Clinical governance manager Martin Docherty, a physiotherapist and CSP member, offers Aviva’s perspective on the profession’s role in managing MSK claims.
A key theme at Physiotherapy UK from 16-17 October will be Public health, prevention, and wellbeing. Delegates will have the opportunity to consider the role of physiotherapy in public health, the potential for digital technology to encourage healthy behaviours, and the use of clinical outcomes to guide best practice.
The prevention and management of musculoskeletal (MSK) disorders is high on the public health agenda. Last year Arthritis Research UK published a report titled Musculoskeletal health: a public health approach, which highlighted the importance of shifting our focus from treating musculoskeletal disease to promoting lifelong musculoskeletal health. Achieving that change in focus will require significant investment in health promotion, addressing abnormal health beliefs, and empowering patients to adopt self-management strategies. This leaves physiotherapists as the obvious choice to lead innovation in this area. Helpfully, the profession also has an abundance of clinical evidence to support its role in the successful management of MSK disorders.
Here we consider Aviva’s view of the challenges posed by MSK claims, the important role physiotherapists can play in helping us meet those challenges, and how we can best support the profession to deliver evidence-based and cost-effective healthcare.
De-medicalising MSK disorders
In recent months, the National Institute for Health and Care Excellence published an updated quality standard for the management of osteoarthritis promoting non-surgical core treatments and the benefits of increased physical activity. Similarly, we have strong evidence that best practice for acute low back pain favours a biopsychosocial rather than a biomedical approach.
And yet, the perception among patients that little can be done for chronic MSK pain, or that surgical interventions are highly effective, persists. In the world of private medical insurance (PMI), patients have high expectations of being referred to a specialist when suffering with MSK symptoms. Convincing them that conservative treatment is clinically ‘the right thing to do’, while simultaneously avoiding the suspicion that an insurer is simply trying to limit costs, can be a difficult task.
So Aviva work hard to ensure that physiotherapists involved in treating their members are confident in communicating the clinical evidence in a way that is meaningful for patients. We equally have a role to play in establishing a relationship with patients long before they reach the point of making a claim. In doing so, the patient is more likely to have the right expectations of what best practice MSK healthcare looks like, and will also have the opportunity to implement lifestyle changes which reduce the likelihood of a claim ever being made.
Associated mental health disorders
The association between MSK symptoms and mental health disorders is also clear. Depression is four times more common in patients with persistent pain than those without and two thirds of people with osteoarthritis report symptoms of depression when their pain is at its worst. Developing physiotherapists’ skills in the assessment of mental health symptoms and recognising those patients who require onward referral is vital to the success of a conservative approach. Similarly, PMI providers need to ensure their MSK and mental health services complement each other and can be delivered in a co-ordinated way.
Outcome measures have become an essential feature of modern healthcare. They provide a detailed insight into the clinical effectiveness of an intervention, the patient’s experience of the service, and any associated commercial benefits.
The challenges here are achieving consensus on the measures to be used and making the collection of that data as efficient as possible.
The goal for Aviva is to ensure that the collection of outcome data does not impact the valuable treatment time therapists spend with their patients.
Digital healthcare will inevitably assist in streamlining this process but the profession and PMI providers in general need to work closely to ensure that whatever process is implemented meets the needs of both parties.
Digital healthcare is still in its infancy but the potential to improve patient accessibility to MSK services and their engagement with self-management strategies is huge. It is anticipated that as technology impacts how we deliver MSK services, therapists will develop a detailed understanding of mobile apps and ‘wearable tech’ as well as demonstrating skills in data analytics. Employers of physiotherapists will need to address the training needs of those delivering digital healthcare, while IT experts are undoubtedly set to become an essential part of every frontline healthcare team.
MSK disorders now account for the largest cause of disability in the UK, following a pattern that has emerged over the last two decades. With an ageing population and rising levels of obesity and inactivity, the cost and impact of these conditions is on an upward trend.
Aviva’s BacktoBetter case-management service continues to ensure that members presenting with MSK symptoms receive the right treatment at the right time. Physiotherapists have played an essential role in its success, enabling our clients to reduce the average cost of an MSK claim by 15 per cent, largely by targeting unnecessary specialist referrals.
Nonetheless, MSK disorders continue to represent a significant cost for employers and PMI providers alike. Physiotherapists have a unique role to play in highlighting the effectiveness of conservative treatment and Aviva is committed to working collaboratively with the profession to achieve that goal.
- Arnow BA et al (2006) Comorbid depression, chronic pain and disability in primary care. Psychosomatic Medicine 68 (2): 262-268.
- Arthritis Care (2010) Arthritis Hurts: The hidden pain of arthritis
- NICE Quality standard 87 – Osteoarthritis
- O’Sullivan P, It’s time for a change with the management of non-specific chronic low back pain. British Journal of Sports Medicine 2012; 12: 224-227.
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