FierceHealthPayer, "The Centers for Advanced Orthopaedics seeks data-driven partnership with payers"

Published April 22, 2016

by Leslie Small

At The Centers for Advanced Orthopaedics, a group of physician practices in Virginia, Washington and Maryland, one of the main purposes of its founding was to build enough scale to mine data about best care practices to support its independent practice model.

"I think everybody in our world is at the same point--we're collecting the data, we're looking at it, we're analyzing it and we're trying to improve outcomes," Executive Director Denny Tritinger (right) tells FierceHealthPayer.

"Right now, we have about 10 clinical protocols that we believe are the best ways to treat patients. But we need the data in order to prove that."

To that end, the practices have been working with a data aggregator to help it make the most of its clinical information. And the group also has been meeting with commercial insurers, because, as Tritinger notes, both sides can benefit from sharing information.

"I'm really excited for this time of disruption--although it's a headache for groups like us to try to find our way through," he says. "It's not a win-lose like fee-for-service has always been--it's more win-win."

The practices have internal data about their clinical outcomes that insurers don't have, but payers have more information about, for example, total facility costs or total cost of anesthesia, both of which would help the physicians determine the total cost of a bundled service.

Ultimately, Tritinger says, his organization wants to work with payers to take on some risk. Private insurers have been particularly receptive to working with providers in orthopedics, he adds, given their tendency to follow the lead of the Centers for Medicare & Medicaid Services, which has introduced a bundled payment initiative for joint replacements.

"If we can work with payers, we can reduce their costs," Tritinger says.