Detroit-based Henry Ford Health is rethinking how orthopedic care can succeed under value-based, as well as risk-based, payment models.
Eric Makhni, MD, is a sports medicine orthopedic surgeon and senior clinical advisor for the Center for Patient Reported Outcome Measures (at Detroit-based Henry Ford Health, as well as team physician for the Detroit Lions. He said the shift toward value-based care requires aligning incentives around outcomes rather than volume.
“In orthopedics, our traditional focus on value-based care has been on how to deliver surgical episodes with high quality and low cost,” Dr. Makhni told Becker’s. “What we are missing in all of this is optimizing who should get surgery and when they should get it. It is about ensuring that we deliver the right treatment to the right patient at the right time, surgical or non-surgical.”
Dr. Makhni said bundled and risk-based payment models are pushing orthopedic practices to redefine success.
He outlined two types of bundles shaping musculoskeletal care: episodic bundles, such as 90-day surgical payment models, and condition-based bundles that focus on longer-term management of conditions like arthritis or low back pain.
“When you look at episodic bundles like the bundled payments for care improvement or comprehensive care for joint replacement programs, those are still largely fee for service,” Dr. Makhni said. “You’re just trying to contain costs around a procedure. The question is, what if surgery isn’t the right treatment? What if it’s physical therapy or education instead?”
Condition-based bundles, he added, take a more holistic approach.
“Sometimes it’s surgery, but often it’s not,” Dr. Makhni said. “Education, nutrition, weight loss, mental health and pain management are just as important.”
At Henry Ford, that philosophy has shaped a broader push toward integration. The system’s physicians, hospitals and health plan align around outcomes and cost — a structure that led to bold innovations around patient reported outcome measure collection and multidisciplinary specialty care.
It also led to the creation of Protera Health, an independent digital health company launched through Henry Ford Innovations and founded by Dr. Makhni, who serves as CEO. The company operates as one of the nation’s only digital musculoskeletal centers of excellence.
“Protera Health was built to expand access to multidisciplinary musculoskeletal care through human-first clinical delivery enhanced by technology,” Dr. Makhni said. “It is a win-win for patients and orthopedic surgeons because it optimizes nonoperative treatment as front line care while triaging appropriate surgical patients to orthopedic practices when needed.”
He added the model benefits both surgeons and patients.
“Orthopedic surgeons love these tools because we want to see patients who truly need surgery,” he said. “We do not want to see patients that do not need surgery.”
As a Henry Ford Health clinician leader, his team built a system within the electronic health record that collects outcomes for every orthopedic patient at every visit, tracking function, pain and mental health.
“What we found is that if someone is functioning well and has low pain before surgery, they’re less likely to benefit from it,” he said. “By using patient-reported outcomes, we can identify who truly needs surgery and who doesn’t — and that’s what value-based care is all about.”
The approach has reduced unnecessary procedures while maintaining appropriate surgical volumes.
“We were actually doing less surgery that was unindicated,” he said. “Our surgical volumes were still fine — we were offering people that needed surgery and not offering people who did not need surgery.”
Dr. Makhni said smaller orthopedic practices can also engage in value-based care by tracking outcomes and using data for shared decision-making, though implementing such systems requires support.
“The orthopedic surgeon’s role is to collect outcome measures on their patients and use them for shared decision-making and to study their own outcomes to ensure high-quality care,” he said.
Looking ahead, Dr. Makhni believes orthopedic practices will need measurable proof of value to thrive.
“If you want to claim you provide value-based or high-quality care, you have to prove it,” he said. “PROMs is the way to do that.”
