UnitedHealthcare Services, Inc. (UHC) has championed a bundled payment model specifically for hip, spine and knee surgeries known as the Spine and Joint Solution.
The health policy under this bundled payment model is available to employers around the country and is part of collaboration with hospitals and post-acute care facilities that have experience with spine and joint replacement surgeries and indicate some complications.
Michelle Lobe, vice president of Network Strategy and Innovation at UHC, said, “The key reason for establishing a bundled payment program is that, in most huge companies, high spend is actually associated with orthopedic processes. For the most part, about 17% of company spend is in the orthopedic arena. Hip, knee, and spine procedures constitute about 33% of that.”
UHC is planning to expand the bundled payment model program to forty markets in the year of 2017. It has already qualified the surgeons and facilities engaging in the bundle, recognized as UnitedHealthcare’s Centers of Excellence. In accordance to the news release, UHC considers that sufferers who use UHC approved facilities will confront a comparatively lower risk of complications when undergoing spinal fusion, spinal disc repair, knee or hip replacement surgeries.
“The 1st step is to go through few very specific analytics in the markets that we are targeting to evaluate which the right centers of excellence might be,” Lobe told. “Before we get into any conversation about payment methodology, we are looking first to find the highest quality centers to target for those discussions. Utilizing our own data as well as CMS [Centers for Medicare and Medicaid Services] data, we review centers for their outcomes and select those partners. Once we recognize in a market which Center of Excellence might be a great partner, then we begin to entertain the conversation about negotiating a prospective bundle.”
Providers are reimbursed for a particular episode of care instead of the more conventional payment for every clinical service provided as is done in the fee-for-serve model. The pilot program for the bundled payment model has demonstrated an average savings of $10,000 or more for each episode of care in contrast to overall median costs for the similar processes in the same region. Worker out-of-pocket costs also declined.
With the population aging, hip and knee replacement surgeries are hoped to increase. The Health Care Cost and Utilization Project discovered that the number of knee replacement operations will rise by 500% by the year of 2030. Bundled payment programs give a method to better manage the charges of joint replacement surgery and spinal operations.
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