Musculoskeletal conditions are one of the main causes of workplace absence in the UK, and, unsurprisingly, represent the leading cost in healthcare claims and absence for almost all employers.
In 2009, Aviva UK Health identified that early intervention and access to effective care pathways were essential to reducing workplace absence and managing claims costs.
We have evolved our musculoskeletal service over the years, and in 2013 we further developed our approach using BacktoBetter, a musculoskeletal support service for our large corporate private medical insurance (PMI) clients. One year on, we have seen compelling results for both employers and employees.
Key learnings
Employees with relatively straightforward musculoskeletal conditions are often receiving too much treatment at too advanced a level. For example, they often receive scans and surgery when alternatives, such as physiotherapy, may have been more appropriate.
Combine this with treatment being sought too late, because of waiting times and appointment availability, and the outcome is prolonged recovery, making expensive treatment more likely.
Making the right decisions around the appropriate amount and level of care, along with early intervention and the effective gatekeeping of clinical pathways, is an important consideration for employers when managing costs and absence.
Since we first adopted this approach in 2009, we have seen a demonstrable change in the impact of musculoskeletal claims on scheme performance. There has been a significant reduction in the number of employees needing onward referral to a specialist (down from 65% to 25%) because early intervention has led to many more staff being managed effectively with high-quality advice and physiotherapy.
Removing the need to see a doctor
Removing the need to see a doctor, as well as removing the excess and out-patient benefit level for physiotherapy, has enabled more employees to access expert support earlier.
And although there has been an increase in the number of claims, we believe more staff are seeing value in their private medical insurance (PMI) cover. To further support this, we have seen a reduction of up to 30% in the average musculoskeletal claim. This shows that although the propensity for staff to claim may have increased, claims are for short, sharp, effective interventions, rather than complex surgical treatment.
It is reassuring for employers to know that their healthcare budget is being spent responsibly, and that they may consequently see a real-term reduction of an average of 5% in their overall musculoskeletal spend. Of course, this varies from employer to employer, with those adopting this approach most effectively seeing a reduction of more than 10% in their overall musculoskeletal spend.
But managing and reducing musculoskeletal claims spend is valid only if the quality of the employee outcome is assured, which means affected staff get better sooner.
Future developments
One key factor for the future is the availability of high-quality healthcare advice and support to both claimants and staff that want to stay fit and prevent problems from developing.
Aviva’s partnership with the Chartered Society of Physiotherapy is making more and more information readily available to employers and their workforces in a digestible format, to help staff adopt healthier lifestyles and prevent problems from developing.
Significantly, the information is designed to assist those with musculoskeletal conditions to recover and manage their condition in the long term.
To reduce absence and claims costs, we encourage employers to adopt a co-ordinated approach to managing staff health, and musculoskeletal conditions in particular.
If HR professionals, occupational health and purchasing teams can work together as business units, the potential benefits from embracing broader, longer-term approaches to budget responsibility can be far greater than any short-term fixes.
Mark Sharpe is rehabilitation clinical lead at Aviva UK Health
