Musculoskeletal Solution
Set the right care in motion
Our Musculoskeletal Solution enables high-quality, cost-effective musculoskeletal care for all your members. It does this by promoting evidence-based care to help improve outcomes, optimizing the site of care when appropriate, and connecting your providers to specialty-matched physicians for consultation.
We manage some of the most common, costly musculoskeletal treatments, like interventional pain management, joint surgery, and spinal surgery. For members with back pain, our solution uses predictive modeling, a virtual care platform, and a multidisciplinary care team for early identification and personalized guidance.
Lines of business
• Commercial
• Medicare
• Medicaid
• Federal employee
Imagine sustainable musculoskeletal care
The rising demand for musculoskeletal care prompts a big question: are the decisions driving your members’ care actually based on proven care standards? That’s what we solve for. Our solution optimizes clinical and financial decisions for your members and providers across the musculoskeletal care journey. Together with your health plan we create a future of healthcare sustainability.
Create affordable, convenient member experiences
Few decisions impact sustainability and member satisfaction as much as site of care. We reimagined how to optimize it. With our solution, your members are directed to the optimal site of care based on their specific clinical condition. When clinically appropriate, we also direct recovery to their homes after surgery.
Embed a value-based mindset among your providers
When variation in treatment options is high among providers, inefficiency, inappropriate care, and costs often are too. We help separate the noise from the evidence. As your strategic partner, we collaborate with your providers and educate them on up-to-date, conservative pathways.
Reduce your spending on low-value decisions
Spending on musculoskeletal conditions is unsustainable. In fact, it eclipses the GDP of many countries. By emphasizing conservative management, less-complex procedures, and ambulatory surgical centers, we find opportunities for your health plan to create savings.
Inside our Musculoskeletal Solution
The musculoskeletal care journey is long, filled with many different choices for treatment, site of care, and recovery. To manage it and create value, we designed a balanced, comprehensive solution informed by clinicians in that very specialty.
Clinical appropriateness review
Specialty-matched provider consultation
Clinical setting optimization (optional)
Practice engagement resources
Advanced analytics and reporting
How our solution works
Request
Your providers submit requests to us online or over the phone.
Review
Our automated platform reviews the requests in real time.
Determine
Requests that meet clinical criteria are immediately approved. Our clinical reviewers, including specialty-matched physicians and nurses, are available to consult with your providers about any requests that don’t meet our clinical guidelines.
Redirect
If included in your program design, we redirect services to high-value sites of care when clinically appropriate.
Synchronize
Request data is shared with your system(s) for claims, care management, and reporting purposes.
Explore related solutions
Ask us about our Musculoskeletal Solution
Health plan leaders, contact us to learn more about the possibilities and impact of our Musculoskeletal Solution.
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card.
Provider inquiries
For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team
Business hours: 8:00 a.m. – 5:00 p.m. CST.
