Musculoskeletal (MSK) conditions are the largest driver of employer healthcare spending, accounting for nearly $980 billion annually in the U.S. Yet many vendor ROI claims rely on engagement proxies and self-reported estimates. This white paper outlines how claims-based evidence, independent actuarial validation, and peer-reviewed results establish a higher accountability standard for measurable savings.
Most MSK ROI claims fail independent validation because they rely on vendor-reported modeling assumptions and surgical intent proxies.
A claims-based actuarial framework, using propensity matching and difference-in-differences analysis, removes self-selection bias and isolates true program impact on utilization and total cost of care.
Independently validated outcomes across commercial, fully insured and Medicare Advantage populations show surgery reductions, pain improvement and ROI that holds up under scrutiny.
Benefits leaders should demand claims-reconciled guarantees, not engagement thresholds, before committing to any MSK vendor contract.
