Transforming MSK Care with a Digital PT-First Approach: Lessons Learned from Kaiser Permanente and Corewell Health

With more than 50 percent of adults in the U.S. suffering from back, shoulder, knee, and other joint pain,¹ musculoskeletal (MSK) care costs the U.S. healthcare system an estimated $420 billion²—more than any other chronic condition.

To help lower the costs of care while improving outcomes for MSK patients, many organizations are turning to a PT-first approach driven by digital care tools such as home exercise programs, patient education, patient mobile apps, telehealth, and remote therapeutic monitoring (RTM). With this approach, patients are screened for red flags first. Candidates for physical therapy are then directed to virtual therapy or an in-person visit instead of to Primary Care.

Evidence strongly demonstrates the benefits of this type of care model, from shorter episodes of care to lower costs. Patients engaging in PT-first care have an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of advanced imaging, and a 15 percent lower probability of an emergency department visit.³

When Kaiser Permanente and Corewell Health were looking for alternative ways to manage their MSK population, they turned to a PT-first approach driven by digital care. In this article, we’ll take a look at the best practices, lessons learned, and results that these two organizations have experienced from implementing this model.

How Kaiser Permanente Leveraged PT-First

Background and Goals

Kaiser Permanente serves about 12.4 million members in eight states and the District of Columbia, with the majority of members located in California. The organization’s mission is to deliver high-quality, evidence-based, affordable healthcare services that improve the health of its members and the communities that it serves.

With primary care facing resource constraints, Kaiser was finding that many providers didn’t have enough time to properly address MSK issues. At the same time, patients wanted choice and ease of access to care on demand. In response, Kaiser decided to improve access to care for MSK patients while reducing the MSK demand on its primary care doctors in order to give them more time to provide high-value care in other areas of their practice.

Strategies Used

In 2018, Kaiser launched Online PT, a program and integrated platform that increases access to physical therapy treatment plans. It provides clinicians with a central tool to engage with patients, assign exercises, and monitor pain, and allows members access to view assigned exercises, report on pain, and track completed exercises.

Kaiser also launched MSK E-Visits, an online self-service alternative for patients seeking advice for common conditions, to help streamline care and relieve back-end demand without sacrificing quality or care experience. Within this model, patients can have access to advice from a PT within hours of engaging in an e-visit.

Results of Online PT:

For Kaiser, Online PT is one of the most used programs within the organization. In 2019, 15,000 to 18,000 patients used the program each month, with 60,000 or 70,000 total logins. Since then, usage has increased, with 50,000 to 55,000 patients logging in over 200,000 times a month. Results have included:

• Better clinician access, with the ability to easily assign home exercises using pre-existing templates and monitor patient progress with a visual reporting dashboard.
• Time savings for clinicians by allowing them to leverage commonly prescribed exercises or customize their own with easy-to-use templates.
• Elevated outcomes by utilizing patient feedback, actual data, and adherence tracking to further increase engagement.

Results of E-Visits:

E-Visits have allowed Kaiser to better match the right provider to the patient early in their care. Approximately 19,000 low-back-pain patients are appropriately diverted from primary care to the proper resource—and this number is growing. Results have included:

• Excellent patient experience, with 90 percent of patients reporting that they’ve received the information and care they need, and 70 percent reporting that they’re able to effectively self-manage their symptoms.
• Excellent clinician experience, with a high number of clinicians reporting that they’re able to get the right care to the right patients at the right time.

How Corewell Health Leveraged PT-First

Background and Goals

Corewell Health is an integrated, managed care organization based in West Michigan, with subsidiaries that include hospitals, treatment facilities, urgent care facilities, and physician practices. Corewell’s primary goals in implementing a PT-first approach using digital care tools included:

• Creating a patient journey that achieves superior outcomes while also being more accessible, affordable, and engaging.
• Preventing or prolonging surgical interventions for MSK patients, in particular those with spine and osteoarthritis complaints.
• Strengthening payer relationships.
• Becoming better positioned for the future of patient care.

Strategies Used

To achieve its objectives, Corewell used a four-step approach:

1. The organization established a guiding principle of leveraging technology to automate clinical pathways and drive consistent, reliable, and sustainable care.
2. The organization determined what those clinical pathways should look like to ensure the right utilization and care journey for patients while reducing the administrative burden for clinical team members.
3. Once those clinical pathways were established, Corewell worked to create clarity for each team member on their roles and expectations within the pathway itself.
4. Finally, the organization created aligned goals for the clinical pathways among all team members.

Results

During its PT-first pilot, Corewell served approximately 1,900 patients and saw the following results:

• Elevated patient satisfaction, with 99 percent of patients reporting that care was convenient and easy to access. Press Gainey outpatient scores also improved by 5.3 percent, and inpatient scores improved by 7.7 percent.
• Better clinical outcomes, with 85 percent of MSK complaints resolved in just one to three PT visits.
• Improved payer relationships due to better performance on key metrics such as patient outcomes, care utilization, and cost of care.

Lessons Learned

Corewell found that following these best practices helped its program succeed by:

• Ensuring that its providers were open and receptive to the PT-first model.
• Establishing a solid screening or triage process by working together with the intake and scheduling team.
• Selecting PTs with solid MSK expertise and good emotional intelligence, with an ability to build strong trusting relationships with the primary care team.

How MedBridge Helps

The MedBridge Digital Care Solution for Hospitals and Health Systems allows organizations to deliver a higher quality of care at a lower cost with a solution that combines powerful staff and patient engagement tools. Our solution works by allowing organizations to:

Triage Effectively

Get patients to the right place at the right time, regardless of where they enter: primary care, orthopedics, sports medicine, e-visits, emergency departments, or therapy directly.

Catch Problems Early

Our solution targets high-risk patients early before MSK problems become too serious and costly.

Get Patients Better

Engage and motivate patients to effectively progress through care while providing insights and risk notifications to providers to engage when needed.

Refine Through Data

Collect data that allows your organization to refine the patient management process.

References

1. Centers for Disease Control and Prevention (CDC). “NHIS Data, Questionnaires and Related Documentation.” National Center for Health Statistics: National Health Interview Survey. Adult sample, 2015. July 23, 2016.
2. Dieleman JL, Cao J, Chapin A, et al. “US Health Care Spending by Payer and Health Condition, 1996–2016.” JAMA.
3. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018 Dec;53(6):4629-4646.