How a top U.S. health plan used AI to prevent pain and avoid costs

One of the nation’s largest health insurers, this Pennsylvania-based plan covers over 7 million lives across commercial, fully insured, and ASO clients. Known for its forward-looking clinical strategy, the plan partners with proven digital health solutions to meet the rising cost and complexity of MSK care.

MSK conditions are the #1 driver of healthcare spend in the U.S., yet access to effective care is often limited by appointment delays, poor adherence, and rising surgery rates. Half of all patients drop out of traditional PT within four sessions. Costly downstream care such as imaging, specialist visits, and ER utilization continues to rise.

To stay competitive, the plan needed a scalable MSK solution that could engage members earlier, lower costs, and demonstrate value across both ASO and fully insured populations.

After a robust review, the plan selected Sword’s Thrive solution to serve ASO clients and later expanded access to its fully insured population. Members gained access to at-home care powered by Sword’s proprietary FDA-listed technology and guided by Doctors of Physical Therapy.

The program used real-time feedback, clinical-grade personalization, and behaviorally intelligent nudges to boost outcomes without the friction of traditional PT.

Sword drove high member engagement and significant symptom improvement. More than two-thirds of participants reported relief from significant pain. Additionally, 26% saw improvements in work or productivity impairment, which benefited both members and employers.

Based on real-world results from ASO members, the plan’s 2024 expansion is projected to save $30M in MSK-related healthcare costs. Key drivers include lower surgery, imaging, ER, and specialist utilization. These outcomes were achieved without compromising care quality.