Mark Luck Olson

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Every day, it’s becoming more clear that the COVID-19 pandemic is not going away soon. Limiting potential exposure is critical for flattening the curve and preventing greater surges in infections. That can spell trouble for patients with musculoskeletal (MSK) health challenges. 

roughly 50% of the U.S. population is estimated to live with an MSK disorder

, which can not only cause pain and limit function but also account for 264 million lost work days per year—resulting in 

some $980 billion in treatment costs and lost wages,

 effective MSK treatments are incredibly important.

In the era of social distancing, however, the risks of in-person visits to recovery and physical therapy (PT) locations, not to mention physician offices, are a cause for concern, especially in patients with chronic conditions. Patients, providers, and health plans need an alternative means of delivering appropriate recovery care to prevent and manage these conditions. Fortunately, advances in virtual physical therapy are helping patients and providers address that need—here are the major benefits virtual physical therapy can deliver:

Removing the barriers to convenient, accessible care

Patients need quick, easy access to care when it’s convenient for them. This was true before the pandemic, but traditional scheduling and bureaucracy often stood as a barrier to that kind of access. In light of the current situation, patients—especially older patients and those living with chronic conditions—should avoid in-person visits whenever that can.

In good news, virtual physical therapy is easily delivered. Traditionally, physical therpay visits covered by insurance were limited, and could have ended before patients had made a full recovery. Thanks to virtual models, care sessions and duration can be extended until the patient actually recovers and can return to a more active lifestyle.

The positive health impact of a virtual physical therapy solution extends well beyond improving symptoms from MSK disorders. The regular physical activity that successful treatment of MSK disorders makes possible helps reduce the risk of many 

 including type 2 diabetes (which affects 

), heart disease and hypertension (which affects nearly 

, a quarter of whom do not have the condition under control), dementia, and mental health issues like depression and anxiety.

What should a virtual physical therapy program include to effectively address MSK disorders and the management of other chronic health problems? 

 outlined the essential components of a successful virtual physical therapy solution, including:

A patient-centered, individualized approach that tailors care to the patient’s needs and preferences.

Careful screening and triage to identify patients whose condition may be more serious and require additional assessment such as imaging and other diagnostic testing.

Tracking and assessment of patient progress based on validated outcome measures.

Patient education to help patients better manage their conditions.

A focus on evidence-based non-surgical care as a first step in the treatment continuum.

Inclusion of an exercise plan tailored to address the specific MSK condition.

A plan to help patients regain the function and comfort level needed to continue or return to work or other activities.

Beyond providing employees and plan members with access to a virtual physical therapy solution that checks all these boxes, employers and plan administrators should consider the program’s ease of access. Virtual solutions provide more convenient access, with sessions available when they’re most convenient for the patient without the hassle and time of travel to a physical therapy facility. Offering this type of virtual physical therapy has the potential to improve employees’ and plan members’ overall health and, because they value this benefit, strengthen their loyalty to their employer or plan.

Mark Luck Olson is CEO of RecoveryOne, formerly known as Trainer Rx. A 30-year healthcare veteran, Olson is known as a health tech strategist who can accelerate performance and top line growth. His areas of expertise include government healthcare markets, market development, consumer engagement, and health management and delivery models.

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Physical therapy or the regular physical activity that successful treatment of MSK disorders makes possible helps reduce the risk of many chronic conditions including type 2 diabetes, heart disease and hypertension, dementia, and mental health issues like depression and anxiety.

Virtual Musculoskeletal Care: Key Benefits for Patients, Providers, and Health Plans

All across the country, and in fact globally, musculoskeletal (MSK) care has become difficult if not impossible for most patients to access because of the COVID-19 pandemic. These injuries may be piling up on couches and porches across America as many go without help. Many hospital-based physical therapy (PT) centers and private PT practices have paused providing in-person assessments and care to avoid close personal contact that increases the risk of spreading the virus.

Although access to MSK care has contracted, the urgent need for these services has not. MSK disorders affect half of all American adults, with more than 126 million Americans over the age of 18 reporting being 

. These disorders have a significant impact on the health and quality of life of those affected, with approximately 18 million reporting an MSK disorder prevents them from performing daily activities, including walking unaided, bathing, and using the bathroom.

Beyond the pain and limitations experienced by individuals, MSK disorders also exact a high economic cost, affecting employers in every industry as well as insurers:
	• MSK disorders account for $213 billion in direct and indirect costs, 

responsible for 290.8 million lost workdays

 on MSK disorders, accounting for 17% of their total healthcare budgets.
	• Direct medical expenses cost payers a 

Could the US, World Benefit From "Whole Person Care" Program?

numbers are projected to continue to grow

 substantially as the number of older Americans increases.

Even before the COVID-19 pandemic, there was a large unmet need for PT and other MSK care in the U.S. Lack of access to that care can not only lead to poorer outcomes and greater need for surgical intervention, but also to higher healthcare costs. Fortunately, these issues can be successfully addressed by redefining how this care is delivered to those who need it.

The first challenge is meeting short-term MSK needs during the COVID-19 pandemic; although, in the case of this pandemic, short-term is a relative concept. With the number of cases still increasing across the country, no definitive treatment protocol, and a vaccine projected to take 12 to 18 months to develop and test, patients will continue to have significant difficulty accessing care for the foreseeable future. In addition, vulnerable patients - including people over 65 and those with underlying health conditions that put them at higher risk for COVID-19 - are unlikely to quickly return to crowded settings like healthcare facilities.

When hospitals begin to perform elective MSK-related surgeries again in the medium-term, a flood of patients will require pre and post-op PT and recovery care. It’s unlikely that traditional PT practices will be able to handle this sudden increase as they ramp their operations back up. In addition, many smaller practices may not be able to reopen, creating further pressure as demand far outpaces supply.

Beyond its impact on healthcare delivery supply, that pent-up demand likely will negatively impact workplace productivity and medical loss ratios (MLRs) and rebates later this year, as those with unmet medical needs begin to seek care for conditions that have exacerbated during the crisis. Further, the opiate crisis is likely to exacerbate as people self-medicate to deal with the isolation resulting from weeks and months of social distancing.

The solution to these short- and medium-term challenges is a new model for MSK care that incorporates both technology and individually tailored care created and guided by clinical experts, experienced PTs, and behavior-change coaches. This new approach should harness the power of telemedicine via a website and mobile phone app, while ensuring that the care each patient receives is carefully tailored to her or his specific needs, whether focusing on a single or multiple MSK problems.

Key elements of an effective model for MSK care during the pandemic and beyond include:

• A hybrid model that combines the convenience of technology with the personalization of human guidance. Users should be able to access on-demand video exercise and recovery sessions tailored to their needs, pain severity, and fitness level. The model should also include access to skilled PTs and coaches who can provide guidance, answer questions, and troubleshoot problems users encounter when performing the recommended therapy.
	
	• Easy access with multiple entry points. People should be able to access care via an online portal or an app on their phone or any other device, from the convenience of home or other locations.
	
	• An easy-to-use digital assessment tool. This tool should collect the right information to guide people along a path to recovery using an individualized, evidence-based approach. It should triage users and recommend outside medical care where appropriate.
	
	• Live behavior-change coaches to help motivate users to stick with their recovery program through completion, with the goal of achieving a significantly higher adherence rate than is achieved with a traditional approach. Constant progress tracking and feedback for the patient should be included and will also encourage adherence.
	
	• Continuing care and support until the condition improves and the user can return to performing self-care, work, and leisure activities. In place of a limited number of in-person PT visits and expensive medical and surgical interventions, users can get as much or as little support as they need.
	
	• Lower costs. This model can lower the high costs of our current approach to MSK care by reducing expensive medications, imaging tests and surgical interventions.

This redefined model is the innovation we need now to ensure that those suffering from MSK disorders can access the care they need during and beyond the crisis. Even when medical offices are closed, people can easily seek the guided intervention they need to regain mobility, reduce pain, avoid worsening symptoms, and reduce the high costs associated with surgery and medication.
	
	The good news is that this new model already exists, and the current crisis is heightening demand from insurers and employers. It represents the future of MSK care, opening access for hundreds of thousands of those who will want to mitigate pain so they can get back to their work and life again long after the pandemic ends.

All across the country, and in fact globally, musculoskeletal (MSK) care has become difficult if not impossible for most patients to access because of the COVID-19 pandemic.

Author | Mark Luck Olson

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