Health Plans and Employers ‘Muscle Up’: Virtual Care Delivers Safe, Effective MSK Recovery

During the COVID-19 global health emergency, people are avoiding hospitals and other health care facilities because they’re concerned about being exposed to the virus. In fact, a recent Sage Growth/Black Book research survey found that 33% of respondents feel unsafe going to their doctor’s office and 41% feel unsafe going to a hospital. While that reticence may help hospitals avoid being overwhelmed, it’s absolutely not helping the people who’ve chosen to delay getting the care they need. How big is the issue? A recent Morning Consult-American College of Emergency Physicians poll found that nearly a third (29%) of survey respondents said they had avoided or delayed seeking medical care due to concerns about contracting the virus.

Half of American adults (127 million people) are estimated to be living with musculoskeletal (MSK) disorders. For them, the impact of delaying or going without care is significant and includes:

  • Living with ongoing pain, which in turn has the potential to increase use of and reliance on opioid medications
  • An increase in dysfunction that results in an inability to perform daily activities or work
  • A progression of the disease’s severity that may increase the likelihood of surgery or permanent disability

Before the pandemic struck, people with MSK disorders could access care safely and fairly easily. But even pre-pandemic, there was a significant unmet need for this care. Insurers typically pay for a limited number of physical therapy visits. If the person’s condition hasn’t improved, he or she needs to get approval for another limited number of visits, which can be time-consuming and frustrating. In addition, completing even this limited course of therapy can be challenging for many people who need to take time off work or secure childcare and travel to the location where their therapy is provided.

“I think it’s fair to say that the advent of telehealth has been just completely accelerated… there’s absolutely no going back.”
– Seema Verma, CMS administrator

A better way, now and moving forward

For the foreseeable future as the pandemic continues without an approved vaccine, people need a safe new way to access MSK care. And even if the pandemic can be contained, not everyone will feel comfortable returning to health care facilities, especially those who are more vulnerable and at risk from the virus, like people over 65 and those with underlying chronic health conditions. There’s also likely to be a backlog of people in need of care, which may make it a lot more difficult to get an appointment with an orthopedist or physical therapist, further delaying access to care.

The solution, for both the current situation and the future, is making quality MSK care available on patients’ terms—safely, outside a health care facility, when and where it’s most convenient. Telehealth can provide that solution in both the short and long term.

CMS Administrator Seema Verma

CMS Administrator Seema Verma (courtesy of Wikimedia Commons)

The time is right for telehealth to expand its reach. Medicare has relaxed its guidelines on the type of telehealth services it covers and enhanced its coverage through the summer, and many commercial insurers are following suit. And it’s likely these coverage enhancements will continue in some form indefinitely. Even CMS administrator Seema Verma has gone on the record saying, “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

Along with better coverage and reimbursement for telehealth, patients are also embracing virtual access to care. At the end of March, the Wall Street Journal reported a marked increase in telehealth visits by Medicare patients, from 100,000 per week to 300,000 per week. A Sage Growth/Black Book research survey also highlights patients’ growing desire for and acceptance of telehealth services. Of survey respondents, 48% are seeking more digital health solutions to manage their health and well-being and more than two-thirds (69%) of respondents want their provider to offer more telehealth visits as an alternative to office visits even after the pandemic ends.

But not all telehealth or digital solutions will deliver what people with MSK disorders truly need. Beyond ease of access from the safety of home, people need to receive care on an episode basis, not on a limited visit basis, so that they can receive care as long as it takes to recover. They need clinically validated assessments and recovery pathways, and access to personalized exercise plans overseen by physical therapists and coaches.

The good news is that RecoveryOne has already created this new model of care and is delivering on-demand, clinically validated MSK recovery care to people across the country. A growing number of insurers and employers are including this new resource in the benefits they offer, opening access for hundreds of thousands of those who will need this care long after the pandemic ends. After delivering millions of sessions, we’ve proven that this model can improve outcomes by up to 54%, reduce the need for surgery, lower costs for patients, payers, and employers—while earning a patient satisfaction rate of over 88%.

The essential role of health plans and employers in the safe delivery of care

But even as more health plans and employers make coverage for telehealth an integral part of their benefit offerings, there’s more work to be done to keep people safer during and after the height of the pandemic. They need to move from passively offering new virtual MSK solutions to taking proactive steps to identify and engage those who most need this care.

That means mining their own databases to identify those who’ve been pre-certified for MSK surgery, who have an existing MSK disorder that has gone untreated, and those prescribed opioid medications for pain related to MSK disorders. Plan administrators can connect these populations with virtual MSK services, helping them avoid unnecessary visits to healthcare facilities where they risk exposure to COVID-19.

Health plans and self-insured employers cannot afford to be passive, communicating the availability of telehealth coverage on a one and done basis. We all need to be proactive partners in the effort to keep people safer in this new world by encouraging the appropriate use of remote care.

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