Part 1 of 9: Understanding the Value You Deliver to Consumers Through Episode Treatment Group (ETG) Data

Utilization Trends by First Provider Seen and Relationship to ETG Outcomes

Introduction

Neck and back pain are among the most common reasons for healthcare utilization in the United States. Care pathways for these conditions vary substantially depending on the type of provider initially contacted. This variability affects service utilization, total episode costs, care duration, number of providers seen, and outcomes. Arete Network analyzed national data from a commercially insured population with an uninterrupted 3-year coverage period to characterize these pathways, focusing on how the first provider seen influences downstream care.

What is ETG data? An episode refers to all the healthcare services and costs related to the treatment of a single condition (e.g., low back pain) from start to finish, including office visits, imaging, procedures, and follow-ups. ETG data groups all claims (diagnosis codes, procedure codes, provider types, etc.) to cluster services into episodes. ETG data often incorporates severity and comorbidity adjustments, allowing fair comparisons of care across different populations or providers.

Which Provider Types Are Most Common as Initial Contact?

• Primary Care Provider or Nurse Practitioner: 41.1%

• Chiropractor (DC): 33.6%

• Emergency/Urgent Care: 6.9%

• Orthopedic Surgeon: 6.1%

• Physical Therapist (PT): 5.5%

Care Pathways by Initial Provider Type - Summary Table

First Provider Seen	Top Services Utilized	Total Episode Cost ($)	Avg. Providers Seen	Episode Duration (days)
Chiropractor	Manipulation (90%), Active Care (40%), Passive (30%), X-rays (25%), Manual (20%)	$565	1.57	93
Primary Care/Nurse	X-rays (34%), NSAIDs (29%), Muscle Relaxants (24.4%), Opioids (19.6%), Active Care (9.6%)	$1,101	2.62	96
Orthopedic Surgeon	X-rays (50%), NSAIDs (35%), Muscle Relaxants (28%), Opioids (25%), Injections (15%)	$2,737	3.69	106
Physical Therapist	Active Care (85%), Manual (60%), Passive (40%), X-rays (10%), NSAIDs (8%)	$2,300	3.66	127

Implications: Positioning chiropractors and physical therapists earlier in care pathways reduces costs, unnecessary services, and promotes conservative, guideline-aligned care.

Conclusion

Care pathways for neck and back pain vary significantly based on the first provider seen. Chiropractors demonstrate the lowest cost, fewest providers involved, shortest episode duration, and highest rates of episode resolution without escalation. Early integration of chiropractic care represents a high-value strategy for improving musculoskeletal care outcomes in commercial populations. Physical Therapy provides significant avoidance benefits for injection, opioid, and surgery compared to common medical care pathways, in addition to delivering guideline-concordant care.

Figures:

• Figure 1: Total Episode Attributes by First Provider Seen

  

  By the way, feel free to download these graphics to use for patient education!

  Figure 2: Use of MRI, Opioids, Injections, and Surgery by First Provider Seen