Quality over quantity. Primary care and prevention. And the dreaded “S” word—“Standardization.”
What’s the orthopedic world coming to?
It’s coming to a revolution. Are you ready?
OTW checked in on one hospital system that, along with the Cleveland Clinic, is embracing standardization, value-based healthcare (VBHC) and a culture where less is more.
And we think we have seen the future of orthopedic healthcare delivery.
Value-Based Healthcare – VBHC
The Affordable Healthcare Act (ACA), when it was signed into law in 2010, caught the orthopedic care system in mid-transition. Private payers and Centers for Medicare and Medicaid Services (CMS) had been pushing for more risk sharing and outcome-based reimbursement for years.
And, while the ACA triggered lots of debates, one thing became clear—a single-payer system might be able to increase insurance coverage, but it didn’t necessarily solve the problem of rising health care costs.
Enter VBHC.
The traditional fee-for-service model bases payments and financial incentives on the volume of services delivered, irrespective of health outcomes.
It’s an unsustainable model.
VBHC, by contrast, is a more patient-centered payment model which ties incentives to value or quality, as opposed to quantity.
According to a report published in 2016 by The Economist Intelligence Unit, “Value-based Healthcare: A Global Assessment”, value is looking at the full cycle of care cost, comparing it with patient outcomes, plus a greater focus on primary care and prevention. The first thorough presentation of what a VBHC system would look like was outlined by Michael Porter and Elizabeth Teisberg in their 2006 book Redefining Health Care: Creating Value-based Competition on Results.
The Cleveland Clinic adopted the VBHC methods. The Centers for Medicare and Medicaid Services is currently funding seven types of innovation models promoting value-based care.
HOPCo Takes the VBHC Challenge
We’ve been hearing about Healthcare Outcomes Performance Company (HOPCo) and the Center for Orthopedic Research and Education (CORE) in Phoenix, Arizona for years.
CORE is a medical group that specializes in orthopedic, neurology, and spine health. HOPco manages the entire flow of musculoskeletal care, from initial evaluations to post-operative care, for hospitals and orthopedic practices, including CORE. We’d meet their surgeons at meetings and we were hearing amazing reports about the HOPCo system.
Turns out, HOPCo and CORE are also, along with the Cleveland Clinic, leaders in the VBHC revolution.
“The key [to VBHC] is providing the right care at the right time,” said Peter Slate, chief business development officer with HOPCo. “You’re at risk for care, but you’re also at risk for the outcome. We have every incentive to make sure our patients stay healthy and don’t need surgery. If they do, we make sure they get the right surgery, in the right facility.”
The first step in shifting from the traditional fee-for-service to VBHC is the ability to track patient outcomes and costs. This requires high-quality IT system and data infrastructure that takes time to establish. Over the last decade, HOPCo has done just that; the result is a unique software platform, VirtueHealth, that allows them to manage the continuum of orthopedic care for each patient.
From pre-op to post-op care, the system collects data on the entire patient journey. Using that data, they’ve developed predictive analytics that helps them see what a new patient’s likely care pathways are, monitor physician compliance with protocols, and measure patient satisfaction. Ultimately, physicians are incentivized to delivering the best care, not the most care.
Reading your article and as much as we can to educate ourselves on this new format of patient care being the end result and not the volume. Looking forward to the experience along with the assurance and comfort of knowing we can have Dr Wolff as the Surgeon for a knee replacement. Thank you!
Dean Yeagle