Exploring the Value of Population Health Partnerships for Delivering Musculoskeletal Value-Based Care

At the 2021 Fall Managed Care Forum, two executives from the Healthcare Outcomes Performance Company, vice chair Jason Scalise, MD, and chief operating officer Osmel Delgado, PharmD, explored the potential for population health partnerships for delivering value-based musculoskeletal care.

First, Drs. Scalise and Delgado described the unsustainable landscape of U.S. health care expenditures, noting that the care of musculoskeletal conditions represents the largest portion of spending on managing chronic medical conditions. Delivering value-based care in musculoskeletal conditions is made difficult by practice pattern heterogeneity, but, in the race to delivering high-quality, high-value care, the presenters warned against a “race to the bottom.” This term implies a rapid reduction of costs to levels that are functionally or financially unsustainable, when cost-cutting is the predominant driver of change.

They then looked at the desirable infrastructure for delivering value-based care, which includes care standardization and outcome management tools, network management, and stakeholder alignment. To engage physicians in prioritizing value-based care, they recommend establishing protocols that provide rapid feedback to physicians and incentivize meeting quality targets.

Drs. Scalise and Delgado offered a case of a bone health program to reduce unnecessary health resource utilization. A patient with fragility fracture may typically receive surgical treatment as part of an episodic surgical bundle and then spend time in surgical recovery. When that patient is enrolled in a bone health program, though, a provider’s adherence to enrollment protocols can be tracked and the practice can receive a bonus for adherence, which offsets downward pressure in the surgical bundle and reduces disease burden. This type of program unlocks opportunities beyond perioperative activities alone, minimizing avoidable utilization and improving value.

Summarizing the approach to value-based care, the presenters noted that downward pressure on costs will continue. “Physicians, payors, and health systems can and should design and implement aligned programs,” they concluded. “Physicians don’t have luxury to focus only on the clinical care aspect and should be looking to partner with payors and other key stakeholders.”