Economic Impact of Digital Musculoskeletal Care versus In-person Physical Therapy: A U.S. Claims Analysis of Healthcare Utilization and Outcomes.

Abstract

To evaluate healthcare utilization and spending of individuals enrolled in a musculoskeletal (MSK) digital care program (DCP), compared to those who initiated in-person physical therapy. Economic retrospective analysis of comparative matched-group cost-savings from a payer perspective. Healthcare claims data from a commercial platform (PurpleLab), through a de-identified U.S. dataset spanning March 2022 to October 2024. Adults (≥18 years) with an MSK-related index event between March-October 2023. The intervention group (IG) enrolled in the DCP, and the comparator group (CG) initiated MSK-related in-person physical therapy (index event). The DCP included biofeedback-mediated exercise, education, and behavior change, asynchronously managed by a physical therapist. In-person physical therapy was detected through physical therapy evaluation claims. Total healthcare and MSK-related utilization and costs 12-months pre- and post-index were compared between groups. Comparability was ensured through exact and propensity matching. Subgroup analysis stratified by acuity was performed. IG self-reported clinical outcomes were evaluated. Matched groups included 2,183 patients each. The digital intervention was associated with annual per-person savings of $2,025.7 in MSK care (95% CI: 1,362.0;2,689.4; P<.001) and $2,369.5 in total healthcare (95% CI: 1,305.4;3,433.7) versus CG. These were mainly driven by surgery avoidance, imaging, and medical office visits, with generally consistent patterns across acute and chronic MSK conditions. The DCP executed a larger number of sessions and had significant clinical improvements and an estimated $518.1 (95% CI: 480.5;555.7) in productivity-related savings per patient at program end. This study showcases that a fully remote, digital MSK program is able to drive significantly lower healthcare utilization and spending, mainly by avoiding care escalation into invasive, high-cost interventions. The results highlight the potential of digital-first models to scale value-based MSK care.