We have seen an evolution of musculoskeletal (MSK) care and injury prevention over the past 25 years that has recently been gaining more and more attention. While employers can see the positive effects of well-executed safety, early intervention, and ergonomics programs in their workers’ compensation costs, they also must recognize that costly MSK injuries must be addressed with the proper tools that effectively impact musculoskeletal disorder (MSD) risks both on and off the job.
Not all MSK health solutions are the same. Some solutions can prevent injuries on the job and can have an impact on personal health risks off the job. Others are just different approaches to managing injuries once they occur. Forward-thinking employers are seeking preventative solutions more and more. So which solution is best?
In this article, we will evaluate several common MSK solutions that have become more prevalent within the workplace, looking at which solutions have the best cost avoidance possibilities, ease of implementation, and cultural impact. Specifically, we will examine:
- Early Intervention Solutions
- Physical Abilities Testing
- Ergonomics Programs
- Digital MSK Solutions
- Onsite Occupational Health
MSK Solutions in the Workplace
In the past 5 years, we’ve seen an explosion in opportunities in the marketplace that all claim they can help reduce MSD costs, but can they work in ANY organization? Does it matter which one you choose? Is one solution better than the other? These are important questions to answer when your organization is looking to address employee health and safety with an eye specifically on MSD prevention and wellness.
Many factors influence organizations’ decisions on which solution to choose. The obvious factors of cost, the potential return on investment (ROI), and efficacy typically inform at least part of the decision. However, other factors have a meaningful effect as well. Perhaps the most impactful aside from cost, ROI, and efficacy is the “agency” issue. Translated, this means “WHO” in the organization needs the solution and “WHICH” cost center are they most closely affiliated with.
As an example, human resources professionals look for effective means of screening new employees, so they are not hiring their next injury. They, along with those within the organization who purchase and administer benefits, also look at solutions to reduce MSD costs that they pay in their group health or self-insured health plans. At times, they work closely with return-to-work professionals that focus on disability cost reductions. Occasionally we see a crossover from these professionals to the environmental health and safety departments (EH&S) who look more closely at reducing occupational hazards that drive MSDs.
NIOSH and the Centers for Disease Control have strongly promoted a “Total Worker Health” model. These initiatives seek to impact employee health around the clock, recognizing that it doesn’t matter whether an injury or illness occurs on or off the job; the employer still winds up holding the bill. So, if you and your organization agree with this notion, then when comparing “MSK Solutions,” the Total Worker Health philosophy should be a guiding principle. If you can impact an employee’s health by addressing the occupational risks, non-occupational risks, and personal health risks together, the overall impact on the employee’s MSK health is enhanced and the costs associated with managing injury and illness reactively (through the workers’ compensation, health insurance, and/or disability insurance systems) will be reduced or eliminated.
So which solutions crossover well between the “benefits” and “occupational health” domains? We’ve broken down and hopefully demystified the myriad of MSK solutions that are available in the health and productivity industry and defined their scope of impact, relative effectiveness in managing or avoiding costs, ease of implementation (including cost), and cultural impact. This analysis can serve as a guide for you in choosing the appropriate solution based on your organization’s needs.
Early Intervention Solutions (Industrial Sports MedicineTM)
Overview: Early Intervention Solutions, sometimes called “Industrial Athlete” or “Industrial Sports MedicineTM” programs, have become increasingly popular with employers as a tool to directly engage with their employees to reduce environmental, ergonomic, and personal health risks that drive MSDs. These programs often include placing an MSK specialist onsite to provide:
- Self-care activities
- Job coaching
- Wellness coaching
- Return to work
- Early discomfort management (aka “early symptom intervention”)
These initiatives have an impact across the entire workforce and are a popular choice when an employer seeks to keep an aging and experienced workforce healthy and productive. These programs are occasionally confused with “onsite physical therapy” or “onsite athletic training.” The credentials of the provider placed onsite do not define the program, but rather, are governed by vendor specialty or employer preference.
MSD Impact: Very High
- These programs impact workers’ compensation, group health, and disability since they address the employee, avoiding the distinctions of whether a discomfort occurred on the job or off. While this distinction has an impact on the procedures that the vendor can apply (because of OSHA recordability parameters), the mix of service offerings impacts the worker holistically.
Cost Avoidance Possibilities: Very Significant
- These programs are popular because they have a dramatic impact on MSD costs both in workers’ compensation as well as group health and disability. Service can impact the entire life cycle of injury development including prevention and wellness, condition management (onsite treatment), return to work, and retention.
- Cost avoidance can be impaired if you choose providers that might view their engagement with you as an opportunity to feed offsite clinics or facilities. Your provider should be narrowly focused on prevention of injuries and should not have a secondary motive of billing your group health or workers’ compensation policies for care in other treatment venues. That conflict will impair your results.
Ease of Implementation: VerySimple
- Implementation for these programs is relatively simple. However, geography, availability of providers, and scope of work requested (smaller employers may have more difficulty in staffing smaller needs) can have an impact on the ease of implementation.
Cultural Impact: Very high
- Onsite providers quickly develop deep and meaningful connections and relationships with employees thereby delivering a measurable impact on engagement and a culture of “care.” However, it is important that the vendor deliver consistency in the provider(s) placed onsite as well as making sure that the provider fits your organization’s needs from a personality and communication standpoint.
- Utilizing contractors that may change from day to day or week to week or utilizing vendors that have high turnover rates because of impaired employee retention programs or utilizing vendors that don’t vet providers for “fit” can be a problem. Make sure the provider that is placed onsite is stable, consistent, and a good fit so that the program can have a positive impact on culture.
Physical Abilities Testing (PAT)/Post-Offer Employment Testing (POET) Programs
Overview: Physical Abilities Testing (PAT) is commonly applied after a conditional offer of employment has been given to a candidate so that they can prove they are physically able to perform the job. This is called Post-Offer Employment Testing (POET). POET programs are a popular choice for preventing musculoskeletal injuries in industries or situations which have high employee turnover or when injuries in specific jobs tend to occur early in tenure.
POET programs should not be confused with traditional medical tests wherein health data is collected, but not used to disqualify candidates. When employers use POET to screen and disqualify candidates who cannot safely perform the physical demands of essential functions, they must do so while adhering to strict compliance measures to avoid triggering exposure from EEOC or ADAAA claims. History has proven time and again, however, that when POET programs are implemented correctly and uniformly, this risk can be completely contained. But be careful. The POET protocols need to EXACTLY match the physical demands of the essential functions. Standardized or “boiler-plate” POET protocols should be avoided at all costs.
Physical Abilities Testing can also be used as a preventative measure post-placement and with incumbent employees. The difference is that instead of testing physical abilities so that you can disqualify or reassign, the test results are used to identify musculoskeletal impairments that can then inform specific activities for the employee in a musculoskeletal wellness program. This allows employees to focus on their area of physical need thereby reducing musculoskeletal risk imposed by personal health issues.
MSD Impact: Very High
- PAT/POET programs allow employers to disqualify candidates before placing them if they prove, by failure on the PAT/POET test, that they cannot safely perform the job. This has a significant impact on injury rates as employers avoid hiring those employees who cannot do the job safely. It stands to reason then that aggregate injury risk is lowered. The primary impact is with workers’ compensation claims reduction and reduction of OSHA recordables.
Cost Avoidance Possibilities: Very Significant
- Reduction of workers’ compensation claims is expected provided that the POET protocol is sensitive enough to disqualify candidates who can’t safely perform the physical demands of the job. For medium and heavy Physical Demand Classification (PDC) level jobs, it is common for sensitive PAT/POET protocols to disqualify between 10 and 25% of candidates. This has a meaningful impact on injury rates and associated costs.
Ease of Implementation: Initially Complex/Ongoing Simple
- Initial implementation of legally compliant PAT/POET programs is relatively complex. Protocols must be tightly based on accurate and recent Physical Demands Analysis (PDA) so that the testing components accurately reflect what physical demands the job requires. Incumbent testing is also important to generate data that supports content and/or criterion validity. Additionally, periodic updates to the PDAs and PAT/POET protocols should be conducted to ensure that the protocols address “creep” in required physical demands and essential functions. Also, test results data should be periodically analyzed to identify trends in disqualification that might point to adverse or disparate impacts on protected classes. Once up and running, the delivery of PAT/POET tests on an ongoing basis is relatively simple and inexpensive.
Cultural Impact: High
- PAT/POET programs can have a positive impact on safety culture as they demonstrate the employer’s desire to maintain a safe work environment.
Overview: Ergonomics programs are as diverse and varied as the type of professionals that lay claim to “ergonomics” as a core competence. In its purest form, however, ergonomics, being the science of fitting the work to the worker, involves developing processes to measure risk, identify and test risk abatement solutions, then tying those solutions to business practices. While ergonomics is usually associated with “equipment” (e.g., office chairs, keyboard trays, pallet jacks, robotics/automation, tool design), comprehensive programs incorporate work practice and management controls as well. Employees, the key stakeholders in ergonomics programs, must be part of the program development as well as subjects of training and other behavioral approaches that are important to effective ergonomic management.
MSD Impact: Very High
- Ergonomics programs are limited solely to occupational risks as they address only occupational hazards.
Cost Avoidance Possibilities: Very Significant
- Ergonomics programs can deliver significant cost savings in the form of injury reduction, but also can have a meaningful impact on key business metrics such as productivity, cycle time, and product quality.
Ease of Implementation: Simple
- Ergonomics programs are moderately difficult to implement because they require the assembly of groups of stakeholders that steer the program over time. Aligning the needs of multiple stakeholders within an organization can prove challenging. These challenges are overcome by careful consideration and documentation of the business benefit of a sound program.
Cultural Impact: Very High
- Because of the integration of input from multiple stakeholders, including employees and end-users, an ergonomics program can have a significant positive impact on culture. Ergonomics programs should include input from everyone. For this reason, these programs bring individuals together into a common purpose and vision. This can provide a significant boost to employee sentiment and engagement.
Digital MSK Solutions
Overview: Digital MSK solutions serve as a point of connection for injured employees so that they can access automated content and activities as well as in some cases, virtual/telephonic support for specific conditions. They focus primarily on substituting in-person care for specific diagnoses with apps armed with “artificial intelligence” algorithms supplanting traditional care models.
MSD Impact: Very Low (After injury)
- These apps are primarily used in the Group Health marketplace as a component of service offered by insurers as an add-on benefit for insureds. Digital MSK solutions are not designed to prevent injuries, particularly occupational disorders, but rather reduce costs of treatment once symptoms and injuries occur.
Cost Avoidance Possibilities: Low
- Anecdotal evidence of “per claim” cost reduction in health plans is usually associated with a cost avoidance of expensive procedures (radiology, surgery, pharmacy, etc.)– a common argument for other face-to-face MSK solutions such as physical therapy - but digital MSK solutions look to replace those face-to-face interactions with less-costly automated solutions for common conditions. Since the apps are relatively inexpensive, they can return on investment for individual cases. When apps are coupled with virtual care, however, cost avoidance can be negatively impacted as the virtual care pricing models parallel face-to-face medical models. The benefit that the apps promote is that users might not need to escalate their care to more expensive procedures such as surgery.
Ease of Implementation: Very Simple
- Digital MSK solutions are very easy to implement so long as the insureds have access and are accustomed to using technology for medical interventions. They often come packaged with health plans.
Cultural Impact: Very Low
- Adoption rates are dependent upon the socialization of the system, user values and beliefs, and the scope of care offered by the app. As such, cultural impact within the organization is minimal or non-existent.
Suggested Use: Organizations with exorbitant MSK costs in their group health plans associated with MSK facility and procedures costs. These apps should not be mistaken for MSK injury prevention, but rather less expensive care for injuries once they happen.
Onsite Occupational Health
Overview: Onsite medical services started early on with occupational medicine only. Primary care opportunities supplanted this as a focus, but onsite occupational health services remain an important component of onsite care for some employers. Occupational health and safety models offer additional services specific to occupational health management such as auditory testing, Department of Transportation (DOT) testing when applicable, travel medicine, drug testing, and others. MSK condition management and prevention is becoming more popular in onsite occupational health medicine, this stands to reason considering MSK is the largest cost driver in workers’ compensation for most employers. Reactive measures for MSD management such as onsite physical therapy are sometimes offered, but not always.
MSD Prevention Impact: Medium
- The focus is primarily on the treatment of occupational disorders as well as compliance-driven medical testing. Onsite medical staff, unless specifically trained in MSD prevention and then applying that training outside of the clinical setting, are less focused on prevention and more focused on condition management. However, onsite Occupational Health and Occupational Medicine can work hand in hand to deliver focused MSK solutions to employees. As such, these onsite occupational medicine services can augment MSK solutions already in place or being considered.
Cost Avoidance Possibilities: Medium
- Non-MSD workers’ compensation and related disability costs can be reduced effectively by onsite medical providers. The addition or incorporation of MSD-specific providers and programs can have a meaningful impact on this large cost driver if effectively linked to the occupational health service mix. No cost avoidance is available for dependents. This is for employees only.
Ease of Implementation: Very Complex
- Depending on the scope of services offered, implementation can be moderate to difficult. Dedicated space and build-out with their associated costs are necessary.
Cultural Impact: High
- Onsite occupational medicine can have a medium to high impact on a positive “safety” culture. The impact is dependent on the scope of engagement that the providers seek with employees.
Given the numerous MSK solutions on the market, it is imperative for an organization to evaluate the specific needs and goals associated with the program to determine which type of solution will best match their needs and desired results.
To aid in the evaluation of these MSK solution types, Briotix Health has created a free reference chart. Click the download button below to save the resource.