CHAPEL HILL, N.C. — Starting March 1, Blue Cross and Blue Shield of North Carolina (BCBSNC) customers became eligible for a new bundled payment program for total knee replacement surgeries through an arrangement with OrthoCarolina. Under the new agreement, BCBSNC customers will pay a single price for knee replacement surgeries and benefit from OrthoCarolina’s coordinated care approach. Overall, participating BCBSNC customers are expected to save 10 to 30 percent on the cost of knee replacement.
Bundled payment agreements provide incentives for doctors and hospitals to work collaboratively to deliver higher quality, evidence-based care to reduce complications and readmissions, according to studies by the Centers for Medicare and Medicaid Services.
“The way insurers have traditionally paid medical professionals is through the ‘fee-for-service’ model. This model pays medical professionals for each service they provide patients, including tests, appointments and procedures,” said Brad Wilson, BCBSNC president and CEO. “But bundled payment agreements, like this one, prevent BCBSNC customers from paying unexpected costs. Patients pay one bill, even if they have to come back for another procedure or follow-up visit.”
With this new agreement, BCBSNC customers, including State Health Plan members, between the ages of 19 and 64 will pay a one-time fixed price, rather than receive multiple bills from the surgeon, hospital, physical therapist, anesthesiologist and others. The agreement includes:
- Pre-operative care and appointments for three days before the surgery takes place
- All services associated with the surgery, including post-surgical care, follow-up appointments and physical therapy for up to 90 days after the surgery
- Personalized care coordination from an OrthoCarolina Patient Navigator
“At OrthoCarolina, coordinated care means our patients, doctors and nurses all agree on a treatment plan. And we focus our treatment plans on each of our patient’s unique situations and needs,” said Dan Murrey, OrthoCarolina CEO. “This agreement with BCBSNC allows us to take our commitment to coordinated care a step further. Our care teams can better communicate with our patients about what they can expect throughout their knee surgery and recovery. We expect to see positive results with the knee replacement episodes and believe it can be expanded to other orthopedic procedures in the future.”
Last year, approximately 200 BCBSNC customers benefited from similar bundled knee payment agreements. On average, BCBSNC customers saw:
- Cost savings of 10 to 30 percent for knee replacement surgeries
- Outcomes better than national benchmarks
- A reduction in complications as compared to other total knee replacements performed in North Carolina
- Very high patient satisfaction with the care team
BCBSNC customers who are interested in taking advantage of this payment model can contact OrthoCarolina at 704-323-2452. To learn more about OrthoCarolina’s coordinated care program, visit www.orthocarolina.com/coordinatedcare.
*BCBSNC customers under FEP and Blue MedicareSM do not qualify for this payment model.
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. Since 1933, 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, 2013 and 2014. 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.
OrthoCarolina is one of the nation’s leading independent academic orthopedics practices serving North Carolina and the Southeast since 1922. OrthoCarolina provides compassionate and comprehensive musculoskeletal care including operative and non-operative care, diagnostic imaging and rehabilitative therapy. Widely known for musculoskeletal research and training, OrthoCarolina physicians have specialized expertise in foot and ankle, hip and knee, shoulder and elbow, spine, sports medicine, hand, pediatric orthopedics, and physical medicine and rehabilitation. Our 120 OrthoCarolina physicians see nearly 1 million patient visits throughout western North Carolina each year. OrthoCarolina. You. Improved.
Connect with OrthoCarolina at www.orthocarolina.com or on Facebook, Twitter and YouTube.