UnitedHealthcare Launches New, Value-Based Care Payment to Help Improve Health Outcomes and Reduce Costs for Knee, Hip and Spine Procedures

December 01, 2016
  • Bundled payment program works in connection with high-quality, efficient health care providers in 25 markets to help improve care for musculoskeletal procedures
  • Initial participating employers report an average savings of $10,000 or more per operation, and fewer patient complications and readmissions
  • Large and mid-sized companies nationwide can now participate in the program, with more than 2.2 million people eligible as of 2017

UnitedHealthcare has launched a new value-based care payment for knee, hip and spine procedures that focuses on quality patient care and better outcomes. The initiative – the Spine and Joint Solution – is available to employers nationwide and works with health care facilities that perform a higher number of these surgeries and have demonstrated better outcomes and fewer complications.

The Spine and Joint Solution gives UnitedHealthcare employer-sponsored plan participants access to surgeons and facilities that qualify as UnitedHealthcare Centers of Excellence and accept bundled case rates for certain procedures, including knee and hip replacement, spinal fusion and spinal disc repair. The program currently includes more than 40 health care facilities in 25 markets across the country, with plans to expand to more than 40 markets during 2017.

The bundled payment method reimburses a care provider or hospital for a defined episode of care, such as knee or hip replacement, under a single fee or payment. This is a shift away from the common fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care.

The Spine and Joint Solution is currently available nationwide to large and mid-sized companies with self-funded health plans, helping expand access to high-quality, cost-effective care and potentially saving employees out-of-pocket costs. Since the program’s introduction as a pilot in 2015, participating employers have recorded an average savings of $10,000 or more per operation when compared with median costs in the same metropolitan area. Through the initiative, eligible employees may save more than $1,000 in out-of-pocket costs per procedure when accessing a participating facility rather than another in-network medical facility.

Musculoskeletal procedures are becoming increasingly common due to an aging population and higher obesity rates. For instance, the number of knee replacement surgeries performed nationally is expected to increase by 500 percent by 2030, according to a recent study from the Healthcare Cost and Utilization Project. Moreover, these surgical procedures are expensive (knee/hip replacements average $35,000 per operation) and costs vary widely among care providers.

“Knee, hip and spine surgeries are among of the fastest increasing categories of medical procedures, so this program provides a new way to help improve the quality of care, produce better outcomes for patients and better manage costs for employers,” said Sam Ho, M.D., chief medical officer of UnitedHealthcare. “Our partnership with participating health care providers and facilities is an important step toward achieving better health outcomes while reducing the overall cost of care.”

UnitedHealthcare Value-Based Care Portfolio Continues to Grow

Value-based care models have made tremendous gains in adoption across America’s health care system over the last few years. UnitedHealthcare’s care provider reimbursements that are tied to a variety of value-based care arrangements have nearly tripled in the last three years to nearly $50 billion annually, and are expected to reach $65 billion by the end of 2018. To date, more than 14 million people, or nearly one in every three people enrolled in UnitedHealthcare benefit plans, currently access care from providers in value-based care relationships.

The Spine and Joint Solution currently partners with health care facilities that have been independently evaluated for providing quality patient care and better outcomes. Participating facilities are located in major markets nationwide, including Boston, Chicago, Dallas and Los Angeles.

“Providing the best outcomes and an exceptional patient experience in an affordable way are key to helping our patients live healthier lives,” said Tim Cappel, executive director of Population Health Management for Cincinnati’s The Christ Hospital, one of first facilities to participate in the program. “Employers seeking effective cost-containment strategies recognize the value of fixed and competitive prices. Through these and other innovative approaches, The Christ Hospital Health Network is transforming the way our patients receive care.”

For more information about the Spine and Joint Solution and Value-Based Care, visit