Expanded Collaboration Provides BCBSNC Customers with 10-20 Percent Savings on Hip Replacement Surgeries

New Coordinated Care Arrangement Expected to Lower Costs and Improve the Quality of Orthopedic Surgeries

TOA

CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina (BCBSNC) and Triangle Orthopaedic Associates (TOA) are expanding their efforts to provide better quality and cost options to BCBSNC customers through a coordinated care arrangement. The two organizations today announced the first bundled payment model for total hip replacement surgeries in North Carolina. Effective Nov. 1, 2013, BCBSNC customers, including State Health Plan members, became eligible to pay a flat fee for hip replacement surgeries performed at North Carolina Specialty Hospital in Durham. The one-time payment will be 10-20 percent less than the average cost of hip replacements in North Carolina.

“The cost of a hip replacement surgery and follow-up care in North Carolina can range from $22,000 to $52,000, and the prices of many surgeries aren’t always available to patients when surgeries are scheduled,” said Brad Wilson, BCBSNC president and CEO. “This lack of transparency drives up health care costs more than $100 billion in the U.S. each year.[i] Our new agreement with TOA takes the guesswork out of paying for hip replacements, allowing our customers to save money and make better-informed decisions about their health care.”

Under the new agreement, BCBSNC customers will pay TOA a one-time fixed rate for hip replacement surgeries rather than receive multiple bills from the surgeon, hospital, physical therapist, anesthesiologist and others. This approach, known as coordinated care, improves efficiency, reduces unnecessary paperwork and ultimately lowers health care costs. The agreement between BCBSNC and TOA covers:

  • All appointments and care occurring during the inpatient stay, including the total hip replacement surgery and care related to any complications
  • All related post-operative care for 90 days after surgery, including physical therapy and follow-up care received at TOA

BCBSNC and TOA launched a similar agreement for knee replacement surgeries in 2012. To date, more than 120 BCBSNC customers have benefited from the agreement. Overall results show:

  • An average cost saving of more than 22 percent in the Triangle for knee replacement surgeries*
  • Peer-based outcome measures that are trending better than national benchmarks*
  • A reduction in potentially avoidable complications  as compared to other total knee replacements performed in North Carolina*
  • Patient satisfaction with the care team carries 97 percent rating*

“We know this approach to care works from the results we’re already seeing from our knee replacement agreement,” said Thomas A. Dimmig, MD, President of Triangle Orthopaedic Associates. “We are pleased to work with BCBSNC again to bring another high quality, lower-cost orthopedic surgery option to BCBSNC customers.”

BCBSNC customers who are interested in taking advantage of this payment model can contact TOA at 1-800-359-3053 for more information.

**BCBSNC customers under FEP and Blue Medicare do not qualify for this payment model. 

About BCBSNC
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.74 million members, including approximately 1 million served on behalf of other Blue Plans. For generations, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina was recognized as one of the World’s Most Ethical Companies by Ethisphere Institute in 2012 and 2013. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. ® Marks of the Blue Cross and Blue Shield Association. All other marks are the property of their respective owners. 

About TOA
Triangle Orthopaedic Associates, P.A., is the Triangle’s largest physician-directed medical practice, caring for patients through state-of-the-art medical treatment, orthopedic surgery, physical medicine and rehabilitation, rheumatology, general surgery, physical therapy, occupational (hand) therapy, and other medical and diagnostic services responsive to the needs of patients living within the counties TOA serves. For more information, visit triangleortho.com.

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[i] U.S. Government Spending, 2012

*These results are based on the results of 100 knee surgeries performed in 2013.