The Efficacy of Virtual MSK & On-Site Clinics, and More! Competitive Advantages Issue 58

Virtual Musculoskeletal Solutions Are Working, According to PHTI

The Peterson Health Technology Institute (PHTI) published a report about the effectiveness of virtual MSK solutions like Sword and Hinge Health, a good read for anyone considering these programs.

The report found that physical therapist-guided solutions (Hinge, Omada, RecoveryOne, Sword, Vori) provide an effective alternative to in-person PT and can reduce health plan spending. They were found to both improve pain and function when compared to in-person PT, while also decreasing net spending with savings due to avoided care.

For patients with low acuity needs, app-based exercise therapy can be effective but the argument is more price-sensitive.

Recommendations for employers are to:

• Incorporate virtual MSK with medical benefits, not wellness programs
• Encourage more PT-first MSK care
• Opt for value-based payment arrangements when possible
• Seek out partnerships to improve patient triage depending on complexity of each case

Let's chat if you want to think through your MSK strategy in more detail.

On-site Wellness as a Health Plan Strategy

Beyond offering a health plan, employers can take a more proactive approach to helping employees by providing direct access to providers through onsite clinics that include panel screenings, health assessments, immunizations, and more.

The benefit of doing this is to get employees seen by providers sooner than later, with the goal to nip potential high cost claims in the bud. This is part of our focus on flipping the traditional health plan model on it's head.

The typical health plan starts with a financial conversation of how to manage risk first, before it addresses health outcomes and clinical strategies, if it ever does. We think this is backwards. Instead, bring a long-term approach to the health and well-being of your employees to bring down your long-term claims costs, and in turn your premiums.

This focus on health is the next area of savings for employee benefits in the coming years, as small and mid-market employers have already gotten the initial pop in savings by shifting to self-funding. You got directly exposed to your claims; now let's do something about them!

From X (Twitter): Go Self-Funded, Then Attack Cost Drivers

This is a comment we make frequently; you won't get the full benefit of a self-funded or captive health plan from just making the switch to one.

You need to pair it your change in funding to strategies that attack the underlying cost drivers in YOUR plan. This could be unnecessary pharmacy costs (Change PBMs), high reimbursement rates (direct contracting & cash pay strategies), poor primary care usage and preventative health usage, certain high cost claims/conditions, for example.

You'll get the most bang for your buck with a self-funded plan when you put in the effort to pay less for healthcare.

A good starting point here is to partner with a health analytics platform to start understanding your health data. Start here if you don't currently have an analytics platform interpreting your claims data yet.

Long-Term GLP-1 Use and Regaining Weight

GLP-1's for weight loss and diabetes treatment are a common topic lately for health plans. While treatment with GLP-1s is yielding significant weight loss and benefits, such as for cardiovascular health, research keeps finding that many individuals regain a significant portion of their prior weight loss.

Research from Prime Therapeutics found that many patients with GLP-1 drugs often don't keep using the drug long-term. The persistence rates were 47% at 180 days, 29% at one year, and 14.8% after 2 years. These results are a sobering reminder that while GLP-1s have potential to help individuals initiate drastic results, they must be paired with strategies and education to help users maintain the results after they taper off the medication.

??Compliance & Legal Updates

The FTC’s Non-Compete Ban Suffers Its First Setback: The Federal Trade Commission’s (FTC) attempt at a nationwide ban on employee non-compete agreements suffered its first setback last week when a Texas federal district court preliminarily enjoined enforcement of the rule. While the ruling is limited to the plaintiffs in that case, the decision is a roadmap for similar legal challenges Read More

Court Denies Injunction in Case Involving DOL Salary Regs: In our most recent bulletin on the new Final Rule increasing salary levels for exempt whitecollar employees under the Fair Labor Standards Act, we noted that there was an additional challenge to the new regulations and that we were awaiting a decision in that case. Last week, the court in that case refused to stop the rule from taking effect. Read More

AI Hiring Tools: ACLU Warns Employers and AI Companies It Won't Stand for Deceptive "Bias-Free" Promises: Over the past few years, the Federal Trade Commission (FTC) has kept a close eye on the development and use of AI, releasing a number of blog posts and reports warning companies of the risks of using AI tools in their business. For example, the FTC has warned companies about using AI to combat online problems because of concerns that AI tools can be inaccurate, biased, and discriminatory by design and incentivize reliance on increasingly invasive forms of commercial surveillance. Read More

Is That a Gun in Your Pocket… at the Office? New Thoughts on Workplace Concealed Carry: Can you prohibit your employees from bringing firearms to your workplace? You may think the answer is yes, but it’s more complicated. Recent state laws on gun rights have raised questions regarding guns at work. Here we will try to boil it down for you. Read More

OSHA Proposes Workplace Heat Safety Standard: The Occupational Safety and Health Administration (OSHA) released a long awaited proposed rule to prevent heat related injuries and illnesses in the workplace. OSHA initiated the rulemaking process in October 2021 as part of its ongoing heat-related illness prevention initiative. Read More

Viral Layoffs: Important Considerations for Employment Actions in the Digital Age: The prevalence of smartphones and social media means there is always a risk that interactions with employees are being recorded and shared to social media. Employers need to be aware of possible avenues for damage control if any employee interaction is recorded without the employer’s consent and must plan for the possibility of recording when deciding how, when and what to communicate to employees. Read More

California-Specific: Is Your Workplace Violence Prevention Plan In Place? Governor Gavin Newsom signed into law Senate Bill 553, which amended Labor Code section 6401.7 and created new section 6401.9 to require employers (with few exceptions) to develop and implement a detailed workplace violence prevention plan and to train their employees in addressing workplace violence. Employers were required to comply by July 1, 2024. Read More

As always, let's connect if you want to do a deep dive on anything above!