Spine surgeons who have an outcomes-based approach now will see a strong payoff in the value-based care landscape in the near future.
Two spine surgeons discuss what’s ahead for value-based care and how it will fit in a fee-for-service landscape.
Note: Responses were lightly edited.
Question: Where does value-based care stand in spine now? What’s your five-year outlook?
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Value-based care in spine is gaining momentum, but we are still early in trying to successfully adapt. The concept is starting to make more sense, but the execution remains difficult because spine is heterogeneous, outcomes are harder to standardize, and current models still do not account well for complexity. Over the next five years, I think the biggest progress will come from smaller, clearly defined pilots, stronger risk stratification and better alignment around what we are actually measuring.
Just as important, we have to reduce the administrative burden attached to these models. If value-based care becomes more paperwork, more denials, and more friction, clinicians will not want to (nor may be able to) extend the initial energy to apply these models. At the end of the day, we need programs that can combine careful patient selection, rigorous data, and streamlined workflows to deliver better outcomes at lower total cost without making care “less human” and trying to fulfill variable metrics.
Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: Value-based care in spine is in an awkward adolescence. The promise is real, but the infrastructure hasn’t caught up. Most spine surgeons are still paid for procedures, not outcomes. Bundled payment models have shown early promise in joint replacement, but spine is harder: the indications are murkier, the patient populations more complex, and the long-term recovery windows don’t fit neatly into 90-day episodes.
Where we stand now: value-based contracts exist, but they remain a small fraction of spine reimbursement. The surgeons who have leaned in by building care pathways, investing in conservative care, embracing remote monitoring are ahead of the curve, but they’re still operating against a fee-for-service tide.
My five-year outlook: the shift will accelerate, driven by three forces. First, payers — both commercial and CMS — are running out of patience with the cost trajectory of spine care. Second, AI-enabled tools will make it possible to identify who actually needs surgery versus who will do equally well with structured conservative care — and to document that distinction at scale. Third, a generation of younger spine surgeons is entering practice with outcome-based thinking already baked in; the cultural shift is coming from within the specialty, not just from payers.
The surgeons who will thrive in five years are those building outcome-driven practices today, not waiting for the payment model to force their hand.
