How to Safeguard Your Employees From Unnecessary Surgery
There is an over-treatment problem in the US that is causing more harm than good to patients, employers and the total US economy. Between the years 1996-1998 and 2012-2014, the GDP, in constant 2014 dollars, has risen from $12.0 trillion to $17.0 trillion, an increase of 42%. Over the same two time frames, total direct and indirect costs of musculoskeletal conditions rose from $411.9 billion to $980.1 billion, an astounding increase of 138%.¹ Orthopedic issues are the #2 reason for a doctor visit in the US and #1 in costs.²
Despite the lack of conclusive research acknowledging orthopedic surgeries are effective, Americans are signing up for planned surgeries at an alarmingly high rate. Recent data released from Blue Cross Blue Shield identified planned orthopedic surgeries increased 44% over an 8 year span, costing the economy an additional $25 billion in 2017 alone. The main cost driver of this increase was planned knee and hip procedures, which increased by 17% for knee replacements and 33% for hip replacements.³
The path back to good functional health after surgery can be derailed by lengthy and painful recoveries, necessary revision surgeries, dissipating results, medication dependency and increased musculoskeletal problems. These setbacks have additional time and cost-of-care that call to question if elected surgery is even justifiable in many cases.
How To Stair-Step Current Musculoskeletal Care With an Interventional Approach
Many employers have identified musculoskeletal conditions as one of the costliest and fastest growing diagnostic categories but have a disproportionate emphasis on ways to encourage a low-risk and cost-effective progression through orthopedic events and chronic conditions.
As the fiduciary and healthcare gatekeeper, architecting a well planned stair-step process and incentive program before elective surgery is considered is one of the most effective tools to mitigate the potential loss of employee-health and company expense in a category that pays for patient care with such unproven results.
Why Regenexx as an Interventional Strategy?
“Regenexx reviewed and improved our musculoskeletal model. They were the experts in how to identify the potential employee subset that typically seeks surgical care for an orthopedic event as well as helped us implement a key steerage plan.” – Mike Adams, Dean Foods
The key to valuable use of a direct contracting partnership is to have proper strategies aligned with consumer behavior. Strategies that help direct the best care decisions include covered travel to centers-of-excellence, step therapy practices, high deductible plan design and ongoing education about benefits options – all of which Regenexx has built as part of a turn-key on-boarding and implementation process for our partners.
Adding the Regenexx Corporate Program to self-funded health plans is one of the most powerful methods to manage the pathway to orthopedic surgery so that surgery is only used when medically necessary.
Five Must-Reads About Unnecessary Orthopedic Surgery for the Health Plan Fiduciary