In data we trust: How to align around facts and improve outcomes in orthopedic care

To demonstrate value, healthcare providers aim to deliver the best patient outcomes at the lowest possible cost. Payment models — from the Comprehensive Care for Joint Replacement Model, to the Bundled Payments for Care Improvement, to commercial bundles — require providers to see this value promise through. This proves challenging, however, if patients and providers aren't aligned around the same goals.

This content is sponsored by HealthTrust.

Under alternative payment models, it is more clear than ever that successful orthopedic surgery requires trust and transparency among stakeholders to foster a collaborative operating environment and informed patient population.

"Parties seeking to align incentives and design models of collaboration to reduce costs while maintaining clinical quality and outcomes need information transparency to make it work," says Paul Cummings, COO of InVivoLink. Based in Nashville, Tenn., InVivoLink offers a platform to streamline the orthopedic surgery process through patient education, an implant registry and outcomes data and began partnering with HealthTrust in 2014.

Lane Conger Maples, assistant vice president of account management at InVivoLink, and Cody King, chief technology and product officer at InVivoLink, joined Mr. Cummings in collaboratively discussing how to align an orthopedic care community through transparency, technology and data.

Question: There are many moving parts within an orthopedic episode of care, and all are important in a value-based environment. How can information transparency help align the care community around patients during orthopedic surgery?

Paul Cummings: The transformation in healthcare's clinical, financial and regulatory environment is unprecedented. Competing approaches to healthcare value management collide with the protective instincts of hospitals, payers and surgeons in a continuous cycle of negotiation. Parties seeking to align incentives and design models of collaboration to reduce costs while maintaining clinical quality and outcomes need information transparency to make it work. When the right information is presented to the right care community member at the right time, care delivery partnerships are strengthened and value accountability is increased.

Q: What would you say is challenging hospitals the most when trying to align orthopedic care? How would you advise hospitals to overcome these obstacles?

PC: It may boil down to the word "trust." While every member of an orthopedic patient's care community has patient satisfaction and clinical outcomes as their primary goal, the reality of operating a total joint service line in a financially sustainable way means continuously evaluating ways to reduce costs while keeping partnerships between hospitals and affiliated surgeons strong. InVivoLink surveyed dozens of surgeons who believe that information transparency — both clinical and financial — is the cornerstone of trust in their hospital relationships. When a difficult, but open and inclusive, conversation is founded on transparent information, we have witnessed stronger and more productive partnerships emerge.

Patient journeys are becoming more complex and fragmented as care transforms. Clinic, hospital, ambulatory surgery center, post-acute care and home care only provide each operator a fraction of understanding of the whole patient experience. To optimize the entire patient episode, caregivers and operators across the episode need both patient-specific and aggregate data to inform and evolve their care delivery strategies.

Q: Why will care community alignment be critical to hospitals moving forward in value-based care?

Lane Conger Maples: The payment model landscape is as complex as it is polarizing, with experts lining up on both sides of mandatory bundled payment initiatives arguing the validity of their position. Underlying every payment model, however — from mandatory CJR, to BPCI, to commercial bundles, to homegrown co-management and gainsharing arrangements — is the simple premise of making the most efficient decisions around patient care that create the greatest opportunity for great clinical outcomes at the lowest possible cost. It's a search for waste, inefficiency and eliminating elements of care that do not add health value to the patient during and after his or her episode of care is long over.

As payment design beliefs swing back and forth on political pendulums, as healthcare providers transform and disrupt traditional models, as clinical and marketing science are pursued with equal vigor — the one element that empowers care communities to act in the best interest of the patient is clean, insightful and unbiased information. As a strategic raw material — regardless of the vacillating direction of payment design, medical device technology or clinical partnerships — facts are the foundation with which to flexibly adapt to the surrounding environment.

The change healthcare organizations will have to tackle next is ceaseless, unending change itself: change in law, change in surgery venue, change in payment burden and share, and it goes on and on. Modest outlays in tools that provide insight and extend value to patients are always great investments in the face of change.

Q: Hospitals often struggle with collecting the right data that yields actionable insights. Which data points are critical to achieving care community alignment?

PC: Transparency is about substituting facts and data for marketing claims. At their core, every physician is a scientist, trained to evaluate, challenge and leverage quality data. In a market where billions of dollars annually are spent on effusively marketed, relationship-leveraged orthopedic implants, price inflation can run rampant in the absence of quality information. At InVivoLink, we are passionate about collecting and assembling data that increases transparency so the entire care community is working with facts. Our solution has evolved in response to this mission, including scanning implant components in the operating room, assembling them into comparable clinical constructs, associating client contract pricing for implant systems, associating patient-reported outcomes with these systems and augmenting data with clinical evidence synthesis. The net result is a set of delivered insight that uniquely brings cost, quality, outcomes and evidence into a format that challenges current practices and fosters an open dialogue around clinical practice choice.

As a member of the HealthTrust family of companies, informing the clinically integrated supply chain in this way is a very unique and actionable value-add to traditional group purchasing offerings.

Q: Which elements are pertinent to a CJR pathway?

LCM: Facilities in CJR markets have been forced to address incentive alignment and value management ahead of other markets, and yet the underlying objectives are universal. By establishing episode cost reimbursement caps, facilities and surgeons are forced into transparent evaluation of all available information to develop strategies to bring elements of cost across the episode under caps. InVivoLink analytics become a perfect companion for establishing and monitoring implant case cost performance, the single largest controllable cost-influential component of the episode. Furthermore, CJR introduces the requirement of capturing and reporting patient-reported outcomes measures, which InVivoLink services with digital patient engagement marketing and online PROM administration.

In the performance period 1 evaluation with a large integrated delivery network partner, we measured that 79 percent of facilities with a positive CJR Net Payment Reconciliation Amount had InVivoLink solutions installed and operating for at least a year. In contrast, within those facilities with a negative NPRA amount, 71 percent did not have InVivoLink solutions present.

Put together, InVivoLink solutions become the perfect proven partner for any facility in a CJR market, but the benefits of cost and outcomes insight apply to any program regardless of payment structure.

Q: What role does technology play when hospitals and surgeons are improving care quality and coordination through orthopedic episodes of care?

Cody King: It's about "frictionless-ness" and relevance, to every member of the care community. InVivoLink splices into the OR workflow unobtrusively, using bar code scanning technology to add on average less than a minute of additional tasks into a circulating nurse's intraoperative workflow. Collecting PROM data online from patients at home or via onsite tablets in preadmission testing or joint camps make outcomes data collection low-friction for the facility.

As it relates to a patient's overall journey, technology has moved from a nice-to-have additive and supplement, to a competitive necessity if a provider is going to truly engage his or her patients and drive the best outcomes. Today's consumer expectations by patients are very high, as other industries have done a fantastic job intelligently engaging their customers and holding their hands through an experience or journey. InVivoLink is no different in that our solution reaches out to patients at scale and engages them in an empathetic, human way. An online surgery companion application like InVivoLink's YourCareSteps patient portal helps patients feel informed and less fearful about their impending operation. By filming and digitally distributing video of their own surgeons, YourCareSteps doses the right message at the right time to patients based on their countdown to surgery.

Physician workflow needs to remain unobstructed, and delivered analytics need to be compelling, clear and contextual. InVivoLink provides physician-specific reporting and works together with hospitals to deliver, communicate and support findings in forums such as orthopedic council meetings or other venues. When surgeons can see both absolute and relative performance levels of key clinical and financial measures, especially where their performance is tied to specific value-based payment systems, they feel like they're making more informed decisions with a true hospital partner.

The ROI on technology investments in frictionless data collection, education and insight delivery can be measured both in the hard costs of reducing episode implant cost per case and in the softer measures of increasing patient satisfaction and improving clinical outcomes.

Q: What tools does InVivoLink offer surgeons and hospitals to manage patient-reported outcomes, implant utilization and patient engagement?

CK: InVivoLink was founded on engaging with care teams to solve for driving patient outcomes and optimizing implant utilization. This starts with a solid foundation of high quality, reliable and benchmarked data at critical points along the patient's care pathway.
InVivoLink's set of offerings is always evolving around the passion to provide clean, valuable insight to every member of the care community. We're always challenging ourselves and always improving the ways we collect data, synthesize insight and influence change.

Our YourCareSteps patient engagement software digitally extends the surgeon's bedside by dosing their message in their voice at the right point in the patient's surgical journey. Our intra-OR software ties directly into EMRs and supply chain management systems to capture and assemble orthopedic construct data as well as trigger reorder workflow. Online PROM capture experiences begin with branded hospital and individual surgeon digital engagement outreach, and is always evolving to improve patient engagement. Bringing together PROM data, implant construct costs and utilization with evidence-based medicine and longitudinal study synthesis creates an information framework of long-term patient clinical outcomes indexed by cost.

When the care community opens important conversations fueled by data transparency to improve clinical, financial and patient satisfaction value, everybody wins.

Interested in learning more about InVivoLink solutions? Please visit or call us at 866.478.8981 x3

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