Did you know that musculoskeletal care is one of the biggest challenges facing the value transformation of healthcare? Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade! Many of these procedures (such as knee replacements and spinal fusions) contribute to overspending on care that is not even needed, as it has been estimated that only 50% of MSK procedures are evidence-based. The rising costs ofmusculoskeletal care is now a top cost driver for employers and health plans. Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years. Studies have shown that, despite a dramatic increase in health care expenditures for patients with back and neck problems over the last decade, there has not been a corresponding improvement in patient clinical outcomes. In short, spending more money has not correlated with better outcomes. We are in dire need of a value-based revolution in the provision of musculoskeletal care. The current system is clearly broken. Studies have demonstrated that common approaches to MSK care (surgery, imaging, injections, opioids) do not effectively resolve back and joint pain. And the challenges of escalating costs associated with such low value are too big to ignore.

There is a better way, and this week on the Race to Value, we interview two of the leading innovators in orthopedic value-based care! In this special episode, we will begin with an interview with Dr. Kevin Bozic, the chair of surgery and perioperative care at the Dell Medical School at The University of Texas at Austin. He is an internationally recognized leader in orthopedic surgery and value-based health care payment and delivery models and currently serves on the Board of Directors for the American Academy of Orthopaedic Surgeons – a clear signal from the AAOS that the specialty is moving into the value-based care arena. Our second interview on the podcast is with Dr. Kian Raiszadeh, the CEO and Co-Founder of Livara and SpineZone, an orthopedic surgeon who has created an innovative orthopedic care management system for payors, providers, and health systems to unify the patient experience and transition to orthopedic value-based care.

Episode Bookmarks:

01:30 Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade!

01:45 It has been estimated that only 50% of MSK procedures are evidence-based.

02:00 Increased MSK spending in healthcare not associated with a corresponding improvement in patient clinical outcomes.

03:00 Introduction to Kevin Bozic, M.D., MBA and Kian Raiszadeh, M.D.

03:45 Upcoming conference in value-based orthopedics – OVBC on January 26^th-28th

05:00 At the Musculoskeletal Institute at UT Health Austin, Dr. Bozic has created a MSK Integrated Practice Unit.

06:30 Dr. Bozic provides an overview of the Musculoskeletal Institute and how it functions as an Integrated Practice Unit.

07:30 “The vast majority of patients with musculoskeletal conditions do not require or benefit from surgery.”

08:00 The role of the primary care in treating MSK disease within a “musculoskeletal medical home”.

08:45 Comorbid conditions with chronic MSK disease (e.g. anxiety, depression, obesity) are rarely treated in a non-integrated model.

09:45 Holistic integration of primary care-based orthopedic physicians, APPs, physical therapists, dieticians, and social workers.

12:30 Dr. Bozic discusses the potential for condition-based bundled payments in the treatment of MSK disease.

13:45 The role of bundled payment care pathways in lowering overall costs with better clinical outcomes.

14:00 How reduction of inpatient post-acute care can result in lower episode spend with “no detrimental impact on patient outcomes.”

15:00 The big value opportunity — addressing the continuum of care across the spectrum of disease (not just focusing on the surgery).

16:00 Redesigning MSK delivery for optimizing outcomes associated with pain, functional status, and quality of life.

16:30 “Value is all about improving health outcomes in ways that over time reduce the cost of health care. Health is inherently less expensive than disease.”

17:00 The Value Institute for Health and Care and its work in improving health outcomes. (Reference podcast with Elizabeth Teisberg).

19:00 Dr. Bozic discusses the important of patient-reported outcomes (PROs) and how they are used in his musculoskeletal IPU.

20:45 How PROs provide an understanding of a patient’s baseline for pain, functional status, quality of life, and mental health.

23:30 Dr. Bozic provides his parting thoughts on physician leadership in the progression of VBC and the role that AAOS will play in this movement.

26:45 Dr. Raiszadeh and his founding of SpineZone and Livara to reverse the trend of overutilization in orthopedic care through integrated care delivery.

29:30 Dr. Raiszadeh provides perspective on the lack of value-based care from his years of practicing as an orthopedic surgeon.

31:00 “We can create a radically new patient experience in orthopedics allows patients to heal without surgical intervention.”

33:30 Dr. Raiszadeh describes the concept of Orthopedic Whole Health and how it evaluates patients comprehensively from the top-down.

35:30 The impact of obesity, anxiety, and depression on hormonal physiology that affects how patient sense musculoskeletal pain.

36:30 “MSK pain is like the canary in the coalmine. It is giving us an indication of something that is deeper, and that is what Orthopedic Whole Health addresses.”

37:30 The life altering perspective of orthopedic whole health and how this model can be built to scale.

38:00 Transitioning orthopedic care from a biomedical to a biopsychosocial model.

39:00 In the 1990’s, doctors began to view pain as a fifth vital sign, and they over-prescribed opioids (without focusing on safer and more holistic interventions).

40:00 Dr. Raiszadeh discusses the Bio Psychosocial Model of Pain Management in value-based care.

41:30 60-70% of orthopedic patients experience some degree of anxiety, depression, or shame and anger associated with childhood trauma.

42:30 How 1:1 and group sessions, expressive writing, and meditation can be used in MSK treatment.

43:30 Opioid dependency and risks of addiction in orthopedic care.

45:00 “How you feel is the overall foundation of health. It changes our entire chemical environment.”

46:00 The rise of consumerism in orthopedic care and how SpineZone’s consumer-centric model boasts an industry-leading net promoter score of 94.

47:30 Dr. Raiszadeh provides his insights about orthopedic consumerism and how to change a patient’s mindset for MSK treatment.

49:30 How orthopedic consumerism and bio psychosocial care aligns with employer expectations for risk-based payment.

50:30 Creating a MSK model that is non-transactional and opens one up to all aspects of life.

51:45 The launch of Livara – an orthopedic care management system to transition to value-based care at scale.

53:00 Using cost and clinical outcomes data to build a scalable platform that applies to all of orthopedics.

54:30 Leveraging data-driven algorithms to drive diagnosis and value-based care interventions.

57:00 Parting thoughts on the movement to value-based orthopedic care.

Special Report: Julia (2021)