State of MSK Report 2021

Changing Musculoskeletal Trends Are Redefining MSK Care

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Musculoskeletal medical spend is a top cost driver for many employers. But it doesn’t have to be this way. Based on analyzing MSK medical claims data from 2010 to 2020, this report takes a deeper dive into the underlying trends behind these rising costs and offers insights into how employer benefit leaders and health plans can redefine MSK care and better manage spend. Hinge Health commissioned an analysis of medical claims data for 40+ million Americans covered by leading health plans 2010 to 2020. Based on this analysis, our State of the MSK Report 2021 uncovers the latest MSK healthcare trends including costs, types of treatments, and treatment settings over the last decade 2010-2020, what these MSK healthcare trends mean for employer benefit leaders and health plans, how COVID impacted MSK trends in 2020 and implications for the future of MSK care and actionable insights for benefit leaders and health plans on how to better manage MSK spend and care.

MSK Healthcare Trends 2010-2020

Looking at MSK spend over the last decade, we discovered MSK costs doubled from $10 billion to around $20 billion between 2010 and 2019 in our analysis of 40+ million Americans. (Note this is only a fraction of the cost to the US system as a whole).

This doubling of MSK spend was driven by two main trends. First, there was a 40% increase in per-member costs from 2010 to 2019. Second, the number of health plan members in our dataset grew by 42% in this same time period, although the number of members filing MSK medical claims remained roughly constant.

Rising costs of MSK care mean employers and health plans should expect MSK to continue to be their top cost driver. Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years.1 Studies have shown that, despite a 65% increase in health care expenditures for patients with back and neck problems from 1997 to 2006, there has not been a corresponding improvement in patient clinical outcomes.2 In short, spending more money has not correlated with better outcomes for members.

The reality is, the current system is broken. Studies have demonstrated that common approaches to MSK care (surgery, imaging, injections, opioids) do not effectively resolve back and joint pain.4 Employer benefits leaders and health plans need to fundamentally approach MSK care differently to reverse this upward pressure on costs. This presents a new urgency for employer benefits leaders and health plans to manage and reduce MSK spend through more innovative forms of care. We’ll dive deeper into just what types of MSK care are driving these spiraling costs.

  1. Malik, Khalid M et al. Musculoskeletal disorders a universal source of pain and disability. Anesthesiology and Pain Medicine. 2018.
  2. Martin, BI et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008.

Key Takeaways

Medical costs
MSK care costs doubled in last decade
Per-member costs
Average MSK spend per member increased by 40% from 2010 to 2019
Outcomes
Improvement in patient clinical outcomes has not corresponded to the increase in spend

What’s behind these cost increases?

Types of facilities and treatments driving up MSK costs

The fastest-growing MSK medical claims spend over the last decade came from emergency room visits, which grew 155%. Outpatient hospital care facilities came in a close second, growing 149% in the last ten years. Outpatient care facilities perform MSK surgeries, procedures, and injections without an overnight stay. In contrast, inpatient hospital care, which includes surgeries and procedures that often require expensive overnight stays, grew 100%. Finally, ambulatory care centers which are often billed as modern healthcare services with same-day surgery and procedures at an even lower cost than outpatient facilities, grew 95%.

This hefty price tag is largely driven by per-member cost increases in the types of treatment and services provided, not an increase in demand. Inpatient hospital unit costs topped the list, growing at 98% over the last decade, with ER coming in second at 96%.

The good news is that more members are using lower-cost outpatient facilities for same-day surgeries and procedures—jettisoning the hefty overnight-stay price tag common at hospitals. MSK outpatient services utilization by members had the highest growth in the last decade at close to 50%.

Key Takeaways
Outpatient services utilization
had the highest growth in the last decade (50%)
Key Takeaways
Outpatient services utilization
had the highest growth in the last decade (50%)

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