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Some of you may have read this article recently in the Star Tribune, which addresses cost efficiency and better results in treating spine issues.   Effective Jan 1st, HealthPartners’ members will have to be evaluated by a spine specialist first to review nonsurgical options before they can see a surgeon. The specialist will help members review all surgical and non-surgical options to ensure they make the best decision for their physical and financial health.  HealthPartners spent $28.3 million on spine surgeries in 2011, and as a result, they are changing their approach to spine surgeries in 2012 to align with a triple aim:  reduce cost while improving quality and the member’s experience.  They are not acting as a gatekeeper, even though some members initially may see it that way.   Dr. Thomas Mart, HealthPartners’ Medical Director of clinical relations said, “Patients can still see a surgeon if they wish, but after this new approach, they will be better informed about all of their options, and can make decisions more aligned with their own values.”

HealthPartners modeled this program after Priority Health, a program instituted in Grand Rapids, MI, who found over the past four years their spine surgeries have dropped by 26%, and 87% of patients said they understood their options better, and nearly three-quarters reported being satisfied or very satisfied with the care they received.  Many of the larger hospital systems and spinal care practices in Minnesota already use this approach, but HealthPartners is the first insurer to require it.  They are expecting criticism from some spine surgeons, who will say they don’t like meddling from insurance companies, and so there will be careful monitoring of patient experiences and outcomes.  Part of federal health care reform law is a call for more satisfying patient experience, and finding ways to rein in costs.  If this program proves to be successful, you can be sure your other insurers will do the same.  Happy New Year!

Sources:  Star Tribune  Jan 6, 2012 and HealthPartners

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