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COSPT grew out of a small clinical practice established by Tom Kane in Tallahassee, Florida, in the early 1990s. The practice's lead researcher, Chad Gray, believed the prominent regional clinic had the makings of a world-class musculoskeletal condition management company. Gray invited Mark Miller (an international faculty member in MDT methods and a protégé of the method's pioneer) to join the Tallahassee-based clinical practice. Gray and Miller jointly led literature reviews, practice-based research initiatives, and Fortune-500 insurance claims analysis projects to better understand current practice patterns and establish a new gold standard in orthopedic care.