Musculoskeletal Solution
Set the right care in motion
Our Musculoskeletal (MSK) Solution helps health plans provide high-quality, cost-effective musculoskeletal care for members with conditions such as back pain, joint disorders, and musculoskeletal injuries. We promote evidence-based care, optimize the site of care when appropriate, and connect providers to specialty-matched physicians for consultation. Our comprehensive MSK program helps manage common, costly treatments including interventional pain management, joint surgery, and spinal surgery.
Lines of business
- Commercial
- Medicare
- Medicaid
- Federal employee
Imagine sustainable musculoskeletal care
Rising demand for musculoskeletal services raises an important question: are the decisions shaping your members’ care actually grounded in proven care standards? That’s what we solve for. Our solution helps inform clinical and financial decisions for your members and providers across the MSK care journey — supporting consistent care and more sustainable spending.
Create affordable, convenient member experiences
Few decisions can impact affordability and member satisfaction as much as site of care. We reimagined how to optimize it. Our solution helps guide members to the appropriate site of care based on their specific clinical condition. When clinically appropriate, we also direct recovery to their homes following surgery.
Embed a value-based mindset among your providers
When variation in treatment options is high among providers, inefficiency, inappropriate care, and costs can follow. We help separate the noise from the evidence. By collaborating with your providers and educating them on current evidence-based care pathways, we support musculoskeletal program performance and consistency in MSK delivery.
Reduce your spending on low-value decisions
MSK care represents a significant and growing area of healthcare spending. We support efficient delivery of that care. By emphasizing conservative management, less-complex procedures, and ambulatory surgical centers when clinically appropriate, we help health plans create savings.
What’s included in our Musculoskeletal Solution
The MSK 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 and aligned to modern MSK healthcare needs.
Clinical appropriateness review
Specialty-matched provider consultation
Clinical setting optimization (optional)
Practice engagement resources
Advanced analytics and reporting
How MSK management and utilization review work
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria can be approved immediately. When additional review is needed, our clinical reviewers, including specialty-matched physicians and nurses, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Redirect
When clinically appropriate, we can redirect imaging services to high-value sites of care to support more efficient MSK delivery. This capability is optional.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable, to improve visibility into musculoskeletal program performance.
Ask us about our Musculoskeletal Solution
Connect with us to explore the potential impact of our Musculoskeletal Solution for your health plan.
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Frequently asked questions about musculoskeletal solutions
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 member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.