant is recommended for surgery or opioids. Members are introduced to in-house orthopedic surgeons who offer free expert medical opinions to educate them on their treatment options. Our integrated care team also works closely to support and educate members on overall lifestyle changes like diet, stress, and mental health which are key to their recovery.

As benefits leaders and health plans design more equitable and inclusive healthcare benefits, Hinge Health can help you overcome challenges with key social determinants of health in MSK like access, income, race and ethnicity, and health literacy.

To learn more about how social determinants of health impact MSK care and how Hinge Health can help you overcome these barriers, download our white paper today.

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Dr. Ryan Sharkey, DPT
About the Author

Ryan Sharkey is a staff physical therapist at Hinge Health. He has 7 years of direct clinical experience treating both acute and chronic pain. He received his Doctor of Physical Therapy from Northwestern University in 2013, and has been a Board Certified Orthopedic Specialist since 2016.

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