Geisinger to cover health plan members’ lifetime hip surgery costs under new initiative

The first patient enrolled in the pilot was a 53-year-old woman who underwent successful total hip replacement surgery in February. (Pixabay)

In a move that takes value-based care to the next level, Geisinger Health System has launched a new program to cover the lifetime costs associated with orthopedic surgeries.

The Danville, Pa.-based system says it will collaborate with Medacta International, a global leader in orthopedic medical devices, on a pilot program to provide a Geisinger Health Plan member who received hip-replacement surgery last month with an unlimited time frame for any costs associated with future surgical care needed as a result of the procedure.

RELATED: Geisinger's 'radical' approach to improve population health


13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

The two organizations intend to share the costs of the care, including the device itself and all hospital costs if the patient remains with the Geisinger Health Plan and is treated by Geisinger providers. It also intends to expand the program to include more patients.

The first patient enrolled in the pilot was a 53-year-old woman who underwent successful total hip-replacement surgery in February.

Although Medicare will often pay hospitals more when something goes wrong during surgery, Geisinger said the new model aims to reverse that trend in order to deliver high-quality care at lower costs.

“Rather than follow the prevalent fee-for-service model, Geisinger rewards value,” Michael Suk, M.D, chair of the Geisinger Musculoskeletal Institute and the Department of Orthopaedic Surgery, said in the announcement. “When it comes to the hip replacement pilot program, what we’re saying to our patients is that the level of service we’ll provide will be so exemplary that if there’s a problem tomorrow or 20, 30 or 40 years from now, we’ll take care of it.”

The program expands upon Geisinger’s ProvenCare program, which uses evidence-based “bundles” to set a fixed per-case rate that covers preadmission, inpatient and follow-up care, including any and all complications 90 days post-procedure. In 2014, Geisinger added hip fracture, total hip, total knee and lumbar spine to the ProvenCare program.

Since the health system introduced the orthopedic protocols, Suk said it has seen a decrease in readmissions and a reduction in length-of-stay rates for total hip replacements. “By affixing evidenced-based protocols to all hip and knee surgeries, we are able to ensure the same high-quality care is delivered to every patient, every time," he said.

RELATED: Geisinger pays out $400K as part of its money-back guarantee

This isn’t the first time Geisinger has raised the bar for patient experience. In 2015 it launched a “money-back” guarantee and promised to refund patients who were unsatisfied with their care experiences. For the first six months of the program, the organization paid $400,000 in refunds. Long ER wait times, impolite employees and difficulty getting appointments with certain departments were among the complaints. But Geisinger CEO David Feinberg said that overall, the program improved patient satisfaction and built trust with consumers.  

Suggested Articles

The Trump administration has released its annual rule governing payments to inpatient providers.

Pharmacy retail giant Walgreens plans to implement a new minimum age requirement of 21 for its customers seeking to purchase tobacco products in its stores.

An artificial intelligence tool can help diagnose post-traumatic stress disorder in veterans by analyzing their voices, a new study found.