Three Questions Health Plans and Employers Should Ask About PT and OT Benefits
American Specialty Health Offers a Practical Framework for Improving Access, Measuring Functional Recovery, and Coordinating Care
SAN DIEGO, Oct. 27, 2026 /PRNewswire/ -- Physical therapy (PT) and occupational therapy (OT) benefits can do more than provide treatment after an injury or for a chronic musculoskeletal condition. When designed around timely access, meaningful outcomes, and coordinated support, these benefits can help people regain function, remain productive, and return to the activities that matter to them.
A recently published review in the Journal of Occupational and Environmental Medicine (JOEM) found strong scientific support for the role of PT and OT in treating musculoskeletal disorders. The findings give health plans and employers an opportunity to assess whether they are simply providing services—or actively partnering with members and employees throughout recovery.
"Benefits leaders should view PT and OT as an important part of supporting people's health, function, and ability to participate in work and daily life," said Jaynie Bjornaraa, PhD, MPH, PT, who co-authored the review and is the Senior Vice President of Clinical Quality Evaluation and Health Services Research at American Specialty Health (ASH). "That starts with examining whether people can access appropriate care, whether the care produces meaningful improvement, and whether everyone influencing recovery is working toward shared goals."
Dr. Bjornaraa recommends that benefits leaders use three questions as a starting point when evaluating existing PT and OT benefits or considering future musculoskeletal care strategies:
- Access: Can members and employees receive appropriate care without avoidable friction?
"Access is the starting point, but access alone is not the objective," Dr. Bjornaraa said. "The goal is to connect people with appropriate care that helps them improve function, resume daily activities, and participate productively at work and in their communities."
Timely access can allow physical and occupational therapists to address pain, mobility limitations, and functional challenges before they become greater barriers to daily life and work. Benefits leaders should consider the steps required to begin care, the availability of qualified providers, and whether the benefit design creates unnecessary delays. - Outcomes: Is care being evaluated by improvements that matter to people and organizations?
"Benefits leaders should ask not only whether people received care, but what changed because of that care," Dr. Bjornaraa said. "Did they improve their ability to perform daily activities? Were they better able to remain productive or return to work? Those functional measures connect an individual's clinical progress with outcomes that matter to health plans, employers, and employees."
By tracking changes in function—not simply whether services were delivered—benefits leaders can better determine whether care is producing meaningful progress.
The JOEM review found evidence supporting PT and OT interventions in reducing pain and restoring physical function across a range of musculoskeletal conditions. It also identified potential benefits associated with earlier PT intervention, including less reliance on more invasive or costly services. - Coordination: Are the people influencing recovery working toward shared goals?
Musculoskeletal recovery may involve health plans, clinicians, employees, and appropriate workplace stakeholders. Each can influence access to care, expectations for recovery, and a person's ability to return to work safely.
"Effective coordination does not require workplace stakeholders to make clinical decisions," Dr. Bjornaraa said. "It requires clearly defined responsibilities, appropriate communication, and benefit structures that support a person's functional recovery."
Health plans and employers can begin strengthening their PT and OT benefits by identifying where unnecessary barriers delay care, evaluating whether success measures reflect functional improvement, and clarifying how the parties supporting recovery communicate and work toward shared objectives. Together, these steps can give benefits leaders a clearer view of whether their programs support recovery while contributing to workforce productivity and responsible healthcare spending.
"Benefits leaders have an opportunity to look beyond utilization and consider the full value of rehabilitation," said ASH President and CEO George DeVries. "A benefit is most meaningful when people can access it, demonstrate functional improvement, and receive coordinated support that helps them return to the activities that are important to them."
American Specialty Health works with health plans and employers to design and manage musculoskeletal solutions that support appropriate access, measurable outcomes, and coordinated care. Benefits leaders interested in evaluating or strengthening their PT and OT programs can visit the ASH MSK Solutions page to learn more.
About American Specialty Health
Founded in 1987, American Specialty Health Incorporated (ASH) is a leading national musculoskeletal (MSK) HealthTech company. ASH co-founder George DeVries says "ASH exists to make healthcare better. We are committed to making healthcare more affordable, simpler, and accessible."
Through its subsidiaries, ASH offers both clinical and fitness programs. Its national clinical provider network includes more than 129,000 integrative in-clinic and virtual providers including physical, occupational, and speech language therapists, as well as chiropractors, acupuncturists, massage therapists, registered dietitians, nutritionists, podiatrists, naturopaths, and over 25,000 fitness centers and exercise studios.
ASH offers a comprehensive PT/OT program to improve member accessibility to high-quality, low-cost PT/OT services. The foundation of ASH's PT/OT program is its national provider network that offers access to in-clinic, at-home, and mobile PT/OT services. In addition, ASH offers its Digital MSK Platform that provides members with options to access online self-care recovery tools. ASH's Digital MSK Platform is offered alongside ASH's Virtual PT/OT program nationally. The Virtual PT/OT program provides members with access to hundreds of online credentialed, live PTs and OTs nationally to help members with their treatment and recovery. These PT and OT services provide a comprehensive fully accessible PT/OT program nationally for eligible members.
ASH's Site-of-Care Hospital Outpatient PT/OT program is designed to ensure members are receiving PT/OT services from the most appropriate, low-cost PT/OT providers whether they be Hospital Outpatient PT/OTs, Network-based In-Clinic, At-Home or Mobile PT/OTs and Virtual Online PTs and OTs.
ASH provides MSK recovery solutions for chronic and acute conditions. ASH leverages technology and clinical performance systems to expedite claims, customer service resolutions, and clinical management activities.
ASH provides benefit administration for hundreds of health plans including fully insured and self-funded health plans, as well as Medicare Advantage, Medicaid, DSNP, Exchange, and other programs. Accredited by NCQA, URAC, and HITRUST, ASH meets national healthcare standards. ASH has received many awards and honors, including 12 different years making the Inc. 5000 List of America's Fastest Growing Private Companies. ASH is a trusted partner with hundreds of health plans covering more than 62 million members nationwide in its clinical and fitness programs. For more information about ASH, visit ASHCompanies.com; follow on LinkedIn and Facebook; or call 800-848-3555.
Media Contact:
Jack Chirrick
American Specialty Health
(619) 557-2361
[email protected]
SOURCE American Specialty Health Incorporated
Share this article