Connected care: Why integrated MSK services outperform digital-only solutions

America's workforce is in pain, and that pain is costing employers far more than they realize.

Musculoskeletal (MSK) conditions affect over 40% of the U.S. workforce, driving an estimated $380 billion in annual healthcare costs and representing the leading cause of workplace disability. 

Roughly 30% to 40% of all primary care visits are MSK-related. And unlike many chronic conditions—high blood pressure, diabetes, elevated cholesterol—pain is the one symptom that reliably drives people to seek care. It's loud. It's disruptive. And when left unaddressed or poorly managed, it compounds fast.

As national director of physical therapy at Marathon Health, I've spent my career watching organizations scramble to address musculoskeletal injuries in the workplace. And I've watched a new category of digital-only vendors attract billions in investment and significant employer attention by promising to solve it conveniently, at scale, and at lower cost.

I want to be clear: I understand the appeal. But employers and labor organizations deserve to know exactly what they're buying, and what they're not.

The MSK problem doesn't discriminate

One of the most persistent myths in workforce health is that MSK issues primarily affect construction workers, first responders, and warehouse workers, but not office workers or knowledge workers. The data simply doesn't support this.

Musculoskeletal disorders are consistently a top three cost driver across every patient population we serve, regardless of industry, work style, or job physicality. The financial and human impact leads to lost productivity, rising claims, and employees who can't fully show up for their work or their lives.

Low back pain is the single most common MSK condition regardless of job type, followed by neck pain, shoulder pain, knee and hip issues, and overuse injuries like tendonitis and carpal tunnel syndrome. 

Because pain is inherently motivating, employees without a clear path to high-quality MSK care will find their own way. Unfortunately, that path is often expensive, fragmented, and ineffective.

The high cost of low-value care 

When patients navigate the MSK care landscape on their own, the results are predictably inconsistent. They may go directly to an orthopedic surgeon or an emergency department. They may cycle through a chiropractor, an urgent care clinic, a primary care physician, or a maze of fragmented point solutions, each operating in a silo, none coordinating with the others. 

Without clinical guidance early in the process, patients are frequently funneled into imaging they don't need, which creates a cascade of findings that lead to injections, medications, and surgeries that may not address the root cause.

The downstream costs are staggering. An employee pushed unnecessarily into surgery faces weeks or months of disability. Their employer absorbs the cost of backfilling the role. Meanwhile, the employee—unable to work or provide for their family—faces financial and mental strain that compounds the physical one. 

Where virtual MSK programs fall short

Over the past several years, virtual-only MSK point solutions have flooded the market promising to solve the MSK problem through smartphones, sensors, and algorithms. The pitch sounds compelling: lower cost, infinite scalability, zero scheduling friction. Patients can access care from their couch. Employers can check a box on their benefits strategy. 

Unfortunately, the clinical care across these solutions is highly varied—some are just exercise apps, and many lack interaction or oversight with a board-certified physical therapist or chiropractor.

I get it. When you're managing a geographically dispersed workforce and trying to contain costs, convenience is a real consideration. 

But a typical digital MSK program follows a predictable path. An employee reports pain, gets quickly triaged by an MSK professional, and is placed into a low-touch program with limited clinical oversight. They can complete exercises whenever it's convenient, but there's no hands-on assessment, no therapeutic relationship, and limited guidance toward truly better outcomes.

That missing interpersonal connection creates a real clinical gap. Physical therapy works in part because of the therapeutic alliance between clinician and patient—the guided progression, real-time feedback, and the ability to adjust treatment when something isn’t working. No algorithm, regardless of sophistication, can replicate the experience.

The case for hybrid, value-based MSK care

The word "hybrid" gets thrown around a lot in conversations, but it's worth being specific about what it actually means in practice. A true hybrid MSK model meets patients where they are on their care journey, whether in person, virtually, or asynchronously in between through tools that allow board-certified clinicians to adjust treatment plans as needed.

The employee gets to self-select between in-person and virtual appointments, while the clinician stays in the driver's seat.

That flexibility matters, but it's only part of the story. What makes a hybrid model genuinely different is when there’s a value-based philosophy behind it. In traditional PT or chiropractic care, providers are incentivized by visit volume. At Marathon Health, our MSK model flips the script. We reward providers based on outcomes, not patient volume.

The result is a lower average number of visits per episode compared to community providers. Not because patients receive less care, but because they're getting more effective care.

Early intervention drives that efficiency. When we engage patients while symptoms are still acute, we significantly reduce the risk of those conditions becoming chronic. When we pair that approach with better-managed metabolic health through integrated primary care—addressing diabetes, hypertension, obesity, and mental health conditions that directly fuel musculoskeletal conditions—episodes become shorter and less costly.

MSK health and overall health are not separate problems. They're a Venn diagram. Remove either piece, and you never fully address the patient in front of you.

How Marathon Health's MoveWell program benefits workers

Marathon Health's MoveWell program connects patients with a trusted provider they can access face to face or virtually, without barriers and before problems become expensive.

We believe trust drives real outcomes—and engagement. When patients build relationships with onsite or nearsite MSK providers, they go there first, often before an orthopedic surgeon, urgent care, or the ER. That shift is where the real savings happen.

This works because our MSK providers integrate directly with Marathon Health’s primary care team. It’s not a referral model. It’s a two-way workflow. MSK providers act as a second entry point to primary care, while primary care directs patients to PT or chiropractic care when pain limits their health. A patient with musculoskeletal pain can receive a same-day warm handoff. And if a PT spots signs of hypertension or metabolic disease, they connect that patient to primary care immediately.

And when patients do need care, we remove most financial barriers. Many Marathon Health centers offer MSK services at little to no cost. For someone who might otherwise pay $60 to $90 out of pocket each week for community physical therapy—competing with groceries and gas—that access isn’t a minor convenience. It’s the difference between getting care early and not getting care at all.

Advice for employers evaluating MSK benefits

If you're evaluating how to prevent musculoskeletal disorders in the workplace, whether that means launching a new musculoskeletal program or assessing what you already have in place, I’d ask the following questions.

How easy is it for your employees to access care? 

Wait times matter. Financial friction matters. If an employee has to wait two weeks for an appointment or pay a meaningful copay every visit, they’ll find a faster, cheaper path. Ease of access is the single biggest lever for driving early engagement, and early engagement is where you protect your downstream costs. Offering a truly hybrid MSK solution removes barriers to that engagement.

How does the program track and report outcomes?

Focus on clear, measurable results such as avoided surgeries, reduced imaging, fewer injections, and fewer orthopedic referrals. These are the metrics that matter. If a vendor can't show you that data, you don't have visibility into whether the program is actually working.

Does the solution integrate with primary care? 

This one is non-negotiable for me. The intersection of metabolic health and MSK health is too significant to ignore. A program that operates in a silo—no matter how well it manages the MSK episode in isolation—leaves value on the table and misses the full picture of your employees' health.

Finally, think about MSK not just as a healthcare line item, but as a cultural signal. Organizations that actively support movement, address ergonomics, and encourage early symptom reporting see lower MSK costs, and a healthier, more engaged workforces. The most effective MSK programs aren't purely reactive. They're built around prevention, early identification, and sustained trust between patients and their care team.

That's what we’ve built at Marathon Health. And in a landscape full of point solutions, apps, and algorithmic protocols, our hybrid model actually moves the needle.

See our MSK model in action

Wondering what these outcomes look like in the real world? Briggs & Stratton, a leading manufacturer, partnered with Marathon Health to integrate primary care, occupational health, and MSK care in an industrial athlete program and the results speak for themselves: a 47% reduction in DART and an estimated $1.5 million in savings from reduced injury, absenteeism, presenteeism, and turnover.

Read the Briggs & Stratton case study to see how the model delivers better outcomes and tangible ROI.