Musculoskeletal disorders (MSDs), or ergonomic-related soft-tissue injuries
from overperformed tasks, are one of the top costs in health care and one of
the most prevalent challenges in the workplace. It affects more people than
cardiovascular disease and cancer combined. Over half of the population is
dealing with an MSD problem on any given day.
Acknowledgment
Thanks to Bob Wiersma for his insight on this
article. Mr. Wiersma is board certified in both ergonomics and human
factors engineering, a Fellow of Applied Functional Science, and a licensed
physical therapist. He has been a multisector thought-leader, disruptive
innovator, serial entrepreneur, business adviser, and health advocate
globally for over four decades. He is president of Solveglobal, LLC, MSD
Health Solutions ().
According to recent data from Aon, MSDs account for 31.6 percent of the
frequency and 40.8 percent of the cost of all work-related claims.
Organizations continue to struggle with exactly how to approach preventing and
managing these injuries.
The last big initiative in MSD management was ergonomics back in the early
1980s. While it had a positive impact, the problem and rising cost of MSDs
persists for most employers today. Organizations are arguably seeing
diminishing returns on traditional management approaches because they are
trapped in outdated paradigms and practices.
The magnitude of MSD prevalence and cost gets overlooked because of coding
fragmentation in both insurance and health care. Only when codes are aggregated
does the size of the problem really become apparent. Curiously, wellness
programs rarely include relevant MSD consideration/inclusion. Further, the
actual cost of MSDs is dramatically understated with the omission of two
critical issues—the opioid crisis and pelvic floor incontinency
conditions.
The prevention of MSDs and their treatment are not a straightforward
exercise and are becoming more complex as the workforce ages. In one recent
study of MSDs within a large multistate healthcare organization, Aon found
links between MSDs and other conditions, including weight, mental health, and
the use of opioids (source: Exhibit 1—Aon MSD Study).
Solving the MSD Challenge
A paradigm shift, new thinking, and disruptive innovation are
essential to achieving dramatically better results. To solve the MSD issue, an
organization must begin with two key understandings and three new
paradigms.
Understandings
- Most MSDs are functional rather than
medical conditions. Prevention, early identification, and
intervention are critical to managing cost and retaining workforce talent.
MSD solutions are to be found while managing their causes, such as inside-out
biomechanical constraints and outside-in work stressors. The alternative is
the medical treatment of only the symptoms.
- Keep in mind that there are two kinds of MSDs. Acute
trauma and cumulative trauma are important to differentiate. It's a
difference that matters because each requires a fundamentally different
strategy. There are also both population and individualization considerations
because one size does not fit all.
Paradigms
Historically, organizations have used a medical bias when responding to MSDs
in the workplace. While there may be a medical component related to an
occurrence of an MSD, there is always a functional component driving the
problem.
- The functional-over-medical approach is about focusing on the specific
issues that impact employee comfort and performance. By responding to those
issues, root causes are exposed, and wasteful overspending on unnecessary
medical tests can be reduced. Most MSDs are functional issues before becoming
medical—once it goes medical, the costs kick in.
- The use of symptom data, found through a proprietary online employee
symptom survey, combined with an early response by specially trained physical
therapists, enables a functional versus medical response. Predictive
analytics and artificial intelligence targets resources where they can have
the greatest impact—before medical treatment is required.
- Misaligned incentives are a core mistake made by many organizations. One
common mistake is placing too much focus on counting reportables
rather than medical costs, which often result in the suppression of
timely MSD symptom reporting and increases both severity and medical costs.
Another example of misalignment is wasteful fee-for-service medical
arrangements that act as an incentive to providers to overtest/overtreat
while driving companies to overspend.
Over the past half-century, science and economics have proven three
unequivocal truths about MSD management. First, medical models fail to fix
functional problems, wasting money and lives. Second, functional problems are
dynamic in nature, highly individualized, and nuanced. Third, dynamic problems
are only solved by smart dynamic systems.
Preventing and managing MSDs will likely become increasingly important for
organizations, regardless of industry. The matter of MSDs has shifted from
middle management to the C-suite and, while applied ergonomics has continued to
evolve, organizations are arguably seeing diminishing returns on traditional
approaches as medical costs continue to rise. These diminishing returns of
early medical intervention and newly found successes of even earlier functional
intervention may be the next big thing in MSD prevention and management.
Case Study
Brakebush is a family-owned poultry processing company in rural Wisconsin
with 1,000 employees. MSD risk is an ever-present reality in the poultry
processing sector. The Function-1st strategy was launched in 2007 for workers
compensation. In 2009, online systems were added and then expanded, enabling
Group Health participation in 2013. The system has proven to be scalable and
sustainable. Since the launch of these strategies, the company net savings
exceed $3.7 million—a 39.7 percent reduction in wasteful MSD overspending.