Knee, hip and spine value-based care program improves outcomes and reduces costs

As knee, hip and spine surgeries have become more and more common due to an aging population and rising obesity rates, efforts to improve health outcomes and reduce costs for these procedures have become increasingly important – especially because these operations vary widely in outcomes and costs among care providers. 

By using a value-based approach known as bundling payments, UnitedHealthcare’s Spine and Joint Solution program has significantly reduced hospital readmissions and post-surgical complications for these orthopedic procedures, including knee and hip replacements as well as spine surgeries. 

Since launching in 2016, the program has cut hospital readmissions by 22 percent and led to 17 percent fewer complications for joint replacement surgeries, as compared to nonparticipating facilities. For spine surgeries, hospital readmissions were 10 percent lower and complications were 3.4 percent lower than at nonparticipating facilities. 

New program saves employees money, too 

Since the program’s introduction, participating employers have saved an average of $18,000 per procedure when compared with median cost in their metropolitan area. Eligible employees saved more than $3,000 in out-of-pocket costs per procedure at participating facilities, with available incentives such as cash, gift cards, additional paid time off (PTO) days for recovery, and health savings account (HSA) contributions. 

The program’s bundled payment method reimburses health care providers and facilities for a defined episode of care, such as a knee or hip replacement, under a single fee or payment. This is in contrast to the traditional fee-for-service structure in which a care provider generates claims for each treatment, appointment or test within a single, broader episode of care. 

Value-based care encourages providers to treat the whole person 

“By effectively coordinating patient care among the primary care provider, the surgeon, hospital and health plan, we can improve postoperative care, reduce readmissions, and enhance outcomes and the patient experience, leading to healthier communities,” said Mark Carley, vice president of managed care and payor relations, Centura Health, which has participated in the Spine and Joint Solution since 2016. 

With 46 participating health care facilities and more than 115 companies enrolled, the nationwide program is available to companies of any size with self-funded health plans. Developed in collaboration with Optum, the program provides employees with access to surgeons and facilities that qualify as UnitedHealthcare Centers of Excellence and accept bundled case rates for knee and hip replacement, spinal fusion and spinal disc repair. All participating health care facilities have been independently evaluated for providing quality patient care and better outcomes. 

New program shows how UnitedHealthcare is reshaping the way health care is delivered 

Value-based care models have become widely adopted over the last few years. UnitedHealthcare’s care provider reimbursements tied to value-based care arrangements have nearly tripled in the last three years to $64 billion a year, and are expected to reach $75 billion by the end of 2020. More than 15 million people, or nearly one in every three people enrolled in UnitedHealthcare benefit plans, now access care from providers in value-based care relationships. 

UnitedHealth Group recently announced advancements in the company’s collaboration with individual doctors, health systems and governments as the use of bundled payment models expands in traditional fee-for-service Medicare. UnitedHealth Group aims to offer data and analytics, technology and care coordination to support the bundled payment models of health care providers, including those participating in the Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement Advanced (BPCI Advanced) program when BPCI Advanced launches later this year. 

For more information about Value-Based Care, visit www.uhc.com/valuebasedcare.