Disclosures: Murrey reports he is employed by Optum and Surgical Care Affiliates, part of United Health Group. Bruning reports no relevant financial disclosures.
January 25, 2021
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AAOS releases value-based care continuum to help physicians navigate health care landscape

Disclosures: Murrey reports he is employed by Optum and Surgical Care Affiliates, part of United Health Group. Bruning reports no relevant financial disclosures.
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The American Academy of Orthopaedic Surgeons released a value-based care continuum to help orthopedic surgeons and practices better understand and navigate various alternative payment models.

“In the last several years, there has been an explosion of value-based health care incentive programs, new payment models and penalty programs that our members are having to deal with,” Daniel B. Murrey, MD, MPP, chair of the AAOS Health Care Systems Committee, told Healio Orthopedics. “While the academy has done work to educate members along the way as these have evolved, it felt like it was time to refresh our understanding of value-based health care and what is out there, what is here to stay and what direction it is likely to go.”

Value-based care continuum

The value-based care continuum covers the three existing alternative payment models developed by commercial payers, Medicare and Medicaid, including fee-for-service incentive-based payments, fee-for-service benchmark-based payments and capitated/sub-capitated payments. By providing a framework for musculoskeletal physicians, Murrey noted the value-based care continuum can help physicians recognize which category they fall under and understand the infrastructure needed for that particular model.

“For the average orthopedist who is trying to figure out whether they should enter into a particular contract or a voluntary program, the guide is meant to give them the definitions and terminology and help them understand what they are getting into,” Murrey said.

Paul Bruning
Paul Bruning

The value-based care continuum is a good introduction for physicians to what is occurring in value-based health care right now, as well as a review of the different goals of the programs and how actuaries look at risk, according to Paul Bruning, DHA, advocacy council chair for the American Association of Orthopaedic Executives (AAOE) and CEO of Florida Spine Associates.

“In terms of the general information, it is all good and it gives physicians a different way to look at some of these trends related to value-based care and how they may be able to participate in the different defined programs,” Bruning told Healio Orthopedics.

Next steps

However, Bruning said it is important for the AAOS to take the value-based care continuum beyond a reference document.

The value-based care continuum is the introduction, Bruning said. “It is the anatomy of what value-based care is, and now [AAOS] needs to come up with something that says this is what you do with it,” he said.

According to Murrey, there is potential for the AAOS to develop tools to help physicians perform or understand what they need to do to perform in these programs, as well as create system-based guides to help physicians lead their local care environment in creating new delivery models.

“There is a lot of opportunity for us as the academy to create educational materials and resources for our members to use as they make this transition,” Murrey said.

As the AAOS updates the value-based care continuum as new programs are developed, Bruning said it could present an opportunity for the AAOS and AAOE to work together on how the document, as well as other projects, can be implemented.

“We talk from different sides of the fence, but we are all working to try and get in the same direction,” Bruning said. “We just have to break down the fence sometimes so that administrators are not seen as the bad guys. They can be helpful to physicians, even though we are the expense and the physicians are the ones making the money; but you need to utilize your expenses appropriately.”