UnitedHealthcare, the nation's largest private payer, said its Spine and Joint Solution program reduced hospital readmissions by 22% and complications by 17% compared to nonparticipating facilities for members that had joint replacement surgeries.
The payer said readmissions after spine surgeries were reduced by 10%, and patients experienced 3.4% fewer complications compared to nonparticipating facilities.
Participating employers saved nearly $18 million, which was an average of $18,000 per procedure. Members saved more than $3,000 in out-of-pocket savings per procedure, UnitedHealthcare said.
Healthcare officials often point to value-based care as a way to both improve outcomes and lower costs. Reducing low-value care is easier said than done, however, even though it costs billions and can harm patients.
One way that payers and employers are implementing value is by turning to Centers of Excellence. The bundled payment programs contract with facilities and providers who are considered high-value and pay based on episodes of care, such as knee or hip replacement, under a single fee or payment. This model is quite different from traditional fee-for-service methods.
That’s the system UnitedHealthcare uses for its value-based model. The program is offered to employers with self-funded health plans and gives access to facilities that UnitedHealthcare determines are Centers of Excellence. These facilities accept bundled rates for knee and hip replacement, spinal fusion and spinal disc repair.
The results, which were released by UnitedHealthcare on Wednesday, will likely interest CMS, which has moved more into bundled programs. CMS announced the Bundled Payments for Care Improvement Advanced program this year. That voluntary bundled payment model will cover 32 clinical episodes: 29 inpatient and three outpatient.
UnitedHealthcare has now expanded the Spine and Joint Solution nationwide to 46 facilities. That includes more than 115 employers and 3 million employees. The payer said musculoskeletal procedures and related expensive procedures are becoming more common because of the aging population and higher obesity rates.
Sam Ho, UnitedHealthcare’s chief medical officer, said the program’s results and expansion “demonstrate the value of this program to healthcare providers, employers and their employees, helping to improve health outcomes and make care more affordable for more people.”
UnitedHealthcare said more than 15 million of its members, which is about one of every three, receive care from providers in value-based care relationships. That number has been growing. UnitedHealthcare’s value-based care arrangements tripled in the past three years and are now $64 billion annually. The payer expects that to increase to $75 billion by the end of 2020.