Overview
Musculoskeletal conditions are a leading driver of health care costs and workplace disruption in the United States. A new approach—tele-physical therapy (TPT) embedded within an advanced primary care model—aims to improve access, outcomes, and cost efficiency by delivering musculoskeletal care through a coordinated, multidisciplinary team. This article summarizes a controlled cohort analysis that examined how TPT integrated into primary care influences access to care, functional outcomes, patient experience, and cost.
What the Integrated Model Includes
The care model centers on five key elements: a multidisciplinary team, a musculoskeletal toolkit for primary care physicians, a peer-to-peer musculoskeletal expert opinion portal, a shared technology platform, and musculoskeletal educational rounds. Patients can access care via synchronous video visits with their 1:1 physical therapist (PT) or in-office visits, with continuity of care provided by the same PT across sessions. PTs are trained in telehealth delivery and supported by ongoing outcomes review and guideline adherence checks.
Multidisciplinary Collaboration
Beyond PT, the model includes primary care providers, behavioral health specialists, and health coaches. When needed, care can be escalated to disease management teams or local specialty partners. A musculoskeletal toolkit guides evidence-based, patient-centered decision-making, helping PCPs steer patients toward effective first-line treatments like PT and education before considering imaging or specialty referral.
Access to Care
Access metrics show that patients could reach care promptly. The average time to secure a primary care appointment (third next available) was about 6.6 days, while starting PT after insurance confirmation occurred in roughly 7.6 days. This rapid access supports early intervention, which is crucial for improving functional status and reducing the need for more invasive interventions later.
Clinical Outcomes
In a retrospective matched-cohort analysis, participants who received TPT within the integrated model achieved significant functional improvements versus FOTO controls. Across various body parts, knee and lumbar spine pain showed the most pronounced gains. On average, patients required 5.4 PT visits to symptom resolution, compared with a risk-adjusted prediction of 10.3 visits, and a recent FOTO control benchmark of 6.5 visits. This indicates that integrated TPT can yield meaningful functional gains with fewer visits.
Quality of Life and Patient Experience
Provider-reported progress was highly favorable, with 97.5% of evaluated patients either meeting or on track to meet goals. Patient satisfaction was high as well, reflected in a strong net promoter score (~97) — underscoring trust in the integrated care team and the convenience of telehealth formats. This satisfaction likely reflects the seamless communication enabled by the shared technology platform and the ability to coordinate care across primary care, PT, and behavioral health components.
Cost Considerations
Direct PT costs in California ranged from $176 to $288 per visit. Importantly, the study found potential cost savings per injury ranging from $193 to $1,411 when considering fewer PT visits and the associated downstream effects. While these calculations focus on PT visits, they hint at broader potential savings from reduced imaging, fewer specialist referrals, and lower rates of invasive procedures when care is well coordinated.
Implications for Employers and Health Systems
This integrated model aligns with employer goals to reduce absenteeism and maintain productivity while controlling health care costs. By enabling fast access to PT, fostering collaboration among care providers, and emphasizing conservative management and patient education, the model supports faster functional recovery with fewer visits and high patient satisfaction. For health systems, embedding musculoskeletal care within primary care can enhance care continuity and patient experience while potentially lowering overall expenditures.
Future Directions
Further work should explore mental health outcomes given comorbid anxiety and depression in musculoskeletal patients, assess implementation in diverse populations (including rural and underserved groups), and conduct comprehensive economic evaluations that capture broader cost offsets from reduced imaging and specialist care. The evolving evidence base suggests that integrated TPT within advanced primary care could be a scalable solution to rising musculoskeletal costs.
