North Carolina’s two big orthopedic physician groups formed a new program to promote “value-based payments” for their services, marking a major shift in direction.
Durham-based EmergeOrtho and Charlotte-based OrthoCarolina created Health Innovation Value Enterprise, or HIVE of the Carolinas, which leaders say can reduce healthcare costs and improve access to care.
“We can’t keep spending on healthcare what we are spending,” says Dr. Bruce Cohen, CEO of OrthoCarolina, which has 40 offices and 1,800 employees. “This is a great opportunity to provide high quality, lower-cost care throughout our entire state.”
Medical care has traditionally been a fee-for-service business with providers paid based on each individual procedure. In recent years, insurers and health care systems have pushed for a different approach in which providers are paid a certain fee for the overall care received by patients, hoping to encourage more efficiency.
Critics of the fee-for-service approach contend it can promote excessive care because of the incentives to encourage more procedures and tests.
The new approach could make up about 25% of the groups’ overall revenue within three or four years, Cohen says.
The organizations plan to collect data on patient outcomes and financial results, then use the information to show how better coordination can benefit insurers and employers.
“We look forward to providing a true patient-centered experience with data-driven, high-quality, cost-effective care which will help eliminate the redundancy and waste present in our current system,” says Dr. Frank Aluisio, president of EmergeOrtho and a Greensboro physician. It is the largest physician-owned orthopedic practice in North Carolina with more than 50 offices in 20-plus counties.
The two businesses make up nearly half of the state’s patients seeking orthopedic care, according to a release.
The cost of providing orthopedic care often increases as much as 15% annually for insurers and employers, EmergeOrtho CEO Allison Farmer said in a Linkedin post. “Value-based care ties the amount healthcare providers earn for their services to the results they deliver for their patients, such as the quality, equity and cost of care.”
The two groups are not merging as part of the agreement, officials said.