Solving One of the Top Healthcare Costs: Musculoskeletal Disorders
Musculoskeletal disorders (MSDs), or ergonomic-related soft-tissue injuries from overperformed tasks, are one of the top costs in health care and one of the most prevalent challenges in the workplace. It affects more people than cardiovascular disease and cancer combined. Over half of the population is dealing with an MSD problem on any given day.
Thanks to Bob Wiersma for his insight on this article. Mr. Wiersma is board certified in both ergonomics and human factors engineering, a Fellow of Applied Functional Science, and a licensed physical therapist. He has been a multisector thought-leader, disruptive innovator, serial entrepreneur, business adviser, and health advocate globally for over four decades. He is president of Solveglobal, LLC, MSD Health Solutions (BobW@Solveglobal.com).
According to recent data from Aon, MSDs account for 31.6 percent of the frequency and 40.8 percent of the cost of all work-related claims. Organizations continue to struggle with exactly how to approach preventing and managing these injuries.
The last big initiative in MSD management was ergonomics back in the early 1980s. While it had a positive impact, the problem and rising cost of MSDs persists for most employers today. Organizations are arguably seeing diminishing returns on traditional management approaches because they are trapped in outdated paradigms and practices.
The magnitude of MSD prevalence and cost gets overlooked because of coding fragmentation in both insurance and health care. Only when codes are aggregated does the size of the problem really become apparent. Curiously, wellness programs rarely include relevant MSD consideration/inclusion. Further, the actual cost of MSDs is dramatically understated with the omission of two critical issues—the opioid crisis and pelvic floor incontinency conditions.
The prevention of MSDs and their treatment are not a straightforward exercise and are becoming more complex as the workforce ages. In one recent study of MSDs within a large multistate healthcare organization, Aon found links between MSDs and other conditions, including weight, mental health, and the use of opioids (source: Exhibit 1—Aon MSD Study).
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Solving the MSD Challenge
A paradigm shift, new thinking, and disruptive innovation are essential to achieving dramatically better results. To solve the MSD issue, an organization must begin with two key understandings and three new paradigms.
- Most MSDs are functional rather than medical conditions. Prevention, early identification, and intervention are critical to managing cost and retaining workforce talent. MSD solutions are to be found while managing their causes, such as inside-out biomechanical constraints and outside-in work stressors. The alternative is the medical treatment of only the symptoms.
- Keep in mind that there are two kinds of MSDs. Acute trauma and cumulative trauma are important to differentiate. It's a difference that matters because each requires a fundamentally different strategy. There are also both population and individualization considerations because one size does not fit all.
Historically, organizations have used a medical bias when responding to MSDs in the workplace. While there may be a medical component related to an occurrence of an MSD, there is always a functional component driving the problem.
- The functional-over-medical approach is about focusing on the specific issues that impact employee comfort and performance. By responding to those issues, root causes are exposed, and wasteful overspending on unnecessary medical tests can be reduced. Most MSDs are functional issues before becoming medical—once it goes medical, the costs kick in.
- The use of symptom data, found through a proprietary online employee symptom survey, combined with an early response by specially trained physical therapists, enables a functional versus medical response. Predictive analytics and artificial intelligence targets resources where they can have the greatest impact—before medical treatment is required.
- Misaligned incentives are a core mistake made by many organizations. One common mistake is placing too much focus on counting reportables rather than medical costs, which often result in the suppression of timely MSD symptom reporting and increases both severity and medical costs. Another example of misalignment is wasteful fee-for-service medical arrangements that act as an incentive to providers to overtest/overtreat while driving companies to overspend.
Over the past half-century, science and economics have proven three unequivocal truths about MSD management. First, medical models fail to fix functional problems, wasting money and lives. Second, functional problems are dynamic in nature, highly individualized, and nuanced. Third, dynamic problems are only solved by smart dynamic systems.
Preventing and managing MSDs will likely become increasingly important for organizations, regardless of industry. The matter of MSDs has shifted from middle management to the C-suite and, while applied ergonomics has continued to evolve, organizations are arguably seeing diminishing returns on traditional approaches as medical costs continue to rise. These diminishing returns of early medical intervention and newly found successes of even earlier functional intervention may be the next big thing in MSD prevention and management.
Brakebush is a family-owned poultry processing company in rural Wisconsin with 1,000 employees. MSD risk is an ever-present reality in the poultry processing sector. The Function-1st strategy was launched in 2007 for workers compensation. In 2009, online systems were added and then expanded, enabling Group Health participation in 2013. The system has proven to be scalable and sustainable. Since the launch of these strategies, the company net savings exceed $3.7 million—a 39.7 percent reduction in wasteful MSD overspending.