Inside HOPCo’s Statewide Musculoskeletal Population Health Program
With trends in healthcare moving towards value-based models, the structures that support fee-for-service programs may need to be adjusted or replaced entirely.
The field of population health fits well with these trends, but how does it interact with medical specialties like orthopedics? In the search for an answer to this question, there is now an example to consider: the population musculoskeletal health program of HOPCo in Arizona.
Jason Scalise, MD, Chief Growth Officer of HOPCo, spoke with Becker’s what such a program looks like, how it works for the average patient, and how payers have responded to it.
Question: What does a statewide musculoskeletal population health program look like?
Dr. Jason Scalise: A statewide program like the one in Arizona includes MSK specialists as participating providers from across the state. The Physician Network provides coverage and patient access to over 85% of the state’s population and is comprised of physicians from a variety of practices and practice settings. Musculoskeletal physicians agree and adopt evidence-based pathways and protocols for the full spectrum of musculoskeletal care, both non-surgical and surgical.
For example, these include best practices in the management of knee arthritis as well as knee arthroplasty and, therefore, are able to address the full spectrum and cost of musculoskeletal care. skeletal, not just the perioperative range to which packages or episodes of care are typically limited. .
Opportunities for quality and value improvement are based on the robust claims analysis and benchmarking data that is brought to the population health program. Participating physicians earn quality incentive bonuses that are tied to adherence to agreed-upon pathways and protocols, which are usually in addition to their fee-for-service payments for services rendered.
Q: How is all this data used and what does it look like at ground level for the average patient?
JS: It really is a massive amount of data and requires a sophisticated platform to ingest, cleanse and correlate it all in a meaningful and clinically relevant way.
For the average patient, however, these programs are relatively agnostic, which is one of the reasons why they can be quickly adopted in all regions. Patients still see and receive care from their orthopedic physician in the usual way. Some patient-reported outcome measures can be initiated if they are not already present, but it is now common for patients to encounter such feedback measures these days.
Q: What have you heard from payers of this program?
JS: Feedback from payers has been very positive about the programs, given the consistent results. Payers seek physician alignment strategies, but are often not best equipped to engage with specialists at the clinical level. Primary care gatekeeper models often lack the focus or fidelity to truly optimize the quality and value of specialty care. Such models can also be frustrating for specialists and patients when care is perceived to be inappropriately delayed, burdened with additional administrative burdens, and often do not translate into lasting savings or lasting value.
However, given their proven successes and ability to generate much greater sustainable value for their members, payers have indicated their intention to replicate these MSK-focused population health programs in other states. As a result, HOPCo is engaged in active discussions with major payers in various states across the country.