Centers of Excellence and Virtual MSK: What the New Evidence Tells Us

The numbers tell a story of solutions.

Two years after the Harvard Business Review published Walmart's landmarkstudy examining the cost and care benefits of its Centers of Excellence (COE) model with Geisinger Medical Center and other providers, Transcarent has announced the results of anational study assessing the clinical and financial impact of itsBridgeHealth surgical COE program, in paid medical claims with self-insured employers. What Walmart determined — that the COE model for musculoskeletal (MSK) and other elective surgical procedures delivered more appropriate and cost-effective care with improved clinical outcomes — Transcarent has further substantiated with the new study of BridgeHealth’s well-established COE program. Conducted by third-party MorningStar Actuarial Consulting, the research findings are notable for:

• BridgeHealth’s value-based care payment model provided an average overall net savings of 49.5% per surgical procedure.

• Per surgery savings varied from 40.3% for orthopedic surgery to 76.9% for spinal surgery.

• Average net savings of $1,500 per case from avoided ER transports, observations and admissions

• Savings were reported in two key areas — bundled case rates and shifts to the appropriate site of care.

• MorningStar analyzed two years of surgical procedures managed through BridgeHealth against a benchmark of $253 billion in paid medical claims associated with self-insured employers.

When the Walmart study was published, it illuminated the impact of an MSK COE program on our troubled healthcare system. As a physician and executive, what I knew anecdotally was being corroborated by data that quantified the benefits of a COE approach. COEs seemed experimental and under the radar prior to the findings, but the study helped catapult them to the front of healthcare innovation. Suddenly, COE programs like BridgeHealth were viewed as promising resources in the effort to align appropriate care with improved outcomes and reduced cost. Now, where the Walmart data felt like a glimmer of change, the BridgeHealth study feels like a beacon of truth that everyone should be able to see. If self-insured employers can become aware of the documented advantages of an MSK program linked to COEs, the days of unnecessary, expensive and sometimes even harmful medical procedures can be eliminated, benefiting employers and members.

Perhaps no category has contributed more to the escalating cost of care than elective surgery for MSK issues such as knee, hip and back pain. Back surgery, in particular, has been an exorbitant culprit, as revealed by the study’s whopping conclusion of 76.9% savings. Local orthopedic surgeons, who are frequently working in a fee-for-service model, will routinely recommend spine and joint surgery when other therapies may be more effective. The COE model, structured around a value-based care and payment model, carefully assesses surgical necessity, bundles payments for certain elective surgical procedures, ensures appropriate site of care and use of COEs, and supports Members pre- and post-surgery.

BridgeHealth, part of the Transcarent family of solutions, provides employees of self-insured employers and other plan sponsors who may need surgery a dedicated care coordinator who guides them through the traditionally complex coordination process and connects them to the appropriate care setting for the procedure. Members are met early in their healthcare journey and provided with unbiased information, trusted guidance, and easy access to high-value care, including alternative treatment options. Leveraging the BridgeHealth surgical success in addressing MSK, Transcarent has developed a more comprehensive program linked to the high-value COE program – a relationship withSWORD Health, currently the industry’s fastest-growing virtual MSK care provider. SWORD Health’s results are impressive and together we are reshaping the delivery of MSK care by creating a seamless Member experience supported by deep integration across technology, data and reporting.

• 34% savings over traditional MSK claims costs

• 88% adherence rate for virtual PT compared to a 30% adherence rate for traditional at-home or in-office PT, accelerating return to work

• 75 Net Promoter Score® for care delivered at home, compared to the 2020 healthcare industry average of 27* (NPS is a patient satisfaction metric based on the likelihood that patients would recommend the service to others)

• 64% reduction in unnecessary surgeries

In its 2020 Large Employers’ Health Care Strategy and Plan Design Survey, theBusiness Group on Health found that 44% of employers ranked MSK pain severe enough to warrant surgery as the top condition impacting their costs, while 85% ranked it among the top three conditions. Those are real numbers representing a real problem for employers. At Transcarent, we are committed to being a leading source of data and evidence to address the challenges facing employers as they seek to improve the health and care of their employees. Just look at the numbers. We’re looking forward to engaging employers fully – knowing that together we can innovate even beyond COEs, beyond backs and knees, and bring the best care to the whole patient.