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Interventional Orthopedic Insights

From the Desk of Regenexx CEO Jason Hellickson

Use Your Data to Build Healthier Employees and Better Business

Data is at the heart of business decision-making. Data analytics is especially important to implement when considering insurance benefits as a strategy to navigate the complexity of offerings and guard against the continuous rise of health insurance costs.

Organizations have amassed a wealth of information that allow them to become more risk intelligent when it comes to making decisions. Companies such as Walmart have used predictive analytics to drive consumer behavior to provide customer recommendations, build purchasing efficiencies and maximize inventory turnover.¹ Big data analysis is at play in every aisle, every cash register and every transaction.

Walmart also constructively leverages data to create actionable long-term healthcare initiatives that improve employee health trends and boost worker satisfaction. Using health benefits data and outcome analysis, Walmart has identified high cost claimants (HCC) and future high-cost claimants to minimize consequences in behaviors and therefore, in risk. They’ve partnered with “carefully vetted” providers that deliver significant amounts of high-quality service to their employees. These services include crafted bundled payment arrangements that cover the cost of an employee’s care for certain episodes from start to finish.These programs have saved companies like Walmart millions of dollars and allow employees to get back to their lives and work faster.²

Claims Analysis Can Lead to New Solutions in Care

Employee benefits managers, TPA’s and employers have similar opportunities to maximize their companies’ investments. The effective use of disparate data can help employers optimize their health, wellness and other benefits programs, and pinpoint the true value of their total rewards.

Alera Group employee, Ellen Lindahl, Clinical Review Director at Relph Benefit Advisors, believes the musculoskeletal care category is prime for this kind of data-driven plan design.

“Orthopedic claims data represents one of the largest diagnostic expenses and is especially helpful to drive plan design decisions and coverage options that correctly incentivize plan members in the care most relevant to them. This kind of intentional plan design is where Regenexx can help employers tackle several of the largest diagnostic claims categories by adding a high value, lower cost approach to orthopedic clinical management.”

Musculoskeletal diseases (osteoarthritis and back pain combined) are the most prevalent conditions seen in the Relph Benefit Advisors client data.

The lack of options to treat musculoskeletal conditions is a major concern for employees, who at times, delay or put off an impending orthopedic surgery due to associated risks and cost of care. Our independent analysis of several large national employers identified that up to 40 percent of employees with a surgical recommendation were holding off on taking this step. Regenexx calls this intentional delay a “gap in care” that ultimately leads to higher costs and more pain and suffering for plan members. The most common reasons to hold off on surgery were: not wanting to incur additional pain and suffering due to invasiveness, the high level of risk with a surgery, unaware of an additional option in treatment and not able to take significant time off of work.

Adding an option in care can mobilize employees to use conservative care options before surgery is necessary.

In addition to the benefits card and educational e-mails, we have developed and successfully piloted a new utilization strategy that uses claims analysis to proactively target outreach to plan members who are on the pathway to orthopedic surgery. In our trial run, 50% of patients contacted scheduled a Regenexx consultation. Use of claims data allows us to identify plan members at high risk for or actively on the pathway to orthopedic surgery. Factors used to identify plan members for targeted outreach include:

• Prior authorization for orthopedic surgeries Regenexx can replace.
• Prior authorizations for MRIs where there is a primary orthopedic diagnosis.
• Opiate prescriptions filled for patients with qualifying diagnoses.
• Pain-management injections for patients with qualifying diagnoses.

Our findings suggest that employees will seek proper care at a much earlier and less costly stage of illness if provided an option in care. Avoiding an expensive surgery, avoiding medication dependency and avoiding ongoing cyclical treatment of an orthopedic condition by including Regenexx is good fiduciary planning. By including Regenexx as part of the care continuum, employers are closing the gap in care between non-invasive treatment options like chiropractic care or physical therapy and orthopedic surgery.

Employees Weigh-In on Regenexx

“I would have likely lived with the pain until I had no choice but to have surgery. The coverage made it a no brainer and cost less for my employer in that surgery would have eventually been more costly to cover. By not having to undergo surgery I was able to go back to work within days and I was able to return to full use within weeks.” – Cary D., Executive Assistant

“I am very appreciative I had this coverage! I avoided surgery and lengthy time off work. I returned to work in two days and am four weeks post procedure and have felt results right away.”
-Renee S., Occupational Therapist Assistant

“It is awesome that our company provides this program. Without, I would have had surgery or scopes performed. I am able to perform tasks now without a great deal of pain and suffering.”
-Lars L., Technician

“If not for my benefits covering the Regenexx procedure I would have been looking at a knee replacement. This is a much better option for me and my employer.” -Dan B., Welder

A company does not have to be the size of Walmart to use data intelligence to act upon insights quickly. “Assuring the provision of clinically appropriate, high-value, evidence-based care is core to our mission in serving employers,” states Ellen. “Rather than going straight to orthopedic surgery, Regenexx can now be an option for many patients – with better outcomes coupled with less risk, cost and downtime.” Read Part 1 of Ellen Lindhal’s interview here.

To learn more about how we work with existing health plans, major carriers, TPAs, Re-insurers and Brokers, call 877-341-5968 or visit RegenexxCorporate.com.

Live Informed,

Jason Hellickson
Chief Executive Officer, Regenexx
1-319-899-4332
jhellickson@regenexx.com

Your Trusted Resource to Reduce Orthopedic Costs and Achieve Better Patient Outcomes

¹ https://www.dezyre.com/article/how-big-data-analysis-helped-increase-walmarts-sales-turnover/109

² https://hbr.org/2019/03/inside-employers-new-health-care-playbook