Name: Ellen Lindahl, RN, MPA
Title: Clinical Review Director
Industry: Employee Benefits Management / Workers’ Compensation
Client Base: Employers with 100 or more benefit eligible employees
What are you seeing in the industry as far as the MSK diagnostic category with your clients?
Musculoskeletal conditions are consistently a top cost driver for our clients and with the aging of the US population, they are becoming a greater burden every year. The cost of treating major musculoskeletal diseases, which often includes long-term pain and disability, is also greater than for treatment of many other common health conditions. Back pain and arthritis are the most common musculoskeletal conditions reported, and these conditions lead to significant healthcare costs associated with physicians’ offices, emergency departments, and hospitals each year. As can be seen in the chart below, musculoskeletal diseases (osteoarthritis and back pain combined) are the most prevalent conditions seen in the Relph Benefit Advisors client data.
Some good news is that employers are becoming more sophisticated in using claims data to drive future benefits decisions in high cost diagnostic categories like musculoskeletal and orthopedic conditions. Orthopedic claims data analysis provides insight into 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.
How important is standardization of care when it comes to introducing an innovative treatment to your employers?
Assuring the provision of clinically appropriate, high-value, evidence-based care is core to our mission of serving self-funded employers. The importance of this cannot be overstated. There are many orthopedic surgical procedures routinely being used to treat musculoskeletal conditions that have very little in terms of a rigorous clinical evidence base. The Regenexx network includes a select group of carefully screened providers who are required to undergo an extensive training and certification program. Regenexx maintains a patient registry and transparently makes outcome data available on their website. Unfortunately, this kind of transparency is sorely lacking in most segments of health care.
Can adding the Regenexx Corporate Program has the potential to save employers on their orthopedic spend?
Moving appropriately screened patients from a higher risk, significantly higher cost surgical procedure to a less costly and less invasive interventional procedure makes both good business and clinical sense. Regenexx is going to be at a much lower price point than an invasive surgical procedure. In addition, employers are going to avoid potentially unnecessary surgeries when covered members go through the Regenexx evaluation and procedure before jumping directly to invasive surgery. The lower price of treatment and equal or superior clinical outcomes will result in lower costs and better care for our clients. It’s ultimately about potentially avoidable surgery and giving members clinically valid options enabling them to make well-informed decisions on what approach is best for them. The ability to avoid even a single unneeded surgery allows an employer to see an immediate impact on their financials—from a treatment cost perspective as well as reduction in associated lost work time. Members who opt for a Regenexx procedure can return to work in a few days as opposed to often several weeks when they have invasive orthopedic surgery.
How do you encourage your employers to strategically attack orthopedic care as a top expense category?
We encourage a multifaceted approach to managing expenses related to major orthopedic conditions. Before Regenexx, employers lacked the benefit of additional innovative solutions in this area of care. Rather than going straight to orthopedic surgery, the Regenexx orthobiologic program can now be an option for many patients– better outcomes coupled with less risk, cost, and downtime. Regenexx is one of the first innovations we’ve seen that can have this level of impact in the orthopedic space.
How effective is adding Regenexx as an interventional approach for one of the most expensive diagnostic categories?
Employers increasingly are moving into the driver’s seat to proactively control healthcare costs and improve outcomes. Because surgery for musculoskeletal disorders represents a significant and growing component of employers’ health care and worker’s comp spend, the addition of a high quality interventional-orthopedic benefit is a slam dunk. Until now, when it came to orthopedic conditions, employers had no good options beyond conservative care other than costly invasive surgery. Employers and patients now have a choice with the addition of Regenexx.