Self-insured Employers and Other Plan Sponsors Are Paying Millions for MSK (Musculoskeletal) Injuries That Would Have Healed Themselves, With Jay Kimmel, MD

The MSK "White Space": How Triage-Before-the-Triage Could Cut Unnecessary Orthopedic Spend. Episode 499. Jay Kimmel, MD, an orthopedic surgeon with over 35 years in practice and co-founder of Upswing Health, joins Stacey Richter to unpack the "white space" of musculoskeletal (MSK) care—the moment a member twists an ankle or tweaks a back and has no one to call for guidance before deciding between the ER, urgent care, or just going home. MSK spend runs 20–30% of total plan spend and about $16 PMPM, and an estimated 80% of low-acuity injuries would heal on their own, yet lack of access to quick triage routinely sends members into unnecessary imaging, referrals, and even surgery. WHAT YOU'LL LEARN ✅ Why musculoskeletal (MSK) spend adds up to 20–30% of total plan spend and roughly $16 PMPM—making it one of the costliest categories for self-insured employers ✅ Why an estimated 80% of low-acuity MSK injuries, like a twisted ankle or minor back pain, would heal on their own without any medical intervention ✅ How the disappearance of doctor's lounges and informal curbside consults left patients to self-triage MSK injuries with no clinical guidance, a gap Dr. Kimmel calls the "white space" of MSK care ✅ Why roughly 50% of spine surgeries are considered unnecessary, and how an ER visit for a low-acuity injury can snowball into imaging, a surgical referral, and lost work time ✅ How Upswing Health's model—an athletic trainer within 15 minutes and an orthopedic specialist within 24 hours—gives members "triage before the triage" instead of defaulting to the ER WHY THIS MATTERS MSK injuries are exactly the kind of healthcare spend where more care doesn't mean better outcomes—it just means more cost without a corresponding health dividend. When patients are left to self-triage a twisted ankle or a sore back with no one to call, the default path is often the most expensive one: the ER, unnecessary imaging, and a surgical referral for something that would have healed on its own. Closing that white space with fast, low-friction access to real triage is one of the more straightforward inches available to plan sponsors. MENTIONED IN THIS EPISODE EP472 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps Study: Lockton High-Cost Claimant 2025 Report EP464 with Al Lewis: Apple Podcasts | Spotify | Other Apps EP470 with Nikki King, DHA: Apple Podcasts | Spotify | Other Apps EP468 with Matt McQuide: Apple Podcasts | Spotify | Other Apps EP471 with Christine Hale, MD, MBA: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Show Notes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Follow us on Apple Podcasts 🎤 Follow us on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 08:01 What is the "white space" in MSK spend? 13:30 How back pain also easily transitions from a low-acuity issue to a high-acuity problem. 15:11 How plan sponsors can detect their white space downstream spend. 18:15 Why where patients start their journey often dictates where they wind up and how costly that medical pathway is. 20:48 Where PCPs fit into this MSK spend issue. 25:39 Why access is key.