Among the commonly misinterpreted irregularities that generally are not the true cause of a patient’s pain and diminished function are rotator cuff tears and defects, spinal stenosis, meniscal tears and defects, bone spurs, muscle tears, bone-on-bone conditions, bulging discs and disc herniations, and degenerative disc or joint disease.
Few clinicians—let alone patients who are experiencing pain or reduced mobility—realize that the vast majority of healthy adults who are fully functioning and 100% pain-free have such physiological irregularities. That is, if a healthy adult were subjected to an advanced orthopedic diagnostic test, chances are the 100% symptom-free individual would be told of a “concerning finding.” If a clinician is either unaware of the widespread existence of (generally irrelevant) physiological irregularities in asymptomatic individuals, then a patient may be queued up for prescription opioids and muscle relaxants, pain injections, and/or surgeries that are medically unnecessary or contraindicated. This challenge is exacerbated if a healthcare provider has financial motives for suggesting a causal relationship between physiological irregularities (i.e., alleged abnormalities and anomalies) where no causal relationship exists.
This is worth repeating.
Asymptomatic individuals—individuals who are not experiencing any musculoskeletal pain, loss of function, or disabilities whatsoever—would more likely than not to be told that “concerning findings” on their advanced diagnostic tests are worrisome abnormalities and anomalies that “qualify” them for (unnecessary or even contraindicated) prescriptions for opioids or muscle relaxants, pain injections, and/or surgeries.
Integrated Mechanical Care (IMC) offers a reliable assessment process for musculoskeletal disorders (MSD) and does not assume that apparent musculoskeletal irregularities are the direct cause of a patient’s pain or mobility challenges.
With IMC’s approach, advanced musculoskeletal specialists use decision-tree logic (i.e., clinical problem-solving algorithms focused on each patient’s step-by-step response to systematic bio-psychosocial testing) to characterize and categorize MSD conditions, determining which are mechanically, structurally, or chemically dominant.
- Mechanically dominant conditions (which represent 90% or more of MSD cases) typically lend themselves to self-care or conservative care.
- Structurally dominant conditions typically require escalation to surgical consults.
- Chemically dominant conditions typically self-resolve with time (e.g., sprains) or may require pain injections or prescription medications.
IMC’s reliable Response-Based Assessment™ process is the best starting point for the evaluation of orthopedic challenges. This personalized, algorithm-driven process helps to ensure that patients receive care that is both timely and medically appropriate for their true underlying diagnoses.
The better the match between clinical diagnoses and clinical interventions, the better the outcomes.
Integrated Mechanical Care (IMC) provides Educational Services, Population Health Management Programs, and Data and Risk Management Solutions—all designed to reduce the incidence, prevalence, and cost of musculoskeletal disorders (MSDs).
In relation to Educational Services, IMC serves a broad range of health industry stakeholders through customized, MSD-focused briefings and training delivered in classroom settings, via online learning management systems (LMSs), and/or through transmedia channels.
The Company’s primary educational services include:
- patient engagement and health coaching (e.g., on self-care methods including self-assessment, self-referrals, and self-management),
- clinician credentialing and hands-on support (e.g., in outcomes-accountable™ musculoskeletal condition management), and
- leadership education and consulting (e.g., on MSD population health optimization).
In relation to Population Health Management Programs, IMC provides:
- self-care programs (e.g., guidelines and tools for self-assessment, self-referral, and self-management),
- healthcare programs (e.g., onsite clinical assessments and treatments), and
- community care programs (e.g., community-wide prevention and wellness initiatives).
In relation to Data and Risk Management Solutions, IMC provides:
- patient-reported outcome management systems,
- practitioner and enterprise performance optimization systems, and
- community and MSD population health informatics systems.
All of IMC’s services, programs, and solutions have one thing in common: they’re focused on helping individuals prevent or rapidly resolve painful and debilitating MSDs with unprecedented ease and speed.
Integrated Mechanical Care (IMC) has long recognized that MSD patients, healthcare’s institutional purchasers, and third-party payers cannot solve orthopedic challenges—which are clinical in nature—with administrative solutions alone. Similarly, business process reengineering (BPR) alone cannot overcome the horrific effects of bad medical decisions. Clinical challenges demand well-matched clinical solutions—and good economic outcomes are a natural byproduct of appropriate clinical care. IMC’s approach to MSD prevention and resolution increases the alignment between individuals’ underlying orthopedic conditions and what patients actually need to do to get better. That is, IMC improves the match between patients’ true diagnoses and the healthcare interventions that they and/or their healthcare providers choose. When the treatment matches what’s actually wrong, better outcomes naturally follow. And when patients get better, they generally stop seeking care. Resolving MSDs saves downstream healthcare dollars—and the more quickly patients get better, the more quickly savings accrue.
IMC’s approach to musculoskeletal disorders (MSDs) is different because it overcomes a poorly understood and very serious challenge in orthopedic care: the challenge of incomplete, inaccurate, and imprecise diagnoses. The vast majority of diagnostic methods in the orthopedic domain—including x-rays, magnetic resonance imaging (MRI), computed tomography (CT), electromyogram (EMG), and nerve conduction velocity (NCV) procedures/tests—have disturbingly high rates of false positives. A false positive occurs when a simple, incidental irregularity on a diagnostic test is misdiagnosed or misconstrued as being an abnormal clinical finding or a concerning anomaly when it actually has no clinical significance or negligible clinical significance. In the case of orthopedic diagnostics, the risk is that an irregularity (i.e., an alleged finding) may be viewed as a causal abnormality or anomaly vis-à-vis a patient’s (unrelated or minimally related) pain and loss of function when what could be erroneously construed as a finding is merely a correlated physiological artifact. That is, the vast majority of physiological irregularities—“findings” that might be erroneously labeled as clinically significant abnormalities and anomalies—have either (1) no correlation with pain and loss of physical function whatsoever or (2) only slight correlations with pain and loss of physical function.
IMC delivers prevention programs, clinical services, and other musculoskeletal solutions that (a) help the vast majority of individuals avoid back, neck, and joint pain; and (b) empower those who develop these musculoskeletal disorders (MSDs) to recover with exceptional speed and remarkably low recurrence rates. The Company prevents and resolves MSDs more rapidly, cost-effectively, and lastingly than standard approaches to orthopedic care. This ensures (a) insurance plan members live and perform at their best; and (b) healthcare’s purchasers not only save money on health benefits, but also enjoy the upside of a healthy and happy workforce.
Among the organizations that benefit most from IMC’s outcomes-accountable™ musculoskeletal condition management programs are
- self-insured employers (SIEs),
- accountable care organizations (ACOs),
- home- and community-based service (HCBS) providers,
- private third-party payers (TPPs) with capitated contracts, and
- government payers, such as the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Defense (DoD).
What all of these organizations have in common is that they have been inadvertently subsidizing the bulk of “institutionalized excess” (unnecessary and contraindicated medical expenditures) in U.S. healthcare.
For healthcare’s institutional purchasers (e.g., self-insured employers), medically unnecessary orthopedic care leads to a surprisingly high level of wasted benefit dollars—counterproductive spending that (1) consumes 5% to 10% or more of Group Health benefit budgets, and (2) dramatically reduces human productive capacity and productivity, as well as corporate earnings, earnings growth, and competitiveness. Integrated Mechanical Care (IMC) reduces the incidence, prevalence, and cost of musculoskeletal disorders (MSDs) through an evidence-based, clinical, and quality-assured approach to the prevention and reversal of back, neck, and joint pain. IMC’s unique bio-psychosocial approach keeps people healthy and gets people better more rapidly, efficiently, and effectively than any other scientifically validated approach to orthopedic care.
An aerospace company with a large manufacturing plant in the Southeastern United States had a disproportionate number of workers’ compensation cases—many running six-figures in value. The Company hired Integrated Mechanical Care (IMC) to implement a JointStrong® musculoskeletal health and wellness program to prevent orthopedic conditions. IMC’s clinical team first assessed workspace ergonomics and then designed a customized leadership training and employee self-care program to mitigate clinical risks. The manufacturing plant enjoyed a dramatic reduction in orthopedic cases and was invited to speak at the Florida Health Care Coalition’s annual Best of the Best Conference. The talk was titled, “The Impact of Addressing the Prevention of Musculoskeletal Interventions in the Workplace as seen through the Practice at St. Marks Powder” and focused on the impact of musculoskeletal injuries at the workplace and the benefits of leading self-care programs from top-management down and encouraging self-imposed work-site accountability.
In early 2012, a Fortune 500 brand-name manufacturer made the decision to reduce the burden of musculoskeletal disorders (MSDs) on employees, dependants, and retirees. The Company asked Integrated Mechanical Care (IMC) to run a pilot program for an onsite clinic focused on preventing and resolving orthopedic challenges. The pilot program was so effective that, within three months of its launch, the manufacturer decided to set up eight (8) clinics—four in onsite family health centers and four in standalone treatment rooms. Since then, these outcomes-accountable™ musculoskeletal condition management sites have saved the manufacturer an average of 25% or more on orthopedic expenditures on covered lives served within the Group Health Benefit Program. In 2012, 2013, and 2014, that equated to more than $1,300 per orthopedic patient per year…or more than $1 million for every 1,000 IMC patients.
Orthopedic costs (especially around low back pain) are escalating without commensurate improvements in outcomes. Variability in diagnostic practice patterns and a lack of inter-tester reliability in diagnostic interpretations lead to a mismatch between medical interventions and patients’ true clinical needs. When musculoskeletal disorders (MSDs) are misdiagnosed, interventions fail to resolve underlying biopsychosocial challenges. This exacerbates demand for medically unnecessary or contraindicated diagnostics, opioid prescriptions, pain injections, and surgical interventions. A technology-enabled, quality assured, and outcomes-accountable™ musculoskeletal assessment and condition management program can help clinicians determine whether MSD patients have structural, chemical, or mechanical challenges. With this insight, clinicians can guide patients toward self-care, conservative care, and/or specialty care—and better align biopsychosocial challenges with treatments. A one-year cost-comparison with “usual” community care, showed that outcomes-accountable™ MSD care resolves the majority of orthopedic conditions, reduces downstream clinical encounters, and generates a 39.8% cost savings.