UnitedHealthcare Launches Spine and Joint Value-Based Care Payment Initiative in Texas


UnitedHealthcare has launched a new value-based care payment for knee, hip and spine procedures that focuses on quality patient care and better outcomes. 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.

Here in Texas, Baylor University Medical Center at Dallas has been designated one of 40 participating health care facilities in 25 markets across the country. UnitedHealthcare plans to expand to more than 40 markets during 2017.

The Spine and Joint Solution gives UnitedHealthcare employer-sponsored plan participants access to surgeons and facilities that qualify as UnitedHealthcare Centers of Excellence and accept bundled case rates for certain procedures, including knee and hip replacement, spinal fusion and spinal disc repair.

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.

The Spine and Joint Solution is currently available nationwide to large and mid-sized companies with self-funded health plans, helping expand access to high-quality, cost-effective care and potentially saving employees out-of-pocket costs. Since the program’s 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 have lower out-of-pocket costs when accessing a participating facility rather than another in-network medical facility.

Musculoskeletal procedures are becoming increasingly common due to an aging population and higher obesity rates. For instance, the number of knee replacement surgeries performed nationally is expected to increase by 500 percent by 2030, according to a recent study from the Healthcare Cost and Utilization Project. Moreover, these surgical procedures are both expensive (knee/hip replacements average $35,000 per operation) and costs vary widely among care providers.

For more information about the Spine and Joint Solution and Value-Based Care, visit www.uhc.com/valuebasedcare.