Bio-Mechanomics: Cost-Effective Mechanical Care for “Fixing” Musculoskeletal Disorders

December 16, 2013

My last post outlined Mark Bertolini’s three-point solution to fixing health care in the U.S. This CEO, President, and Chairman of Aetna advocates promoting evidence-based care starting with “big ticket” health care domains. Aetna currently has diabetes in its cross-hairs for improving cost-effective care.

His second initiative is to transition from a system of fee-for-service or volume-based to value-based reimbursement that rewards good outcomes. Finally he sees the need to re-structure the health care delivery system to enable access to those providers with outcomes documentation that they actually deliver superior care.

Bertolini says his three-point plan “attacks the entrenched establishment that profits from the existing inefficiencies.”  I agree.  Let me provide a real-life illustration.

No health care domain is more expensive and inefficient, and has more unwarranted variation in care, than spine and musculoskeletal management.  The estimated U.S. annual cost in 2004 was $840 billion for direct care and indirect lost wages.  That was nearly 8% of the U.S. GDP (U.S. Dept. of HHS, AHRQ, Medical Expenditures Panel Survey, 1996-2004). Further, there’s ample evidence that these costs have since continued to rise.

There is now substantial health plan and employer claims data documenting that a specific and unique mechanical form of clinically evaluating and diagnosing most musculoskeletal disorders (excluding fractures, dislocations and infections) can identify patient-specific non-pharm, non-invasive treatments that generate both rapid and long-term clinical recoveries. Such outstanding clinical outcomes should naturally be expected to generate significant savings which have indeed been documented in large payers’ claims data at more than 40% in direct costs and even greater indirect cost savings. These improvements include an 80% drop in the low back and neck pain recurrence rates (to <10%) in the year after treatment as well as a 97% patient satisfaction rate.

Patients’ excellent one-year clinical outcomes are also predictably reflected in the substantial drop in re-utilization of care after discharge which drives this large savings documented in payers’ claims data.  It is the documented long-term recoveries and this significant drop in recurrence rates that generate the greatest part of that savings due to the greatly decreased need for more complex and expensive diagnostic and therapeutic interventions.

I’ve coined the term “biomechanomics” to characterize all the clinical and economic benefits of implementing this specific evidence-based mechanical approach to musculoskeletal care.

To achieve these savings, this specific type of management must be rewarded and accessed utilizing Bertolini’s 2nd and 3rd strategies: value-based reimbursement and altering the delivery of care.

So the second key to these payers’ savings is the transitioning of reimbursement from a volume- to a value-based system. For them, this is no longer just some far-off aspiration, but an actual reality. A simple case-rate based on the value of the intervention to the payer works exceptionally well to access these specially-trained clinicians.  It is their advanced training and clinical expertise that provides the key to these outstanding clinical and economic outcomes, coupled with a robust internal quality assurance program that guarantees their delivery of these outcomes.

The further good news is that the alteration in the delivery of this form of care does not require long distance travel to access academic centers of excellence, cited as attractive to Bertolini for the definitive care of other expensive conditions.  Any delivery disruption will be minimal here as the number and availability of these specialized clinicians grows to where this service can be accessed in all cities, communities, and large workplaces, driven by value-based case-rate reimbursement that incentivizes growing numbers of clinicians to seek the required training that enables them to deliver these outcomes.

With the U.S. health care system spending an estimated $500 billion per year for non-fracture/dislocation/infectious musculoskeletal care, a fully-scaled 40% savings translates to a $2 trillion U.S. savings over a ten-year span.

So two essential questions surface: 1-what patient would not want to explore a high rate of safe, non-invasive, and usually rapid short- and long-term recovery with a 97% satisfaction rate? And, 2-what payer would not be attracted to a high percentage of happy recovered members or employees plus a 40% savings across such a huge and expensive health care domain whose costs otherwise will just keep growing?

Publication of these claims data and savings is expected in 2014. However, I would think the Bertolini’s of the health plan and employer world would want to explore this option sooner rather than later in their efforts to lower their health care costs.

As usual, I always welcome feedback and questions. Please be sure to click on “Like” if this was useful and enlightening, or “Leave a Comment” by clicking on “Comment” below.

Have a wonderful week and happy holidays to you all. I look forward to seeing you back here next year.

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