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Musculoskeletal (MSK) Condition Services

Manage escalating spend and utilization.

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MSK conditions are common and costly

  • 80% of people in the U.S. are affected at some point in their lives.1
  • They are the leading cause of disability in the U.S. for people over the age of 45.2
  • Direct medical expenditures per year are over $510 billion dollars.3
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Optum offers a suite of solutions to address MSK conditions and medical spend. Our member-focused, holistic approach includes: 

  • Early intervention to promote conservative care 
  • Outcomes and utilization monitoring to ensure appropriate treatments 
  • Access to high-performing providers and Centers of Excellence (COEs) 
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Integrated capabilities

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Care management

With advocacy at the core, members receive direct, digital or virtual access to specialized nurses and high-performing providers.

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Utilization management

Integrated programs help reduce pre- and post-medical expenses by addressing spinal disease, joint surgery and back pain care. 

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Network access

Top facilities and physical health providers help ensure quality care and convenient access at negotiated rates.

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Digital tools

Access virtual self-management for best-in-class multimodal therapy.

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Solutions

Reduce variation in surgical outcomes, improve care quality and reduce spend through bundled payments, care management and COE referral. Care management seamlessly connects all MSK solutions.

Improve clinical quality through network access, care management and claims administration. Networks include Physical Therapy, Outpatient Therapy, Speech Therapy, Chiropractic and Complementary Alternative Medicine (CAM).

Reduce costs by examining medical necessity of spinal disease, joint surgery and back pain.

Reduce acute inpatient rehabilitation and ensure appropriate skilled nursing facility (SNF) and long-term acute care (LTAC) facility use.

Innovative payment integrity approach targets procedure and facility claims. Experienced, specialized clinicians target highest-value claims.

Proven results

Over 30 years of proven clinical and financial results drive an overall 3:1 ROI.1

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35%

savings with Utilization Management and national Outpatient Rehab network4

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26%

savings per procedure at surgical COE4

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15%

savings with Post-Acute Facility Management4

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10%

savings for services under Spine, Pain and Joint Utilization Management8

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14–28%

savings generated with Focused Claims Review Professional9

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3:1

ROI10

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MSK solutions fact sheet

Download fact sheet (PDF 170.7 KB)

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Sources

  1. American Academy of Orthopedic Surgeons. The burden of musculoskeletal diseases in the United States: prevalence, societal and economic cost. 2015. Accessed June 19, 2018. 
  2. Sinett T, Sinett S. The truth about back pain. New York, NY; 2008. 
  3. Optum book of business, 2018. 
  4. Optum proposed and book of business, 2018.
  5. Optum analytics, 2018.
  6. Ibid. 
  7. Ibid.
  8. Ibid. 
  9. OrthoNet book of business, 2019.
  10. Ibid.