As benefits leaders consider 2026 renewals and plan ahead for their 2027 strategies, new opportunities are emerging in how organizations approach musculoskeletal (MSK) care. While traditional Centers of Excellence (COE) have focused on surgical interventions, a new approach, non-operative COEs, prioritize conservative treatment and early intervention over surgical treatment. This shift represents a strategic response to mounting cost pressures driven by inappropriate utilization of surgery, and recognizes that many MSK conditions can be effectively managed without surgery.

The MSK Crisis Demanding Immediate Attention

Recent data surrounding MSK care in the U.S. paints a sobering picture. A 2024 article published in Elsevier’s Lancet Regional Health – Americas journal reports MSK diseases are “the leading cause of years lived with disability” and “an increasing health burden and economic cost of $980 billion annually.” The study found that research involving all types of MSK diseases are underfunded, especially neck pain (0.83% funded), low back pain (13.88% funded), and osteoarthritis (35.08% funded).¹

More concerning is the evidence of unnecessary surgical interventions. A 2025 analysis indicates that unnecessary MSK surgeries cost Medicare approximately $2 billion annually, with one “low-value” back surgery performed every eight minutes.²

For benefits leaders, these trends lead to rising costs and unnecessary risks to employees of postoperative complications when inappropriate surgeries are performed. Rather more holistic management of MSK conditions—with a focus on expert non-operative care first—will support both controlling medical spend and improved employee MSK health.

The Point Solution Fatigue Phenomenon

Compounding the MSK challenge is what industry experts call point solution fatigue: when HR and benefits managers are overwhelmed by too many health or benefits tools. Some organizations manage up to 20 point solutions, where one or more apply to only one segment of their employee populations.³

This fragmentation creates multiple problems for benefits administrators:

1. Administrative complexity increases with each additional vendor relationship. Benefits teams find themselves coordinating between disparate systems, managing multiple contracts, and attempting to create coherent employee experiences from fragmented offerings.
2. The lack of integration between solutions creates data silos that prevent comprehensive outcome measurement and cost analysis, potentially resulting in lower health outcomes and higher costs.
3. Perhaps most critically, employees may struggle to determine which among many tools applies to a specific health concern. These tools may actually create barriers to care as a result.

Revaluating Traditional Centers of Excellence (COEs)

The traditional Center of Excellence model emerged during a time when benefits leaders recognized the impact of high (and at times inappropriate) surgical utilization and prioritized surgical specialization and volume-based care. These programs typically focus on directing employees to high-quality, cost-effective surgical providers for procedures like joint replacements, spine surgeries, and other complex interventions.

While successful in reducing surgical costs and improving surgical outcomes, traditional COEs often engage only after surgical intervention has been recommended by the patient’s local surgeon.

The new opportunity is for employees to first be sent to a non-operative COE. This pathway is more efficient and value driven as employees are first assessed for whether effective non-operative treatments have been fully explored or should be explored. If non-operative care is unsuccessful, referral to the in-person surgeon COE may be the appropriate next step.  

Ultimately, this model reduces avoidable surgeries, shortens the care journey, increases convenience for the employee, and generates meaningful cost savings for both the employer and the employee.⁴

In practice, these COEs introduce multidisciplinary teams early during employees’ care journey. These teams can apply comprehensive but conservative care that might prevent costly surgeries later.

The Non-Operative COE: A Focus on Conservative Care

We define this new COE as a non-operative Center of Excellence. Rather than focusing on surgical efficiency, these programs emphasize upstream intervention, conservative care pathways, and surgery avoidance when clinically appropriate.

This model prioritizes several key elements that distinguish it from traditional approaches:

• Intervention protocols engage employees early in the course of their MSK issues, before pain and dysfunction progress to surgical necessity.
• Physician leadership ensures clinical oversight of all care decisions.
• Integrated care pathways connect appropriate image ordering, physical therapy, medical management, lifestyle interventions, and behavioral health support within a coordinated framework.

Evidence-based care planning can incorporate the latest research on conservative treatments, ensuring employees receive appropriate care intensity based on their specific conditions and risk factors. Strategic inclusion of virtual or distance care models alongside in-person engagements can improve patient access and reduce costs as well.

In fact, research from the journal Cureus demonstrates that integrated care models, when properly implemented in primary care settings, significantly reduce healthcare costs and disability outcomes.⁵ Integrating virtual and in-person care has shown higher patient adherence rates than traditional in-person care as well, particularly for ongoing physical therapy and lifestyle modification programs.⁶

Strategic Implications for Benefits Leaders

This shift toward non-operative Centers of Excellence carries significant implications for how benefits leaders evaluate and structure MSK partnerships. Traditional metrics focused on engagement rates, satisfaction scores, and surgical discount percentages may be insufficient for assessing programs designed to prevent unnecessary surgeries.

Instead, benefits leaders can develop new evaluation frameworks that prioritize clinical outcomes, total cost of care, and long-term employee health status. Non-operative COEs would connect seamlessly with existing benefits platforms, occupational health programs, and employee assistance services.

This integration enables more comprehensive care coordination and better data analytics for population health management. As a result, MSK care can become a strategic workforce investment rather than simply a cost center to be managed.

Checklist for Evaluating Potential MSK Partnerships

Conducting a systematic evaluation can help benefits leaders take charge of their MSK strategy for 2026, 2027, and beyond. The following framework provides a structured approach to assessing potential MSK partnerships as a part of a non-operative COE model. 

Integration and Implementation Capabilities

Outcome and Value Measurement

Strategic Alignment and Future Planning

The Strategic Window for Decision-Making

Traditional COEs have proven their value in surgery. But the real opportunity lies upstream. By expanding the model to include non-operative MSK care, employers can address the majority of cases before surgery is ever on the table—improving outcomes, controlling costs, and delivering a better employee experience today and into the future.

Mary I. O’Connor, MD
Founder and Chief Medical Officer
Vori Health
[email protected]
https://www.linkedin.com/in/maryoconnormd/