Clinical and Economic Outcomes Associated With Musculoskeletal Care in an Integrated Advanced Primary Care Model: Controlled Cohort Analysis.

Abstract

Background: Health care costs in the United States are skyrocketing, with commercial spending increasing 7.7% between 2022 and 2023. Musculoskeletal conditions affect more than one-third of US adults and account for over US $300 billion in total medical spending, more than any other chronic condition. Employers bear a disproportionate burden of these costs, both because they pay for the care of employees and their families with musculoskeletal conditions and because musculoskeletal pain is the second leading cause of workplace absenteeism, accounting for approximately 290 million lost workdays annually. Tele-physical therapy (TPT) solutions can be an effective alternative to in-person physical therapy (PT) and, especially when provided early in the course of care, have the potential to reduce employer-sponsored health care spending.

Objective: We sought to evaluate the effects of a proactive musculoskeletal treatment approach-TPT integrated into advanced primary care-on patient access, changes in functional status, and employer cost.

Methods: We performed a retrospective analysis of participants (>13 years old) seen by TPT integrated with primary care compared to a risk-adjusted, nationally matched cohort of patients receiving PT. The studied intervention had five key elements: (1) a multidisciplinary team, (2) a musculoskeletal toolkit for primary care physicians, (3) a peer-to-peer musculoskeletal expert opinion portal, (4) a shared technology platform, and (5) musculoskeletal educational rounds. We collected participants' access to both primary care and PT and compared participants' functional status at baseline and at the end of their course of PT to risk-adjusted Focus on Therapeutic Outcomes controls, providers' assessments of participants' progress with PT, participants' satisfaction with their TPT, and costs of care.

Results: We evaluated 1563 participants whose average age was 42.8 (SD 10.4) years. Of these, 586 (37.5%) identified as female, 574 (36.7%) as White, 182 (11.6%) as Asian, and 19 (1.2%) as Black or African American. Their presenting complaints included shoulder pain (282/1563, 18%), knee pain (250/1563, 16%), and low back pain (187/1563, 11.96%). The mean time to TPT appointment was 7.6 (SD 5) days. On average, TPT patients required 5.4 (SD 2.7) visits to symptom resolution, compared to 6.5 (SD 5.5) visits for controls (a 17% reduction) and 10.3 (SD 1.55) predicted visits from risk-adjusted benchmarks, resulting in US $193 to US $1411 in savings per injury per patient. Recovery, defined as patients either meeting, mostly meeting, or on track to meet expectations, was achieved for 461/473 (97.5%) participants for whom it was assessed. Overall participant satisfaction was high, with a net promoter score for PTs of 97.

Conclusions: TPT integrated with advanced primary care was associated with greater functional improvement in 17% fewer visits compared to usual care. This model holds considerable promise for addressing the escalating musculoskeletal costs of US commercially insured populations.