Becker's Spine Review

8 THOUGHT LEADERSHIP What spine surgeons expect for the future of value-based care By Carly Behm Value-based care has seen some growth in spine and orthopedics, with some groups embracing the payment model. Unlike fee-for-service, value-based care encourages a greater emphasis on patient outcomes. Spine surgeons discuss their outlook on value-based care and how it can expand. Editor's note: Responses were lightly edited for clarity and length. Question: What's needed to broaden value-based care's reach? How do you predict it will look in 10 years? Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: I think value-based care's goals have to be defined in their most basic sense: bringing value to whom. As of right now, the only people getting value are the billion-dollar quarterly profits for the insurers. It's time we stopped feeding into it, and make our care better, safer and more efficient. Value will then be a desirable byproduct by doing a good job first. Emeka Nwodim, MD. Centers for Advanced Orthopaedics (Bethesda, Md.): e purpose of value-based care is to optimize quality, performance and the [global] patient experience to control what has become unsustainable healthcare costs. I believe in order for this to be successful and truly fulfill what is intended, it will require all parties involved in the healthcare system to be willing to compromise and be intentional about finding solutions. At this point in time, the most tangible and effective compromise to optimize VBC will have to come from payers, large healthcare systems and hospitals. is does not preclude the responsibility of physicians and multi-specialty practices, such as my own (CAO), which have the responsibility of managing ancillary use and expenses. However the majority of money spent on healthcare is consumed by payers, large healthcare systems and hospitals. Rather than continuing to decrease reimbursements to physicians and medical staff responsible for direct patient care, our society must recognize where most expenses are consumed — and those parties have to be accountable with Orthopedic smart implants can 'reestablish normals' in care, DISC surgeon says By Carly Behm O rthopedic surgeon James Chen, MD, has been with DISC Sports and Spine Center since December and is bolstering its total joint replacement program. At the Newport Beach-based practice, he's leveraging newer technologies including robotics, smart implants and digital care management to streamline administrative work and patient experiences. One of the tools he uses is mymobility which integrates with the Apple Watch and remotely monitors patient movement and recovery. Dr. Chen said he uses the app to improve communication with patients by flagging the care team when to reach out to patients in addition to allowing patients an additional resource to communicate with staff. "[The mymobility app] essentially automates the process," he told Becker's. "It allows nurse navigators to focus on higher priority things and keeps them from being overwhelmed, creating a more efficient staff." At DISC he's also using Zimmer Biomet's Persona IQ smart knee implant, the only device of its kind on the market currently. While smart implant technology, which measures patient recovery and movement metrics, is only available for knees right now, Dr. Chen said he already sees its potential to transform care in all areas of orthopedics. "I perceive a future where this starts to become more ubiquitous and not just for knee replacements but for hip replacements and spine," he said. "There's a lot of information that we classically don't know but then you can start to get insights into that. You have the opportunity to reestablish normals that we haven't been able to define before." These new technologies come with a heftier price tag, and orthopedic practices and surgery centers need to think strategically about offerings. "It is important to come together as a team and decide if a particular technology for your surgery center is right for you, as the situation may be different for every center," he said. Dr. Chen said he would categorize the current era of orthopedics as one where physicians are becoming more retroactive than reactive. "I think we're going to look back and see this as the transition period away from one-size-fits-all surgical plans," he said. "As technologies such as these continue to evolve, we will have more tools to gather more insights into expanding the way we can personalize treatment plans for our patients in attempts to optimize outcomes and satisfaction." n

• Cover