You Can Lead a Horse to Water, but Why is it so Hard to Get Them to Drink?

We’ve all heard the saying.

So why bring it up with Spine Care (and really all of MSK care?)

Over the past decade, we’ve invested incredible time, effort, and resources into building smarter, more efficient care pathways. We’ve created musculoskeletal triage programs, multidisciplinary spine clinics, direct-to-physical therapy models, and algorithm-driven navigation platforms—all designed to match patients to the ⭐ RIGHT CARE, from the RIGHT PROVIDER at the RIGHT TIME. ⭐

These care pathways aren’t just theoretical. They’ve been shown to:
✅ Reduce unnecessary imaging and procedures
✅ Decrease opioid prescribing
✅ Improve patient satisfaction
✅ Lower long-term costs
✅ Even reduce surgical intervention rates when not indicated

And yet, despite all this… ADHERENCE REMAINS LOW

⁉️ Patients still often bypass primary care or physical therapy, landing directly in a surgeon’s office. Advanced imaging is ordered before conservative care is even attempted. High-cost interventions continue to precede low-cost, high-value care. WHY? ❓

The answer is complex.
1️⃣ Is it patient preference?
2️⃣ Provider habits?
3️⃣ System design?
4️⃣ Misaligned incentives?
…. 🔢 Probably all of the above.

**We’ve built the water trough. We just haven’t figured out how to get people to drink**

Can we?
✅ Embed care navigation earlier in the patient journey (1st contact)
✅ Align incentives for providers and systems to prioritize pathway adherence?
✅ Improve digital access and virtual triage tools so patients aren’t forced into fragmented choice
✅ Better track and publish adherence outcomes? Help other systems improve (much like our surgical complications/outcomes).
✅ UItimately, Build greater trust with our patients? Transparency and goals of these pathways

💰 Hopefully, these smarter, safer, and more sustainable pathways will eventually lead to cost savings to patient, health systems, and uhh… healthcare!

**So, with spine care — it’s not just about where the horse drinks. It’s about WHY they ended up at the wrong well in the first place.**

❓❓ With the recent highlights of DIRECT PRIMARY CARE (DPC) models, could that be a viable solution?

🩺 🏥 And let’s be clear—we, as physicians and healthcare professionals, we’ve been part of the problem too. We’ve been slow to adopt some of the very pathways we helped build. We’ve tolerated variability that doesn’t add value—and sometimes, we've added friction and barriers.

😷 By the way, we healthcare providers also make the worst patients.

**So yes, you can question our ability to “lead the horse”… but let’s be honest—we may also be the most stubborn horses when it comes to “drinking” ourselves.**