ACC's recent Secondary Care Market Engagement webinar outlined the most significant redesign of musculoskeletal care contracting in years. A new Musculoskeletal Triage and Assessment Service. Restructured contracts. A clearer pathway from referral to exit.
But the slide that deserves the most attention from MSK providers wasn't about triage, or funding, or even the procurement timeline.
It was this: "We're introducing requirements to enable a more transparent, data-centred system that gives better visibility of how kiritaki move through secondary care and to monitor performance."1
Data. Transparent. Visibility. Performance. That is a shift in the nature of the provider relationship with ACC — from delivering a service to demonstrating one.
The question the sector should be asking now
The KPI framework hasn't been published yet. The specific data reporting requirements won't be detailed until the Request for Proposal process opens in early 2027. But that gap — between the direction being clear and the specifics being defined — is exactly when the most useful thinking happens.
Because the question isn't just what will ACC measure?
The deeper question is: what does the patient journey between appointments currently produce as evidence, and is any of it legible to a funder?
Many providers are already further along than the sector gets credit for. Exercise tracking platforms, patient-facing apps, and digital home programme tools have matured considerably — and the clinicians using them have real visibility into whether patients are logging sessions and completing prescribed exercises.
But there is a layer beneath session completion that most tools don't yet reach: why engagement changes over time, what predicts the drop-off before it happens, and whether the right intervention at the right moment can recover a patient who is drifting out of their programme. Completion data tells you what happened. Behavioural data tells you what's about to happen — and gives you something to act on.
That distinction matters because it is likely to sit at the centre of what ACC wants to measure. The question a funder asks is not just "did the patient attend?" — it's "did the pathway produce the outcome, and can you show the mechanism?"
ACC's data mandate, whatever form it takes, will push into exactly that space.
Why this matters more for ICPMSK providers than anyone else
The Integrated Care Pathway for Musculoskeletal conditions exists specifically to manage the patient over an extended treatment window — not just assess and refer, but accompany. That makes it uniquely exposed to outcome accountability, because the pathway owns the recovery arc in a way that a single-episode specialist assessment does not.
If ACC's performance framework asks: did this patient recover, return to function, and stay recovered? — then the ICPMSK provider's answer depends heavily on what happened in the spaces between appointments.
Home exercise adherence is the most consequential variable in that space — and the hardest to measure in a way that produces evidence legible to a funder rather than just useful to a clinician.
The Sapere Research Group's December 2025 market review — commissioned jointly by ACC and Physiotherapy New Zealand — identified digital self-management tools as a priority intervention for exactly this reason.2 The evidence base for adherence failure in MSK rehab is substantial: between 40 and 65 per cent of patients disengage from prescribed home exercise programmes before clinical recovery is complete.3 The clinical system knows this. What it has lacked, until now, is a contractual incentive to do anything about it.
That incentive is arriving.
What useful data infrastructure looks like in this context
We don't yet know what ACC will require. But we can reason about what would be useful — to clinicians, to funders, and to the kiritaki whose recovery depends on consistent follow-through.
Engagement signals — is the patient interacting with their programme between appointments, and how consistently?
Adherence trajectory — not just a binary completed/not-completed, but the shape of engagement over time. A patient who completes 90% of sessions in weeks one to four and drops to 30% in weeks five to eight is telling you something clinically important.
Drop-off indicators — at what point in the recovery window does engagement decline, and does it correlate with pain reduction? It usually does — and therein lies the core adherence problem.
Recovery-to-behaviour correlation — over a population of patients, do those who maintain adherence return to function faster, re-present less, and generate lower total claim costs?
That last point is the one that matters to ACC at a system level. It is also the one that is hardest to answer from session logs alone — because it requires connecting patient behaviour across the full recovery window, not just within appointments.
A provocation for the sector
The February 2027 market briefing and March 2027 RFP release are closer than they feel. Providers who arrive at that process with outcome data already in hand — even imperfect, early-stage outcome data — will be in a materially different conversation than those who don't.
The procurement question won't just be can you deliver the service? It will increasingly be can you demonstrate what the service achieves?
That is a reasonable ask. It is also one that rewards providers who have started building the infrastructure for data capture now, before it is required.
We think the sector is more ready for this shift than it might assume. The clinical knowledge is there. The patient relationships are there. What has been missing is the layer that connects patient behaviour between appointments to structured, legible outcome evidence.
That layer is what we're building.