Episode of Care Characteristics Following Implementation of a No Copay Physical Therapy Program for Musculoskeletal Conditions.

importanceNew care models promoting early access to physical therapy by reducing or eliminating copays are emerging. Few studies have compared health care use in these programs to other care pathways across musculoskeletal conditions.

objectiveThe objective of this study was to describe episode-level musculoskeletal health care use across different care pathway options, including a no-copay physical therapy program.

designThis study was a descriptive retrospective analysis of claims data. SETTING AND

participantsThis study included health care beneficiaries of a self-insured employer with ~52,000 covered lives. INTERVENTIONS OR EXPOSURES: The study included musculoskeletal care episodes from October 2019 to September 2020 categorized as no copay physical therapy, traditional physical therapy, or other management. MAIN OUTCOMES: Rates of surgery/injection, imaging, inpatient services, physician services, emergency services, physical therapy, and other services by episode type, overall and stratified by body region: upper extremity, lower extremity, and spine.

resultsOf 9696 total episodes, 886 (9.1%) were no copay physical therapy, 1261 (13%) were traditional physical therapy, and 7549 (77.9%) were other management. No copay physical therapy episodes had lower imaging rates (38%) compared to traditional physical therapy (47%) and other management (45%) episodes. Inpatient services were similar for no copay (16%) and traditional (12%) physical therapy, both lower than other management episodes (23%). Physician services were higher in other management (100%) and traditional physical therapy (81%) episodes compared to no copay physical therapy episodes (43%). Surgery/injection rates were similar for no copay (11%) and traditional (8%) physical therapy, both lower than other management episodes (27%). Differences by pathway were more pronounced for extremity conditions than for spine conditions.

conclusionsRates of no copay program use were modest with those who used the program having lower rates of advanced imaging, injection, and surgery. RELEVANCE: Findings may be most relevant for employers, health systems, and payors planning resource allocation and benefit design for similar programs.