New Medicare Study: Health plans save between $4,000 and $8,000 per member with increased physical therapy utilization

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Jan 30, 2024, 08:00 ET

NASHVILLE, Tenn., Jan. 30, 2024 /PRNewswire/ -- A new analysis involving 1.6 million Medicare members reveals a strong correlation between increased physical therapy (PT) utilization and reduced healthcare costs for health plans, ranging between $4,000 and $8,000 per member.

The report, conducted by Wakely and commissioned by Luna, the leading provider of in-home outpatient physical therapy, demonstrates substantial savings associated with high PT utilization across various common musculoskeletal (MSK) conditions.

For example, knee pain conditions, with a prevalence of 27%, offer savings of $4,042 with high PT. Hip pain conditions, with a prevalence of 25%, offer savings of $3,651 with high PT.

Highlighted in the report is the role of PT in reducing the need for costly surgeries. For instance, cervical spine conditions have a prevalence of 0.2% in the population with surgery, incurring an average cost of $67,711, whereas, without surgery, the prevalence is 11.2% with a cost of $20,612. This pattern of increased prevalence and decreased cost without surgery is consistent across all listed conditions.

"The current healthcare landscape tolerates fragmented care and inadequate benefit designs for Medicare members, raising overall care costs. This study highlights how PT innovation can improve care delivery, reduce the healthcare burden, and result in significant cost savings. PT is fast becoming recognized as a key component of proactive healthcare, benefiting both patients' physical well-being and contributing to economic well-being by lowering healthcare costs," said Palak Shah, co-founder and head of clinical operations at Luna.

The study identified key factors crucial for innovating care delivery, cutting costs, and enhancing patient wellness:

Ensuring Adherence

The healthcare community needs to ensure that patients not only begin but also complete their PT care plans. One effective and proven approach to achieving this is by providing in-person care delivered to the patient's home in a convenient way.

Individualized Care

Individual differences emphasize the need for personalized PT care plans. These plans should be tailored to the patient's unique needs and the severity of their condition to optimize health outcomes.

Ongoing Monitoring

Consistent evaluations are essential to validate the effectiveness of PT interventions and ensure they are yielding the expected improvements.

Health Plan Benefit Design

Regular assessments are necessary to ensure that health plans align with the appropriate providers and incorporate patient-centric, effective PT clinical interventions. This approach promotes overall wellness.

SOURCE Luna