Study published in Managed Care first to evaluate value-based centers
INDIANAPOLIS–(Business Wire)–November 15, 2016 — Spine centers of excellence measured on both quality and cost demonstrate similar quality and about a 19 percent cost savings compared with other centers, according to a study conducted by HealthCore, the outcomes research subsidiary of Anthem, Inc.
The study, published in the September edition of Managed Care, compared data on providers participating in the Blue Distinction Plus program created by the Blue Cross Blue Shield Association. The providers were compared based on value and quality with other providers not participating in the BCBSA program. It is the first peer-reviewed study to evaluate value-based centers of excellence.
“This study is important because it tells us that less expensive spine centers of excellence can produce quality outcomes, while also saving consumers, employers and health plans much-needed dollars that can be spent elsewhere,” said Andrea DeVries, HealthCore director of research.
Episodic costs per surgery in value-designated centers were $3,157 or 16 percent less for lumbar discectomy/decompression, $6,784 or 19 percent less for cervical simple fusion, and $11,134 or 18 percent less for lumbar simple fusion. Complication rates were lower at 1.5 percent for value-based centers, compared with 2 percent at other centers, while other quality measures were similar.
The study focused on episodes of care to capture post-surgical follow-ups, which are strong indicators of patient outcomes and quality of care.
Some plans are now lowering out-of-pocket costs for consumers who choose value-based centers. Other consumers would not feel a direct economic benefit by choosing value-based centers because of the high cost of surgeries, coupled with the cap on out-of-pocket expenses. However, there could be longer-term impact on all consumer premiums by consistently choosing higher-cost facilities.
“As benefits evolve and the number and availability of price transparency tools increase, there is a greater need for science-based, consumer-friendly metrics,” said Patricia Martin, director of specialty network management for payment innovation at Anthem. “Programs like Blue Distinction Plus are efforts to get this information into the hands of consumers who are appropriately motivated to act.”
Value-designated centers tended to be larger-bed centers located in metropolitan areas and affiliated with medical schools that perform more surgical procedures and provided more nursing hours.
The study compared 90-day episodic costs, inclusive of surgery and post-operative care and hospital readmissions, and quality criteria, including complication rates and readmission rates, of 33,827 adults who received spine surgery at value-designated centers to 27,686 adults who received spine surgery at other centers.
Blue Distinction Center Plus designations are granted to centers that apply and meet clinical requirements and have spine surgery costs below 1.05 times the national average. The centers are located nationwide with many states offering multiple choices.
The study used claims data from 14 of the 36 commercial Blue Cross and Blue Shield health plans in the Northeast, Midwest, West and Southeast regions of the United States.
Study authors are Sze-jung Wu, Qinli Ma and DeVries of HealthCore, as well as Martin of Anthem.
About HealthCore, Inc.
HealthCore, Inc. is the wholly-owned, independently operating health outcomes research subsidiary of Anthem (NYSE: ANTM), Inc. We work with life sciences companies, payers and providers, and government and academic organizations to provide real-world evidence in support of a wide variety of health care decisions. Our research capabilities include extensive experience in HEOR, Late Phase, Safety and Epidemiology and Survey-Based research services and solutions with our work designed to improve quality, safety and affordability in health care. With more than 20 years of experience, clinical and scientific research expertise, and exclusive access to a robust, integrated research environment containing information on nearly 60 million individuals from multiple health plans across the U.S., HealthCore delivers unparalleled clarity and actionable information to health care decision makers. To learn more about HealthCore, go to www.healthcore.com.
Contacts for HealthCore, Inc.