OrthoCarolina and BCBS of North Carolina “Bundle” Up Knees

In early March, Blue Cross and Blue Shield of North Carolina (BCBSNC) established a new bundled payment program for total knee replacement surgery through OrthoCarolina.

Under the agreement with OrthoCarolina, BCBSNC customers will pay a single price for knee replacement surgeries and participate in OrthoCarolina’s coordinated care approach. Overall, participating BCBSNC customers are expected to save 10 to 30% on the cost of knee replacement.

“The way insurers have traditionally paid medical professionals is through the ‘fee-for-service’ model. That model pays medical professionals for each service they provide patients, including tests, appointments and procedures, ” said Brad Wilson, BCBSNC president and CEO in the March 26 press release. “But bundled payment agreements, like this one, prevent BCBSNC customers from paying unexpected costs. Patients pay one bill, even if they have to come back for another procedure or follow-up visit.”

According to studies by the Centers for Medicare and Medicaid Services (CMS), bundled payment agreements provide incentives for doctors and hospitals to work collaboratively to deliver higher quality, evidence-based care to reduce complications and readmissions

One-Time Fixed Price

With this new agreement, BCBSNC customers, including State Health Plan members, between the ages of 19 and 64 will pay a one-time fixed price, rather than receive multiple bills from the surgeon, hospital, physical therapist, anesthesiologist and others. The agreement includes:

• Pre-operative care and appointments for three days before the surgery takes place
• All services associated with the surgery, including post-surgical care, follow-up appointments and physical therapy for up to 90 days after the surgery
• Personalized care coordination from an OrthoCarolina Patient Navigator

OrthoCarolina CEO Dan Murrey said this agreement allows his group to take their commitment to coordinated care a step further. “Our care teams can better communicate with our patients about what they can expect throughout their knee surgery and recovery. We expect to see positive results with the knee replacement episodes and believe it can be expanded to other orthopedic procedures in the future.”

Better Outcomes, Lower Cost

The BCBSNC press release said that last year approximately 200 of their customers benefited from similar bundled knee payment agreements. On average, their customers saw

• Cost savings of 10 to 30% for knee replacement surgeries
• Outcomes better than national benchmarks
• A reduction in complications  as compared to other total knee replacements performed in North Carolina
• Very high patient satisfaction with the care team

OrthoCarolina is one of the nation’s leading independent academic orthopedics practices serving North Carolina and the Southeast since 1922. Its 120 physicians see nearly 1 million patient visits throughout western North Carolina each year.