Q&A: Stakeholder alignment key to orthopedic practice transition to value-based care




 This article originally appeared in Orthopedics Today.

 The transition to value-based care is here. To address some of the issues that orthopedic surgeons and orthopedic practices should expect to encounter when they begin this transition, Healio spoke with Wael K. Barsoum, MD.



Barsoum, an orthopedic surgeon and President and Chief Transformation Officer of Healthcare Outcomes Performance Company (HOPCo), said that when physicians and practices endeavor to transition to value-based care models begin the process, they should select an appropriate model and an infrastructure for data collection and analysis.


Healio: The transition to value-based care is underway. What overall advice do you have for orthopedists and orthopedic practices in transitioning to a value-based care model?

Barsoum: One of the most important things to consider when transitioning to a value-based care model is determining which model is the most appropriate. There are various models that all have unique benefits and limitations. Additionally, you need to determine what your practice capabilities are in managing a value-based episode and whether this is something you can do on your own or you need a partner.

Healio: Briefly, what one or two steps should orthopedic surgeons take to prepare for this transition?

Barsoum: An infrastructure for data collection and analysis is probably the most important step in the transition process. As I mentioned, there are value-based models that can range from bundled payments or shared savings to true population health. The value of each model can vary, so it is imperative that practices have access to the right data to analyze. This should encompass patient population data points, such as complication rates, payer claims, and overall spending, to determine the best model. However, one common challenge is that the data from the payers may be inaccurate and/or outdated. For our partners, the HOPCo medical economics team works to streamline and verify all of the data from the plethora of data assets to create a precise picture of the present landscape.

Healio: What obstacles surrounding the transition to a value-based care model should orthopedic surgeons and practices should be aware of?

Barsoum: One of the biggest obstacles has always been creating stakeholder alignment where everyone wins. For years, practices have thought that if the insurance company or the hospital saves money, the physician loses. We have to shift away from that zero-sum game mindset and realize that when true stakeholder alignment is achieved, everyone benefits, most importantly patients and society as a whole through improved outcomes and decreased costs.

Healio: What are the benefits of participating in a value-based care model?

Barsoum: For physicians, the aggregation of meaningful data is a significant benefit. Physicians can stratify risk and/or potential complications to make better decisions, which ultimately leads to improved outcomes.

For patients, I think coordination of care is one of the major benefits. They receive more coordinated care from aligned entities, which eliminates waste and duplication and increases patient satisfaction and lowers cost. Finally, perhaps the greatest benefit is to society by taking costs out of the health system while improving the health of our patients.

Healio: What limitations, if any, are there to be aware of in the value-based care model?

Barsoum: There are some models which are more temporary than permanent, for instance, Bundled Payments for Care Improvement-Advanced (BPCI-A). However, these more temporary models should still be seen as an opportunity to participate in a value-based care program and begin to standardize data and protocols while still saving money. Once these programs come to an end, the practice is then prepared to take the next step, which may be a shared savings or even a population health model where they are taking risk on an entire population.

Healio: How long is the transition to value-based care expected to take before a practice starts to see benefits?

Barsoum: The duration varies in every market. Decisions on how and when to make the move to adopt these strategies depend on factors such as government policy drivers, local and regional market drivers, and the practice’s strategic intention to adopt the new care models.

Federal and state initiatives provide a consistent foundation for the transition to value-based reimbursement by pushing for lower reimbursement and more effective management. At the local level, the pace of change is determined by the population size, market costs, employer health plans, payer activity and competitors. Once you have a clear understanding of where the practice is positioned within the external market, it is imperative to focus on how the practice wants to be positioned in the future with regard to adopting value-based models, including the pace of change required to achieve the complete transition.

Healio: What other key actions do you advise orthopedic surgeons and practices take to ease the transition to value-based care?

Barsoum: It is important to understand that the true impact of orthopedic value-based care models comes from participation from various subspecialties. For instance, in spine, only a small percent of the total spend is for surgery and the vast majority is spent on conservative care. So, if only spine surgeons wanted to participate in a bundle program, their savings may not be meaningful enough to make a true difference. This is why it is often better to participate in bundles for a variety of orthopedic and spine conditions to maximize savings. Of course, the ultimate opportunity comes in true musculoskeletal population health management.

Healio: What are some steps that health care executives should take to prepare for the transition to value-based care? How are these different than what physicians should focus on at this time?

Barsoum: Health care executives should be focused on driving alignment between the physicians, health system and payers. This is so important because value-based care models do not work if all the stakeholders are not aligned and continue to see one another as adversaries.

This is different than the focus of the orthopedic surgeons because it comes down to their functional area of expertise. While orthopedic surgeons should be implementing evidence-based care protocols to ensure that variability is reduced, the health care executives should be ensuring alignment. I would also stress the importance of “leaning in” on value-based care initiatives.

Healio: How do the changes made to CMS and the BPCI-A earlier this year, as well as other alternative payment models, affect the transition to and adoption of value-based orthopedic care?

Barsoum: We know that BPCI-A will be sunsetting over the next 2 to 3 years, but we have already seen impending changes coming from the Center for Medicare and Medicaid Innovation. One of the most significant will be the shift to all-encompassing clinical episode service groupings, including trauma. This means organizations participating in value-based care models may have to take risk on more DRGs than they currently are. These are all subtle pushes to have medical decision-makers more responsible for the costs incurred and the quality delivered in health care.

Healio: What other strategies do you recommend orthopedic surgeons and practice executives pursue to move forward in the value-based continuum of care?

Barsoum: To progress with value-based care and related payment reforms, providers should identify specific metrics to improve. Successful alternative payment models target opportunities to reduce spending or improve quality, which may include cutting spending on services with little benefit to the patient or avoiding complications of a specific treatment.

Payers and providers then need to identify changes in services, as well as barriers in the current payment system, that prevent changes in care delivery. Once stakeholders do that, they can design the model to overcome the barriers and deliver higher-value care.