'These are crazy times': Orthopedics' biggest disruptors


The orthopedic industry is constantly changing. 

Two orthopedic surgeons connected with Becker's to answer, "What is disrupting orthopedics?"

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: How would you describe the current state of orthopedic surgeons' autonomy?

Please send responses to Riz Hatton at rhatton@beckershealthcare.com by 5 p.m. CST Thursday, April 11.

Note: These responses have been lightly edited for length and clarity.

Traci Granston, MD. Vice President of MSK Clinical Strategy at Cohere Health: Intelligent prior authorization is disrupting orthopedics. Forward-thinking health plans are investing in intelligent prior authorization solutions that drive cost savings and better musculoskeletal outcomes while reducing provider abrasion and administrative burden.

As an orthopedic surgeon of 20+ years and the vice president of MSK clinical strategy at Cohere Health, I'm fortunate to be able to bring my passion for patient care into the critical work we're doing to improve the prior authorization process for patients and their physicians.

We've seen significant results, like a 43% reduction in medically unnecessary arthroscopies and 92% provider satisfaction. What's more, Cohere's partnership with the American Academy of Orthopaedic Surgeons further enhances access to high-quality, data-driven care by tapping into complementary cutting-edge tech and clinical expertise, respectively.

Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Tacoma, Wash.): 

1. Nontraditional healthcare ventures entering the healthcare space (ex. Amazon, Best Buy, Costco, Uber, etc.).

These are crazy times! Various economic forces are driving consumers (and in this case, patients) to change some of their fundamental behaviors. With inflation rates at all-time highs, Americans have started shifting more of their budgets away from goods and toward services — especially healthcare. Health spending, which is projected to reach $5.2 trillion nationally by 2025 (according to CMS) — has become an alluring growth avenue for many large retailers. 

From the healthcare provider perspective, the ideal situation may be flexible. Although U.S. healthcare largely continues to operate in a fee-for-service model, many of the investments by the big retailers are emphasizing value-based care — which theoretically could lead to a concentrated focus on prioritizing preventive care. Furthermore, the additional capacity and focus on in-home, specialty and primary care could not only improve access for underserved patients and those with limiting social determinants but could also help further advance pay-for-performance (outcomes) over fee-for-service (volume), adding fuel to the quality versus quantity conundrum.

But how will patients be properly worked up and referred? Can these retailers actually increase access to orthopedic surgeons — and how exactly will they choose orthopedic practices to send their patients to? There will be a new push to demonstrate quality of care and maximizing outcomes — a la Center of Excellence Programs. 

2. The consumerization of healthcare and digital health tools.

There seems to be a movement toward the "consumerization of healthcare" to provide patients a desired experience, especially in orthopedic surgery.

Patients are asserting more influence and control over their medical and wellness care. And COVID-19 has accelerated this movement of consumerization of healthcare as consumers/patients increasingly focus on health.

Cuts in healthcare funding and competition for budgets are forcing us to find ways to improve the efficacy and efficiency of healthcare services provision. Engaging patients in the responsible management of their health is critical — and the digital health tools are leading these efforts.

The patient engagement niche has become a booming industry over the past few years. The most common examples include: patient portals, secure email/messaging, social networks, video replays, and various mobile technologies. Findings showed that these tools can improve care, self-management, self-efficacy, behavior promotion (quality of sleep, diet, physical activity, mental health) and medication adherence. The various platforms have proven effective for disease prevention, lifestyle changes, management of cardiovascular disease and diabetes, and is a suitable tool for elderly and younger populations alike.

Although patient care directly addressing their pathology remains paramount, engaging them to provide a better patient experience is a growing focus. Innovation in this field continues to grow — thus, improving the safety, value and experience of patient care.

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