Improving Musculoskeletal Costs of Care Using a Virtual Integrated Practice Unit: A Claims-Based Analysis.

Authors

Charles Bloom, Frank Borschke, Eric C Makhni, Usmaan Zunnu Rain, Philip Raj, Peter Watson

Published in

NEJM catalyst innovations in care delivery. Volume 7. Issue 7. Pages CAT250448. Epub Jun 10, 2026.

Abstract

Musculoskeletal (MSK) conditions are among the leading drivers of health care spending for risk-bearing organizations, including health insurance plans and self-funded employers. Costs are often amplified in Medicare Advantage populations owing to the high prevalence of MSK conditions and overutilization of expensive health care services. At Health Alliance Plan, a Michigan-based regional health insurance plan and subsidiary of Henry Ford Health, MSK costs increased following the coronavirus 2019 pandemic despite already being a top cost-of-care driver. This case study describes the implementation of a virtual integrated practice unit (V-IPU) designed to reduce potentially avoidable MSK services utilization while improving member engagement and health outcomes. Outcomes were assessed using medical claims and patient-reported outcome measures (PROMs), with claims analysis performed by a third-party actuary firm. The program started in September 2024, and members were enrolled on a rolling basis after that. Claims were evaluated over a 12-month pre-post time frame: the 6 months prior to V-IPU enrollment compared with the 6 months after enrollment. For control cohorts (those undergoing traditional MSK clinical care or physical therapy care), the claims analysis consisted of the 6 months prior to clinical evaluation and the 6 subsequent months. Among members who enrolled in the V-IPU, baseline MSK condition-related spending decreased from US$347.12 per member per month (PMPM) to US$149.40 PMPM. In contrast, cost-matched control members receiving traditional MSK clinical care experienced higher spending following index evaluation (from US$346.96 to US$995.30 PMPM), and members evaluated for physical therapy showed a larger increase (from US$347.04 to US$1458.97 PMPM). Annualized gross and net cost savings attributed to the V-IPU were US$10,152.69 and US$8652.69, respectively, per member compared with traditional clinical care; and, when compared with physical therapy, the gross and net savings with V-IPU were US$15,715.74 and US$14,215.74, respectively. From a clinical perspective, the V-IPU cohort demonstrated meaningful improvements in PROMs for physical, mental, and pain health, along with an average program satisfaction rating of 9.2 (range 1-10); such PROMs and patient satisfaction data were not collected for the traditional care cohorts. These findings suggest that a multidisciplinary physician-led V-IPU model may reduce MSK condition-related expenditures while improving PROMs, offering a clinically oriented alternative to administrative cost-containment strategies.

PMID:
42418626
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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