For employers seeking to significantly reduce their healthcare spend, medical and benefits experts point to back pain relief as the low-hanging fruit.

Almost half of American adults have a musculoskeletal condition like back pain, costing employers around $213 billion in annual treatment and employee absenteeism, according to a March 2016 United States Bone and Joint Initiative report. Back pain alone accounts for 10% of healthcare costs and is a major contributor to lost productivity.

By targeting back pain through wellness programs and low-cost interventions such as wearables, on-site clinics with chiropractors or physical therapists and acupuncture, industry experts contend that employers can minimize the much costlier use of medications and major surgery.

Reducing costs with early intervention

Employers spend more than $1,200 per employee per year on musculoskeletal issues — almost three times as much as they spend on cardiovascular disease, says Jonathan Edwards, manager of analytics and consulting at Verscend Technologies, a provider of data-driven healthcare solutions.

“Our data shows that about 35% of that is back-related cost,” he says.

Poor posture is a major culprit and targeting it can be the first line of defense against debilitating back pain. That’s one area smart employers are focusing on.

EY Israel, a branch of the global tax and auditing firm Ernst & Young, partnered with wearables technology vendor UpRight to encourage its employees to correct their posture. A device is placed on the lower or upper back and vibrates once it detects a slouch, helping employees become more cognizant of how they are sitting.

“The reality is that most businessmen and women spend eight to 12 hours a day hunched over at their desks, which leads to back pain, decreased productivity, poor health and missed work days,” says Oded Cohen, UpRight’s founder and CEO. “By gradually and consistently training back and core muscles, UpRight helped participants build muscle memory to improve their posture.”

Thirty-one employees participated in a six-week pilot program, during which 85% became more aware of their posture, 71% felt more confident as a result of better posture and 66% strengthened their core muscles. UpRight plans to continue its corporate wellness program with other companies, Cohen says.

Another approach employers should consider, experts say, is to give employees access to chiropractors and physical therapists at an on-site clinic. These specialists can intervene with back problems before costlier medical treatments are needed.

Plus, physical therapy and chiropractic services are often covered by a majority of employers,

“Bottom line is a return on investment,” says Mark Niebuhr, a physical therapist with Marathon Health, a company that operates workplace health centers for employers. “If the services that are provided are cost effective, it will pay for itself.”

See also: Helping employers understand, address musculoskeletal conditions

Back pain is the No. 1 diagnosis Niebuhr sees at the clinic, and he works with his employer to present on topics like injury prevention or how to improve posture during “lunch-and-learn” seminars. So when employees come to the on-site clinic during the day, Niebuhr acts like a “mechanic,” giving employees tune-ups and helping them increase the function of their muscle tissue.

Another reason these services are important offerings? They are more cost-effective and safer than relying on opiates and other painkillers.

The increasing reliance on opiates and other painkillers presents a danger to employers and employees, especially when these drugs are frequently prescribed for back injuries and chronic back pain, says Jeffrey Levin-Scherz, national co-leader of the health management practice at advisory firm Willis Towers Watson.

Claims costs for injured workers who are prescribed opioids are four times greater than employees treated without the use of opioids, according to the nonprofit National Safety Council.

Surgery and associated tests like MRIs will also send healthcare spending skyrocketing. About 50% of all musculoskeletal healthcare spending is surgery-related, says Verscend’s Edwards, citing the analytics company’s data.

One reason, adds Levin-Scherz, is that employees are often encouraged to get imaging tests too soon. This, in turn, makes it more likely that they will opt for back surgery — which he terms “an overutilized procedure.”

“We still are incentivizing surgeries,” he says. “At the same time, given a shift toward more value-based care toward bundled payments, I think the incentives are starting to shift and there’s more risk now on the healthcare delivery system. There’s more accountability on them to help manage these costs.”

Employees with access to decision-making tools, such as evidence-based videos, are more likely to pursue non-surgical interventions, the Willis Towers Watson consultant notes.

To evaluate the effectiveness of their back-pain benefits, employers should take into account what they spend on various medical and pharmaceutical treatments, as well as the cost of lost productivity, says Edwards. By analyzing this data, they can determine which approaches give them the greatest return and are best-suited to their workforce.

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