Understanding the Escalating Costs of Musculoskeletal Care [PODCAST]

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Understanding the Escalating Costs of Musculoskeletal Care

In this episode, Scott Linthorst, Senior Vice President of Value-Based Care for TailorCare, discusses understanding the escalating costs of musculoskeletal care.

Highlights of this episode include:

• Why musculoskeletal care is such a major financial challenge in healthcare
• Where costs escalate in MSK episodes
• What role early navigation plays in controlling costs
• What role data or predictive analytics play
• Predictive analytics results
• What metrics hospital/health plan leaders should track

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome Scott Linthorst. Scott is the Senior Vice President of Value-Based Care for TailorCare, a leading provider of specialty value-based care solutions focused on improving patient outcomes for joint, back, and muscle conditions. Scott leads the organization’s efforts to optimize outcomes under value-based care arrangements. He oversees the actuary, medical economics, and analytics teams to drive a data-informed strategy that improves clinical, financial, and operational performance. Scott has a diverse background in finance, patient engagement, and healthcare services. In his previous role at Babylon, he led the Value-Based Care Finance Function, managing over $1 billion in deals from contracting to forecasting and ongoing performance management.

Prior to that, he spent eight years at CVS Aetna and also served as the CFO of an internal startup that empowered physician-led organizations to assume medical cost risk and led FP&A teams focusing on digital health, member engagement, and virtual care initiatives. Scott also has a decade of experience as a management consultant, enhancing his strategic and analytical capabilities.

He earned a Bachelor of Science in Engineering from Columbia University. In this episode, we’re discussing understanding the escalating costs of musculoskeletal care. Welcome, and thank you for joining us, Scott.

Scott Linthorst: Hey, Kelly, great to be here with you.

Kelly: Well, let’s go ahead and jump in. So why is musculoskeletal care such a major financial challenge in healthcare?

Scott: Well, I think there are a couple things. I mean, first, musculoskeletal conditions affect about half of all adults. And in the United States, it’s about $420 billion in annual spend, the single largest specialty, more than cardiology, cancer, kidney, and it’s really closely aligned with a lot of other comorbidities, cardiovascular health, metabolic health, behavioral health. I think one of the big challenges is that it’s a mix of both chronic, think degenerative arthritis and hip or knee, and episodic costs, think acute injuries from falls or lifting something too heavy. And for patients, often the biggest challenge is just knowing where to start. Patients begin their journeys in a variety of different places. It might be their PCP, it might be with a physical therapist, it might be with other downstream specialists. And so, it’s just really fragmented and hard to figure out where the costs start and where they escalate.

Kelly: Yeah, no, that makes sense. The chronic and episodic costs that you talked about, that makes sense with this particular care that we’re discussing. So where do you typically see costs escalate in MSK episodes?

Scott: Well, the anecdote I often hear from orthopedic specialists is that patients will suffer a functional decline in silence, think you’ll put your salt shaker on the counter instead of up on a shelf. But when they get to pain, that’s what really begins to motivate action. What we see in the data is there’s little consistency across different patients’ care journeys. There’s imaging. There are specialist visits. And especially when those come before conservative care treatment options are attempted, they predispose patients towards surgery at a much higher rate than if you start with some of those conservative care options. And if there isn’t some form of clinical triage that starts at the beginning, some guidance to those patients, they often end up on the most intensive care pathways as opposed to those that might work best for them.

Kelly: No, that makes a lot of sense. Thanks for explaining that for us, Scott. So, what role does early navigation play in controlling costs?

Scott: I think there’s several things that influence cost. I think the first is just educating patients about their conditions, spending time with them, really understanding not just what is the diagnosis, but what are the functional constraints? What is the impact? And then talking to them about what are their goals, what do you want to accomplish? Are you trying to walk your grandchild down the aisle? Do you want to get back to your gardening habit? What is the thing that you want to be empowered to do? And then really exploring what are the different treatment options and modalities, and what has worked for patients similar to you? Going through that kind of shared decision-making process and navigating patients to the best providers downstream can really help control costs. When patients go through that type of navigation, they’re more likely to start with physical therapy or exercise programs, and those may help them avoid those more invasive procedures downstream.

Kelly: Yeah, no, I love what you said about shared decision-making. That totally makes a lot of sense in this particular instance. So, Scott, what role does data or predictive analytics play here?

Scott: Because there are such a different variety of places that people will start in their care journeys, try to identify patients early and before they get to some of those escalated care modalities is really important. You can identify, using predictive analytics, those patients that are just more likely to have surgery. And if you can look at those patterns and engage those patients early, sometimes you can engage them even before they get to those places that they were likely to get to downstream.

Kelly: I’m always so fascinated by predictive analytics. And I think engaging patients early, that also makes a lot of sense to me. So, what results have you seen from this model?

Scott: When we see patients that begin with that kind of structured evaluation that I talked about, when it’s clear to those patients what are the pathways that they could choose, what we frequently see is that patients choose to start on conservative care pathways, conservative treatment options, exercise programs, physical therapy before they would then continue on to more invasive or more escalated options. And I think when they do that, what we typically see is a decent number of those patients stick to those pathways and report really meaningful improvements in pain and in their function. And they also report a lot higher satisfaction. When patients feel informed, they feel supported through the process, they generally just have a more warm, fuzzy feeling, right? They feel wrapped up by the– wrapped in the warmth of the healthcare system, as opposed to just being hustled through it. And this ultimately can lead to, on average, less imaging, fewer specialist visits, and better follow-through with those conservative care treatment options. For specialist providers, it also can be a better use of clinical resources because when patients do ultimately get to those more escalated pathways to– they get in front of an orthopedic surgeon, those surgeons generally actually convert those patients to surgeries at a much higher rate. So, it’s a better use of the healthcare system resources.

Kelly: Yeah, no, I love that. I was kind of taking some notes here while you were talking because it was just so interesting. The meaningful improvements and higher satisfaction are so key, and sometimes it’s so lacking in healthcare. And I also love the better use of clinical resources. I think that’s really important. So, Scott, what metrics should hospital or health plan leaders track?

Scott: I think some of the most helpful metrics tend to be really straightforward. I mean, if you just look at utilization rates of surgeries and of imaging, I think those are really good indicators of what’s going to happen from a cost perspective. I think we often want to look at how are patients tracking and following through on conservative care pathways with a conservative care pathway like physical therapy, that can be similar, that can be utilization-based metrics. But when you’re talking about exercise programs, then you need to see where you can get that data from. Is that a digital physical therapy platform? Can you get data out of that? And we find that really useful to talk about whether or not a patient is kind of activated in their care. Ultimately, patient satisfaction is both really valuable into itself as an indicator of whether or not you’re treating patients well, but it’s also a really good leading indicator on kind of what the total cost of episodes are going to be in an outcomes basis.

Kelly: Yeah, I know that tracking metrics can be challenging, especially in healthcare. So, what should healthcare leaders understand about MSK as value-based care evolves?

Scott: I think the big thing to understand is musculoskeletal care is impactable. The costs that are in the system today do not have to be the costs that are in the system tomorrow. Conservative care treatment options are accessible, pretty well understood. And when the system actually focuses on engaging members early and coordinating care between pairs, they can make really meaningful improvements in that in a relatively short timeframe. And what we see that’s super encouraging is when there is that collaboration, that coordination between healthcare providers and health plans and other navigation organizations that are focused on engaging and educating patients, we see real improvements in financial outcomes, in patient healthcare outcomes, and ultimately in the patient’s quality of life. And that’s what we want to see.

Kelly: So, collaboration is key, right?

Scott: Totally.

Kelly: Yes. Well, thank you so much, Scott, for sharing your insights with us on understanding the escalating costs of musculoskeletal care. If a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Scott: Well, they can get in touch with us at tailorcare.com or you can come follow us on LinkedIn and look for TailorCare. And that’s Tailor, T-A-I-L-O-R, in case you were confusing us with Taylor Swift.

Kelly: Thanks for making that distinction there, Scott. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes our episode of The Hospital Finance Podcast. For show notes and additional resources, visit us online at besler.holdings. The Hospital Finance Podcast is a production of Besler Holdings; Built on partnership, Driven by success.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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