Designing value-based musculoskeletal care models that benefit patients and providers — 4 insights

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Although costs in the musculoskeletal space are rapidly increasing, that spending doesn't always translate to value. By creating value-based programs that focus holistically on patients, population health data and the right provider incentives, healthcare systems can better control costs while improving care.

During a webinar in October hosted by Becker's Hospital Review and sponsored by Healthcare Outcomes Performance Company, two of the company's leaders — Jason Scalise, MD, vice chair for strategy and growth, and Wael Barsoum, MD, president and chief transformation officer — discussed drivers of cost-cutting initiatives, the impact of existing program models and better alignment strategies for sustainable value-based care.

Four key insights were: 

  1. Musculoskeletal healthcare spending is rising at an unsustainable rate. According to research cited by Dr. Scalise, $4 trillion, or 20 percent, of the U.S. gross domestic product was spent on healthcare in 2020. According to the National Center for Health Statistics, 54 percent of the population reported chronic musculoskeletal conditions in 2020. Dr. Barsoum said, "We know that the inflation rate for musculoskeletal care is going up significantly, anywhere between 10 and 20 percent per year, and much of this is increased utilization."

  2. Popular cost-saving models do not incentivize better value. "In standard episode-bundled payment programs, cost cutting is the predominant lever," Dr. Scalise said. These programs are typically associated with a trigger event. "There's an incentive for practices to find trigger opportunities for surgery to unlock the bundles," he said. However, since savings potential usually occurs after surgery, that savings potential represents a very small portion of the entire overall spend. "For example, the cost associated with spinal fusion surgery over 90 days is only about 10 percent of the overall cost," he said, citing research published in February. "If you're saving 25 percent on that 10 percent, you're really only affecting 2.5 percent of the overall cost of care."

  3. A platform must manage risk by ingesting data, understanding where care is delivered and to which patients, and developing action plans and incentives around best practices. Dr. Barsoum noted the importance of care management programs that ensure patients are optimized before surgery, as well as recovery protocols. "Through that process, you can often take out a lot of costs," he said. Data analytics help track performance and trends.

    For example, Dr. Barsoum argued that not every knee arthritis patient needs physical therapy, MRIs or injections before surgery. "I can tell you that a patient with a 20-degree flexion contracture is going to need a knee replacement; there is not enough physical therapy or steroids in the world to make their function so much better that we avoid replacement. In most cases, it's not about withholding care: It is about giving the appropriate care to the appropriate patient at the right time in their treatment protocol."

  4. Real-time, anytime reporting helps all parties pull in the same direction. "Clinicians, as well as the entire hospital system, must adopt standards around inpatient care order sets, policies, procedures and true clinical pathways that are based on peer-reviewed data," Dr. Barsoum said. "Simply putting automated dashboards on clinicians' cell phones can help them stay up to date on that performance data."

Value-based programs can successfully curb future healthcare spending. Healthcare Outcomes Performance Company worked with a major payer in the Phoenix area to launch a clinically integrated network. In about two years, this client reached a deflationary musculoskeletal care spend rate. "That's the only time that we're aware of that this has been seen in the United States," Dr. Barsoum said.

To view the full webinar, click here.

To register for upcoming webinars, click here.

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