Payer Uses Value-Based Care to Improve Musculoskeletal Disease Care

Blue Cross and Blue Shield of Florida (Florida Blue) recently formed a value-based care agreement with Healthcare Outcomes Performance Company (HOPCo), a value-based health outcomes management organization, to boost healthcare affordability across the state.

Musculoskeletal diseases affect approximately 126 million Americans or nearly one out of every two persons in the United States ages 18 and over, according to a report by the US Bone and Joint Initiative. 

In addition, treatment, medical care, and lost wages related to musculoskeletal diseases contribute more than $200 billion in healthcare spending.

"Treatment of bone, muscle and ligament injuries and conditions accounts for a significant portion of healthcare costs each year for Florida Blue and our members," Phil Lee, vice president of strategic provider partnerships at Florida Blue, said in the press release.

"By working with Healthcare Outcomes Performance Company, we look to expand our partnership with musculoskeletal providers to not only slow rising healthcare costs, but also enable healthier lives for our members."

Through this collaboration, healthcare providers will get assistance on how to meet value-based care standards to reduce the cost of the treatment for bone, muscle, and ligament injuries and disorders.

HOPCo will support a clinically-integrated network of community physicians and facilities treating bone, muscle, and ligament conditions. The network will participate in its Musculoskeletal Outcomes Management Program and offer risk-shared incentives to improve patient care. 

The primary goal is to extend this opportunity to all 26,000 ICD codes related to prevention and management of musculoskeletal condition care, the press release stated. 

HOPco has created a set of standardized care protocols, proprietary claim analytics, and outcome management tools that will help guide the collaboration.

Lastly, the organizations will offer incentives to the network of health care providers, including adherence to evidence-based clinical protocols, care coordination, and medically-appropriate care sites. These moves will support the partners’ overarching goals of lowering costs, improving care quality, and enhancing the patient experience.

"We have proven the efficacy and benefits of this model in other markets across the country, and this collaboration is a significant step forward in the delivery of value-based care in Florida," said Wael Barsoum, MD, president and chief transformation officer at HOPCo. "Our partnership with an organization with the size, scope, and history of Florida Blue helps set the bar for changing the delivery of health care across the country."

Over the last few years, payers have been exploring options related to value-based care. In the first six months of 2021, Blue Cross NC entered a value-based contract with a DaVita Integrated Kidney Care program. 

The value-based agreement encompassed four primary elements. The goal of the partnership was to reduce healthcare spending and boost patient outcomes for members with chronic or end-stage kidney disease.