The right solution for musculoskeletal management 

Minimize avoidable MSK spend and connect the member experience    

At $227 billion a year, musculoskeletal care represents one-sixth of all U.S. health care spending. The aging population, obesity and inactivity, defensive medicine and variations in treatment are expected to fuel continued MSK expense growth.

Regrettably, many interventional procedures and surgeries are inappropriate. For example, roughly 1 in 5 spine surgeries and 1 in 3 interventional pain management procedures do not meet medical necessity criteria. Evolent’s MSK solution ensures appropriateness of musculoskeletal pain management and surgery procedures while promoting the use of appropriate, lower-cost settings.  

Key elements of our MSK Solution include:  

Comprehensive scope  

Our MSK Solution takes a holistic approach to musculoskeletal care. From surgical to non-surgical treatments, we manage it all, spanning spine, large joints, physical medicine, and optimal care locations.

• Expertly oversee a diverse array of interventional pain management protocols and orthopedic surgeries
• Safeguard against inappropriate procedures and redundant treatments to reduce potential complications and place patient outcomes at the forefront
• Identify the optimal level of care and place of service for surgical procedures to ensure patient safety, improve outcomes and reduce costs  

Clinical expertise   

Guided by proprietary, evidence-based clinical policies, our MSK clinical specialists partner with health plans to uphold the gold standard in musculoskeletal care.  

• Dedicated MSK clinical team of specialized nurses and physicians includes board-certified anesthesiologists, orthopedic surgeons, and neurosurgeons.
• Specialty-matched clinicians are utilized for all clinical components, including case reviews and peer-to-peer discussions.
• Physicians are active in clinical practice, academia, professional organizations and medical research. 

Provider-centric processes 

We seek to avoid inappropriate procedures and unnecessary treatments in a way that builds trust with providers.

• Use proprietary algorithms to expedite the review workflow and determination process without compromising clinical quality
• Issue automated approvals for evidence-based, clinically unambiguous requests
• Conduct specialty matched peer-to-peer consultations for highly complex outlier cases 

Detailed analytics  

Continual outcomes analysis ensures clients benefit from leading practices and substantial savings. Our analytical suite also equips care providers with the insights they need.  

• Dive deep into clinical care metrics and quality benchmarks
• Spotlight high-performing providers and facilities, support provider outreach, and help drive the creation of high-performance networks  
• Glean insights from regional care deviations and discern physician practice tendencies

Our MSK Solution is fully accredited by the National Committee for Quality Assurance and URAC.