Employers are asking the same question: Why do MSK costs keep rising?

Self-insured employers collectively spend over $380 billion annually on musculoskeletal (MSK) conditions. 50% of working Americans suffer from MSK-related issues. Yet, despite investing in care navigation, digital MSK solutions, and Centers of Excellence (COEs), costs continue to rise.

For orthopedic groups, understanding the employer’s perspective isn’t optional—it’s table stakes for building meaningful relationships. The days of waiting for referrals are gone. If orthopedic CEOs want to remain relevant in an employer-driven healthcare landscape, they need to understand where MSK costs come from, how employers think about them, and where orthopedic practices fit in this evolving system.

But here’s the challenge: employers don’t think about MSK care the same way orthopedic providers do. If orthopedic groups want to build strong employer partnerships, they must shift their mindset—from being a service provider to being a strategic partner.

A Quick Primer on the Employer’s MSK Cost Problem

Employers face an overwhelming challenge with MSK-related costs. These conditions now account for ~30% of employer healthcare spending, a figure that continues to climb year over year.

The financial burden is split between two major categories:

• ‍Direct Costs (40%) – Clinician visits, therapies, procedures, and medication.‍
• Indirect Costs (60%) – Lost productivity, absenteeism, presenteeism, and disability payments.

The Three Core Cost Drivers

Most MSK-related spending falls into three primary categories:

1. ‍Wear & Tear (63.5%) Chronic conditions like osteoarthritis dominate employer MSK expenses.
2. ‍Trauma (18.6%) Workplace injuries, fractures, and accidents contribute significantly to costs.
3. ‍Autoimmune (16.9%) Conditions such as rheumatoid arthritis also drive spending, to a lesser extent.

Employers keep asking, “What Am I Paying For?”

Despite their efforts, employers aren’t seeing the cost reductions they expected. Instead, they’re dealing with:

• Fragmented care delivery that fails to provide a seamless experience.
• Poor patient steerage leading to unnecessary surgeries and high-cost procedures.
• A lack of ROI clarity from their existing MSK solutions.

The Rise of Employer-Driven MSK Solutions

In response to these ongoing frustrations, an ecosystem of employer-driven MSK solutions has emerged, each attempting to solve the problem through different approaches.

Where Do Orthopedic Practices Fit Into This Picture?

Many employers don’t fully understand how independent orthopedic groups can fit into their cost-containment strategies—because most orthopedic practices haven’t positioned themselves as a proactive solution. So how can orthopedic groups become an integral part of the employer MSK conversation rather than an overlooked player?

It starts with rethinking employer partnerships.

Three Steps for Building Meaningful Employer Relationships

Step 1: Start Seeing Employers as Partners—Not Just Referral Sources

For too long, orthopedic groups have passively processed referrals without understanding where they come from. That mindset must change.

Employers aren’t just another source of patient volume—they are potential long-term partners. And partnerships are built on mutual value.

• Employers have a problem: MSK conditions drive uncontrolled costs and reduced productivity.
• Orthopedic groups have a solution: structured access to high-quality, cost-effective MSK care.
• The challenge? Bridging the gap between what employers need and how orthopedic groups position themselves.

Step 2: Create an Offer to Start the Relationship

Jumping straight into a direct contract is like proposing marriage on the first date. Employers rarely commit to formal agreements without seeing clear value first. Instead, orthopedic groups should start by offering structured access pathways that generate data and demonstrate impact.

Examples of Structured Access Pathways:

• Guidance & Steerage – Prevent unnecessary imaging, referrals, or surgeries by providing expert MSK guidance & steerage to low-cost high-value sites of care.
• Priority Scheduling – Get employees seen faster, reducing lost workdays and improving productivity.
• Virtual Consults – Offer digital services to prevent absenteeism and reduce unnecessary in-person visits.

These offerings provide a low-friction way to engage employers while simultaneously gathering critical data to build a business case for a formal partnership.

Step 3: Use Hard Data & Employer Language to Formalize the Partnership

Employers don’t make decisions based on clinical quality alone—they need financial proof. Once an orthopedic practice has engaged with an employer through structured access, the next step is leveraging data to create a compelling business case. What employers care about:

• Return-to-work rates – How quickly employees can get back on the job.
• Surgical avoidance rates – The percentage of employees diverted from unnecessary procedures.
• Total cost savings per employee – Demonstrating direct financial impact.

To take this conversation to the next level, orthopedic CEOs must speak in the employer’s language—framing their value in terms of cost control, workforce retention, and health plan optimization.

Independent orthopedic groups have an advantage here. Unlike national digital MSKs, they are deeply integrated into their local communities. Employers trust local, high-quality care—but orthopedic practices must proactively position themselves to be part of the employer’s healthcare strategy, not just a reactive service provider.

The Bottom Line

Employers are strategic buyers. Their decision-making process revolves around cost containment, workforce productivity, and access to high-quality care.

Orthopedic groups that fail to understand this will struggle to find their place amidst a growing ecosystem of digital MSKs, COEs, Direct Primary Care and care navigation platforms.

The key to success lies in:

• A deep understanding of the employer’s MSK cost problem.
• A structured, proactive engagement strategy.
• The ability to articulate orthopedic value in employer terms.

Orthopedic care isn’t disappearing—but the way employers engage with it is evolving.

Those who take action now will own the next era of employer-driven MSK care. Those who wait will find themselves outside the employer’s decision-making process.

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