Improving outcomes, reducing costs


Leading US health insurer UnitedHealthcare has launched value-based care payment to help improve health outcomes and reduce costs for knee, hip and spine procedures.

The initiative – the Spine and Joint Solution – is available to employers nationwide and works with health care facilities that perform a higher number of these surgeries and have demonstrated better outcomes and fewer complications.

It gives patients access to surgeons and facilities that qualify as UnitedHealthcare Centres of Excellence and accept bundled case rates for certain procedures, including knee and hip replacement, spinal fusion and spinal disc repair. The programme includes more than 40 health care facilities in 25 markets across the country, including Boston, Chicago, Dallas and Los Angeles. Plans to expand will increase this to 40 markets during 2017.

The bundled payment method reimburses a care provider or hospital for a defined episode of care, such as knee or hip replacement, under a single fee or payment. This is a shift away from the common fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care.

Since introduction as a pilot in 2015, participating employers have recorded an average savings of $10,000 or more per operation when compared with median costs in the same metropolitan area. Through the initiative, eligible employees may save more than $1,000 in out-of-pocket costs per procedure when accessing a participating facility rather than another in-network medical facility.

Bundled fees are a way to get doctors and hospitals to work more closely together to improve quality and outcomes. It is common for a hip or knee replacement to cost more than $30,000 in the USA, but costs vary widely across the country.




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