Despite driving most disability claims, MSK is solvable

My mother gave up custody of me when I was 18 months old. Before that, she was a nurse working in a hospital. While lifting a patient, she injured her back. Through workers' compensation, she was referred to an orthopedist. Surgery was recommended. A spinal fusion followed. Chronic pain followed that. Then came OxyContin. She became addicted.

That sequence, while devastating, is also disturbingly ordinary. I've now spent years working with employers, brokers and providers across the country, serving thousands of employees. The longer I do this work, the easier it becomes to talk about musculoskeletal spend (MSK) in the abstract: claims data, trend lines, renewal pressure, utilization management. These numbers have a way of sanding down the reality that real humans are behind them. 

My mother's story makes that impossible for me to forget. And it shouldn't be forgotten by anyone who advises employers on benefits strategy. MSK and spine-related conditions remain the nation's leading cause of disability claims. That statistic represents real people whose first interaction with the healthcare system often happens too late, at the most expensive and invasive point in the care pathway. The downstream consequences are not limited to claims cost. They show up as lost productivity, dependence on pain medication and, in too many cases, lifelong disability. 

I chose a career in healthcare because of my mother. I left private practice because of my patients. Week after week, I met people struggling with pain that had been building for months or years. When I asked what kept them from getting care sooner, the answers were almost always the same: time or money. Those two barriers are not personal failures. They are design failures. 

Preventive medicine

For brokers and advisers, they represent one of the most solvable problems in employer-sponsored healthcare today. If you advise self-funded employers, you sit upstream from this entire cascade. The good news is that much of it is preventable. Benefit design either accelerates risk or intercepts it early and musculoskeletal care is where that choice becomes visible. 

Most brokers and HR leaders I work with share the same stated goal: they want employees to be more proactive rather than reactive when it comes to their health. That aspiration is sound but often falls short due to execution. Employers do not suffer from a lack of health information. They suffer from systems that reward awareness over action. Knowledge is knowing what to do. Wisdom is acting on it consistently. Most health and wellness initiatives measure the former and hope for the latter. 

Webinar attendance, app logins and email open rates are treated as success metrics, yet none of them reliably change behavior. If information alone produced better health outcomes, the internet would have solved this problem years ago. If behavior change is the desire, employees need a guide and a reason to engage with them. Someone who can translate information into action, provide direction, reinforce habits and create accountability over time. Without that structure, even the best intentions fade under the pressure of work and life. This is where MSK matters. 

Musculoskeletal care is the highest-frequency, lowest-friction entry point into proactive health behavior inside an employer population. Pain creates urgency. Nearly every employee is managing some degree of stiffness, discomfort or declining movement quality, even if they do not label it as a medical problem. 

A design problem

Early access to MSK care captures attention at the moment it matters most. Crucially, this is not a motivation problem. It is a design problem. Most employees delay care, normalize dysfunction and work around pain until the system forces a far more expensive intervention. 

When MSK is positioned as an accessible, early and trusted front door rather than a downstream benefit, engagement follows and risk bends in the right direction. I've seen what this looks like when MSK is treated as an intentional front door rather than a passive benefit. 

In one manufacturing organization, we brought a mobile x-ray unit onsite to remove time and access barriers. Within 30 days, just over 60% of employees completed an initial exam and consultation. More than half of those individuals were found to have injuries that had been building for months or years but had gone unaddressed. Nearly a quarter were classified as high risk, meaning they were on a trajectory toward imaging, specialist referral or surgical intervention if nothing changed. Based on historical claims patterns, that group alone represented more than $800,000 in potential future liability. 

By intervening early and redirecting care before escalation, that risk was largely eliminated. The employer's investment resulted in an estimated tenfold reduction in downstream MSK risk, not because employees were more informed, but because the system made early action easy and obvious. 

A meaningful MSK strategy is not another point solution layered onto an already fragmented benefits stack. It is an intentional front door. One that prioritizes early access, trusted guidance and right-site care before pain escalates into imaging, injections, surgery or long-term disability. When designed well, it gives employees a clear place to go first and a human guide who helps them navigate decisions at the moment they are most vulnerable to making the wrong one. 

For brokers and advisers, this is where MSK shifts from a cost category to a strategic lever. Early MSK engagement does more than bend claims trends. It creates trust. Employees who experience fast relief and practical support are more likely to engage elsewhere in the system. Employers that see avoided surgeries, reduced disability exposure and improved productivity begin to view benefits not as an expense to be managed, but as a tool to be optimized. That trust compounds. It carries into conversations about metabolic health, mental health and other high-cost, high-friction areas that traditionally struggle with engagement. 

This is also where advisers differentiate themselves. Any broker can react to renewals. Fewer are willing to lead upstream, design for behavior and prevent the cascade before it begins. MSK offers a rare opportunity to do that at scale because it is frequent, familiar and immediately relevant to the workforce. 

My mother entered the healthcare system through surgery and medication because no better path was available early. Today, brokers have the ability to change that path for thousands of employees. The question is no longer whether MSK deserves attention. It is whether advisers are willing to lead early or manage consequences later.