Latest / Becker’s Healthcare Podcast / Advancing Value-Based Care in Musculoskeletal Health with Dr. Jason Scalise

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Advancing Value-Based Care in Musculoskeletal Health with Dr. Jason Scalise · Becker’s Healthcare Podcast

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- This is Laura Dierda with the Becker's Healthcare
0:58
- podcast. I'm thrilled today to be joined by
1:00
- doctor Jason Scalise,
1:01
- chief value officer for HOPCO. Doctor Scalise, it's
1:04
- a pleasure to have you on the podcast
1:05
- today.
1:06
- Thanks so much. Happy to be here.
1:09
- Absolutely. Now I'm excited for our conversation. I
1:11
- know we're gonna talk a lot about some
1:13
- of the really cool things you're doing at
1:14
- HOPCO, some of your recent expansion, as well
1:17
- as what's in on the horizon. But before
1:19
- we dive in, can you just tell us
1:20
- a little bit more about yourself and HOPCO?
1:23
- Sure. Happy to.
1:25
- As you mentioned,
1:26
- Jason Scalise. I'm an orthopedic surgeon by background.
1:30
- I, I'm a shoulder surgeon, fellowship trained shoulder
1:33
- surgeon, and I've been with HOPCO for about
1:35
- twenty years.
1:37
- Still actively practice, but my role at HOPCO,
1:40
- primarily is as chief value officer where I
1:43
- oversee all of our national
1:45
- value based care initiatives and platform.
1:48
- We focus on the musculoskeletal
1:49
- space as an orthopedic surgeon,
1:52
- led and created organization.
1:54
- And in the value based care,
1:57
- component,
1:58
- we're known for
1:59
- developing and deploying and managing
2:02
- a whole variety of
2:04
- different alternative payment and value based care,
2:07
- programs, including,
2:09
- full musculoskeletal
2:11
- population health, platforms, which are rather unique.
2:14
- But the hallmark
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- of those programs is it helps
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- physicians,
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- in the musculoskeletal
2:20
- space and their practices lead the value based
2:23
- care efforts in a way that is,
2:26
- very sustainable
2:27
- but also puts,
2:29
- the the patient interaction and the clinical indications
2:32
- for patients,
2:33
- that we care for at the top.
2:36
- That makes a lot of sense. You know,
2:37
- it is really cool to have that type
2:39
- of organization already set up, where you're looking
2:41
- at value based care, where you can support
2:43
- physicians on their journey in that direction, and
2:45
- then also really keep a close eye on
2:48
- what's gonna be most meaningful for patients as
2:50
- well.
2:51
- Could you walk us through a little bit
2:53
- of the recent expansion that you've done into
2:55
- Indiana, Kentucky, Ohio, Oregon, and Virginia?
2:58
- What made those markets the right next step
3:00
- for your platform, and how are you doing
3:02
- there?
3:03
- Yeah. That's,
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- that that's right. It it we're we're pretty
3:06
- excited about that. In fact, we just launched
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- those programs,
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- in within the last week, so on July
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- 1 officially.
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- And,
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- those markets,
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- as you mentioned, Indiana,
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- Kentucky, Ohio, and Virginia,
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- and we're adding,
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- Missouri
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- and Colorado
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- at the beginning of,
3:26
- 2027.
3:28
- All of those markets,
3:30
- represent,
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- a good expansion of our of our platform,
3:34
- that we've been doing in in other regions.
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- They
3:38
- certainly have a substantial
3:41
- population base,
3:43
- in each of those in each of those
3:44
- markets. They also you know, as we look,
3:47
- and
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- work with risk bearing entities and payers,
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- we're able to ingest through our medical economics
3:54
- and analytics platform
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- all of the historic claims data for their
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- membership. So this could be hundreds of thousands
4:01
- or millions of lives and
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- look at the historic
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- spend,
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- utilization,
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- and quality
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- of all aspects of musculoskeletal
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- care regardless of
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- who has, rendered the service or where that
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- service is rendered. So anywhere from, you know,
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- a PCP visit for low back pain
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- to complex orthopedic trauma care at a tertiary
4:25
- facility. And everything in between is is musculoskeletal
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- care.
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- But, generally, what we find is that much
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- of the
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- initiatives are
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- based either just within the surgical
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- episode,
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- and focus just on what happens within the
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- the the confines of the orthopedic
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- physician's,
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- you know, purview,
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- or there are some initiatives that are solely
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- what you might call upstream with, you know,
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- digital patient engagement and physical therapy first.
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- And any of those models,
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- have their,
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- have their, you know, positive attributes.
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- But when we are able to look at,
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- the entire cost of care and the care
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- journey across entire populations,
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- what we see in the markets that I
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- mentioned is still a a a fair amount
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- of variation of cost,
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- spend, and utilization,
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- which generally means that there's opportunities to align
5:22
- around
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- evidence based best practice,
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- standards, which as orthopedic
5:27
- providers,
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- we're actually quite adept at
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- elucidating that and following that, you know, academy
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- best practice standards or, specialty society best practice
5:39
- standards. And and we've always felt that the
5:42
- the musculoskeletal
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- physicians are in the best position to help
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- dictate what is
5:47
- high quality
5:48
- in the best patient interest,
5:50
- clinical care. And so when again, to answer
5:53
- your question, when we look at those markets
5:56
- in particular, and there's a lot of markets
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- that,
5:59
- that fall into this category too,
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- We find that,
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- the the payers,
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- in question are are looking to find solutions
6:07
- that are more progressive and more durable and
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- sustainable than some of the other models that
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- have been characterized as maybe, you know, a
6:15
- race to the bottom or,
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- you know, diminishing returns.
6:19
- And, these these markets in particular have embraced
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- what we've seen as highly successful
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- in other regions.
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- That's great to hear. And, you know, really,
6:30
- fortunate that you've been able to build such
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- a successful business model and then looking at
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- trying to bring it into new markets, trying
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- to figure out how you can scale and
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- grow in a meaningful way. I am curious
6:42
- as you were looking into some of these
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- new markets, what made them really,
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- stand out to you? What is kind of
6:48
- the prerequisite that needs to exist,
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- in that space? And then how do you
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- kind of bring and scale your secret sauce
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- in a way that's meaningful?
6:57
- Yeah. I think, you know,
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- every market, although
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- can be a little bit different and every
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- population can be a little bit different, there's
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- always common themes, especially in musculoskeletal
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- care. And and one of the things that
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- we continue to see around the country
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- is,
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- an increase in overall,
7:15
- cost of care,
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- in in ways that can otherwise be more
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- streamlined. And, you know, one of the things
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- that we do
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- is that as we,
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- manage,
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- the the total cost of musculoskeletal
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- care, so if and we do that on
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- a on a per member per month basis.
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- And if you think about it that way,
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- that that's truly,
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- you know, population health for the musculoskeletal
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- spend. So we will look at
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- the entire,
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- compendium of musculoskeletal
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- care defined by the roughly 30,000
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- ICD 10 codes that have something to do
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- with musculoskeletal care, and we'll be able to
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- determine
7:52
- what the
7:54
- cost utilization
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- and,
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- quality outcomes has been for that particular population
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- over time, say, over the last three years
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- for this particular population across Ohio, for example,
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- or Kentucky.
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- We'll then be able to,
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- reference
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- that,
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- that historical performance against,
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- demographically matched and performance matched benchmark data. We'll
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- be able to determine
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- what what the, cost utilization
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- and,
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- quality could have been or arguably should have
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- been in that benchmark data,
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- what that delta is, what that delta is
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- worth in dollars, and who down to the
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- individual provider or facility in that market is
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- largely responsible for helping drive that delta one
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- way or the other. That then allows us
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- to create a a road map, of where
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- opportunities are in a market and some and
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- some opportunities and, you know, in some populations,
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- clinically
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- unindicated
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- excessive use of post acute skilled nursing facility
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- is still prevalent. In other markets and populations,
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- that's less of an issue.
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- In some populations, there's still
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- quite of opportunity to find
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- more appropriate site of service. So, for example,
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- lower cost ambulatory surgery centers for clinically indicated,
9:13
- patients and clinically appropriate patients in that setting
9:16
- versus more expensive settings. So you get this,
9:20
- again, like a road map or an opportunities
9:22
- list that can be defined and specific for
9:24
- that market.
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- And one of the things that we've been
9:28
- known to be able to do is not
9:29
- just understand where the opportunities are, but then,
9:33
- develop that into an operational plan where we
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- can go into the market and help,
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- operationalize those
9:40
- those tasks, those goals
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- by working with
9:44
- physicians in the market. One of the things
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- that is is critical to that is the
9:48
- way that we develop
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- musculoskeletal
9:51
- physician led clinically integrated networks.
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- And those clinically integrated networks,
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- help align
9:58
- the the physicians and even the PCPs because
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- the PCPs,
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- actually treat a lot of the musculoskeletal care,
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- the low back pain, the knee pain, etcetera.
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- They may not do the surgery, but they
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- certainly are involved in a lot of the
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- frontline treatment.
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- And if you align the physicians
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- and the providers across that region around best
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- practices,
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- we can reliably start to show where savings
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- can occur. And then and then our model,
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- which makes it, you know, very unique and
10:25
- and powerful, is
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- a a portion of those savings can be
10:29
- returned,
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- to the, high performing,
10:32
- providers in that market on a earned
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- performance basis. And so
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- that when you put that all together, you
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- have a scenario where
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- we can, as,
10:44
- collaborators,
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- now,
10:46
- drive savings. And instead of those savings only
10:49
- going back to the payer,
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- they they can be, used as incentives,
10:55
- to align around high performance and best practice
10:58
- in a way that's generally
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- not available to high performing physicians. And we
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- do that,
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- in conjunction
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- with their existing,
11:08
- contractual arrangements that they may have with the
11:10
- payers. So it's not instead of, but it's
11:13
- additive to and therefore,
11:15
- easy to engage with low friction
11:18
- that ultimately
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- helps drive,
11:20
- a much better performance across the markets.
11:24
- I love it. It makes a lot of
11:25
- sense. And, you know, thank you so much
11:27
- for explaining that a bit deeper,
11:29
- in thinking through what it actually shows up
11:31
- as and looks like for the physicians and
11:33
- practices that you're working with. Now what are
11:36
- some of the headwinds as well as opportunities
11:38
- that you anticipate will arrive in the next
11:40
- year or so?
11:41
- It that's a good question because, you know,
11:43
- I can use some of our historical experience
11:44
- to kinda maybe, you know, illustrate that.
11:47
- I'll give an example in in Arizona.
11:50
- So we've had a,
11:52
- a musculoskeletal,
11:54
- clinically integrated network in Arizona for many years
11:56
- now. In fact, it's a as a URAC
11:59
- accredited
12:00
- clinically integrated network, I believe it's still the
12:02
- only
12:03
- specialty care, CIN,
12:07
- accredited CIN in in the country.
12:10
- And that clinically
12:11
- integrated network is is comprised of,
12:15
- orthopedic providers from around the state.
12:18
- About half of the more than 50% of
12:21
- the orthopedic providers around the state participate.
12:25
- It
12:26
- addresses,
12:28
- well over 90% of the state's population from
12:31
- a time and distance perspective.
12:33
- And, all of the physicians, they're they're in
12:36
- different practices,
12:38
- from across the region. They might consider themselves
12:40
- to be, frankly,
12:42
- competitors in the orthopedic practice space, which is
12:45
- fine, healthy competition
12:47
- in, in in their region. But it within
12:49
- the clinically integrated network, they're all collaborators
12:52
- around best
12:54
- practices,
12:56
- clinical indications, and so on.
12:59
- That clinically integrated network,
13:01
- has been successful in,
13:03
- working with payers in that region to, do
13:06
- the things that I had mentioned earlier by
13:08
- looking at entire populations of patients and and
13:11
- managing the total cost of MSK
13:14
- spend,
13:15
- and value across across the board.
13:19
- And then the savings that have been generated
13:21
- are are delivered on a earned quality performance
13:24
- basis back to the participating providers in the
13:27
- clinically integrated network. And the the headwinds, frankly,
13:32
- can be
13:33
- that this is a, you know, a very
13:35
- novel concept. And we've designed it in such
13:37
- a way that,
13:39
- that,
13:40
- orthopedic providers,
13:41
- and PCPs for that matter, can engage with
13:44
- it without being,
13:46
- too administratively or any administratively burdensome.
13:50
- Because if you try to,
13:53
- convert a a standard orthopedic practice into a
13:56
- per member per month,
13:58
- financial reimbursement,
14:00
- arrangement,
14:01
- It it it just is a a bridge
14:03
- too far. It's not it's not a way
14:05
- that a orthopedic practice can engage generally. The
14:08
- revenue cycle platforms don't engage in that way,
14:11
- and that's totally understandable.
14:13
- But there are ways to then interpret those
14:16
- programs in a way and translate them in
14:18
- a way where the
14:20
- physicians and MSK
14:22
- leaders who are the experts in MSK care
14:25
- can really lean in and utilize the infrastructure,
14:28
- the analytics,
14:29
- the network management, the care navigation, and so
14:32
- on that we have,
14:34
- and really become
14:36
- champions in the region in a way that,
14:39
- a way that would otherwise be cost prohibitive
14:41
- or too time intensive for them to do.
14:43
- So we think of ourselves as providing not
14:45
- only the infrastructure, but, you know, all of
14:47
- the operational mechanics so that the high quality
14:50
- physicians can continue to perform at high standards
14:54
- and not have to sort of retool an
14:56
- organization in order to to
14:58
- accommodate a a a new payer program.
15:01
- That
15:02
- alone is is very, very different.
15:04
- And, you could see that as maybe an
15:06
- advantage or or or a headwind.
15:08
- I think, initially, once physicians understand how straightforward
15:13
- this is to be able to engage in,
15:15
- you know, continue to do the high quality
15:17
- things that you already do, here are some
15:19
- additional insights and analytics that you would likely
15:22
- never have access to, but now you do.
15:24
- And here are here are
15:26
- some of the predictors that we can see
15:29
- of success that unlock,
15:32
- not only things like,
15:33
- you know, quality incentive bonuses, but perhaps more
15:36
- importantly,
15:37
- unlock a high quality patient experience
15:40
- and and high quality outcomes. That's where you
15:43
- can kinda flip the script and and make
15:45
- what is a sort of a very novel
15:48
- process, but
15:50
- make it into something where physicians can see
15:52
- this is a way for for,
15:55
- musculoskeletal providers
15:57
- to really influence what value based care looks
16:00
- like in a way that is the most
16:02
- meaningful and the most sustainable for their patients.
16:06
- Got it. I I think that makes a
16:07
- lot of sense. And, you know, it is
16:09
- really
16:10
- zoning in on the things that, the surgeons
16:13
- really need to be able to do, but
16:15
- aren't necessarily
16:17
- in their wheelhouse
16:18
- or or within their toolbox of of things
16:21
- that they've been prepared to do over time.
16:24
- And so I I appreciate that analysis and
16:26
- talking through some of the cost and the
16:27
- challenges
16:28
- associated with really digging into the value based
16:31
- care models. Now could you tell us a
16:33
- little bit more about,
16:34
- the evidence behind your model? What is driving
16:36
- the level of enthusiasm from payers as well
16:39
- as risk bearing entities right now when you're
16:41
- looking at orthopedic procedures?
16:44
- Yeah. For sure. Well, number one, you know,
16:47
- we've been
16:49
- managing these programs and deploying them for well
16:51
- over a decade now, and I and I
16:53
- think, you know, that experience is is pretty
16:56
- unique.
16:57
- And we have a long track record of
16:59
- driving,
17:00
- savings in these type of clinically integrated network
17:03
- models and total cost of musculoskeletal
17:06
- care models. You know, we we've been one
17:08
- of the largest. PAPA has been one of
17:09
- the largest conveners of orthopedic bundles in the
17:12
- country too, but where we like to spend
17:14
- most of our time is is in these,
17:17
- I think, much more sustainable
17:19
- and,
17:20
- broad programs because the amount of the amount
17:24
- of change that we can affect in a
17:26
- positive way is much is much broader than
17:30
- just, say, within the confines of a ninety
17:32
- day surgical episode. I think those are fine
17:34
- too. And to the extent that there is,
17:38
- savings and value and better patient outcomes and
17:40
- experience to be found within that ninety day
17:42
- episode, we should do that
17:44
- all the time.
17:45
- But
17:47
- our point of view is we don't have
17:48
- to stop there. We can we can engage
17:51
- with
17:52
- primary care providers
17:54
- and help educate around best practices
17:57
- so that unnecessary
17:59
- advanced imaging, for example,
18:01
- can be mitigated.
18:02
- Unnecessary
18:04
- referrals to,
18:05
- of a patient referral to the emergency room
18:08
- for something that could otherwise be managed on
18:10
- an outpatient basis. All of that not only
18:13
- drives a better patient experience, but, of course,
18:15
- meaningfully drives,
18:17
- savings
18:18
- and efficiencies
18:19
- across across the board.
18:21
- I think,
18:22
- you know, when we look at,
18:24
- some of our
18:25
- models in this respect, we've seen,
18:28
- a
18:29
- a bend a true bending of the cost
18:31
- curve. The thing,
18:33
- the thing that result that that organizations
18:35
- and payers are and and even our federal
18:37
- government,
18:38
- as it relates to health care is is
18:40
- looking for all, all of the time. And
18:43
- we've seen that,
18:45
- time and time again in our models across
18:47
- broad populations.
18:48
- I can give you an example.
18:50
- If we looked at
18:52
- a program where we had roughly a 120,000,
18:57
- lives across across the region, which isn't a
19:00
- particularly large network.
19:01
- The the programs that we're
19:03
- launching,
19:04
- this month, you know, exceed a a million
19:08
- lives.
19:09
- But regardless,
19:10
- you know, a 120,000
19:12
- lives or so
19:13
- seen a,
19:15
- a a change,
19:17
- a positive change in the
19:19
- overall trend of musculoskeletal
19:22
- spend
19:23
- of of greater than 20%
19:25
- such that
19:27
- the,
19:29
- the the cost of care
19:31
- had reduced by 20% in that population,
19:35
- to the point where it was actually,
19:38
- becoming less expensive
19:39
- year after year for that population of patients.
19:42
- That was in a market that was otherwise
19:43
- considered to be highly well managed because it
19:46
- had a history of bundled payment initiatives in
19:49
- the in the past, and the conventional wisdom
19:51
- was
19:52
- there's no way to save any additional money
19:55
- in this market. Everything's been totally optimized. But
19:57
- when you look at it from the lens
19:59
- of a population and not just from the
20:01
- lens of a episode of care, there is
20:03
- tremendous opportunity when you align musculoskeletal
20:07
- specialty physicians
20:08
- with their upstream PCP colleagues
20:11
- and you,
20:13
- help minimize,
20:14
- for patients and the system overall the the
20:17
- friction that can sometimes occur in our health
20:20
- care system,
20:22
- just by its very nature.
20:24
- And that ability to not only drive additional
20:27
- savings,
20:28
- but demonstrable
20:29
- and,
20:31
- objective better patient outcomes, that's the true definition
20:35
- of a of a high value program.
20:37
- That makes a ton of sense. And, you
20:39
- know, looking at those numbers, that's incredible to
20:41
- see,
20:42
- you know, improvements,
20:44
- and and just really have that opportunity to
20:47
- work in the musculoskeletal
20:49
- space,
20:50
- and have the whole ecosystem
20:52
- understanding what's gonna be most valuable for the
20:54
- patient and then add the most to the,
20:56
- health care system while bending the cost curve
20:58
- appropriately.
21:00
- Before we wrap up here, where do you
21:01
- see the specialty value based care headed next,
21:04
- and what will separate the organizations that succeed
21:07
- at scale from those that don't?
21:10
- Yeah. I think I think there's a lot
21:12
- of signals
21:13
- that,
21:14
- you can see out there that are indicating
21:17
- where
21:18
- specialty care and specialty value based care
21:21
- is heading. Number one, it's quite clear by
21:24
- all of the commentary that,
21:26
- payers and risk bearing entities are are,
21:29
- looking for,
21:31
- increased accountability,
21:33
- by the providers.
21:34
- What I would say is that accountability,
21:37
- although,
21:39
- makes sense,
21:40
- and that we should all be aligned,
21:43
- that accountability also,
21:45
- is,
21:46
- better suited when there is
21:48
- substantial
21:50
- operating infrastructure
21:51
- and and tools
21:53
- that the stakeholders can use to, let's say,
21:57
- hold themselves accountable. And I think that's often
21:59
- a missing piece,
22:02
- in in a in a world where
22:04
- high quality, consistent,
22:06
- and,
22:09
- accurate data can often be elusive in our
22:11
- health care system, and, certainly, the timely nature
22:14
- of that data is very elusive typically
22:17
- to
22:18
- just
22:19
- then stick on
22:20
- a expectation of accountability, I think, is is
22:23
- largely not only somewhat misplaced,
22:26
- but is,
22:28
- doesn't necessarily accelerate the ability for those organizations
22:32
- to hold themselves accountable, and sort of a
22:33
- missing ingredient.
22:34
- We have always looked at being a, an
22:38
- operating
22:38
- infrastructure
22:39
- to be able to help,
22:41
- not only,
22:43
- physician organizations
22:44
- lean in and, as I mentioned earlier, be
22:47
- champions
22:48
- of durable
22:49
- value based care initiatives that truly deliver value
22:52
- to the patients
22:53
- and to be champions in their region.
22:56
- But on the flip side, be a bridge
22:58
- for,
23:00
- risk bearing entities and payers to deliver
23:03
- these types of programs
23:05
- to, physicians
23:06
- and physician communities
23:08
- in a way that would otherwise be elusive
23:11
- or hard to reach. And so I think,
23:14
- you know, you will see that in order
23:17
- to have
23:18
- the ability to truly scale
23:20
- and provide these
23:22
- provide these,
23:23
- solutions on a on a, you know, population
23:27
- basis and and stay away from the sort
23:29
- of
23:30
- very small incremental,
23:32
- or I should say smaller and incremental,
23:35
- programs
23:36
- that,
23:38
- create somewhat of a patchwork of opportunities,
23:40
- you'll need not only, that level of analytics,
23:44
- infrastructure,
23:45
- operating,
23:47
- ability,
23:48
- and to be able to,
23:51
- scale that down to the individual
23:53
- encounter level, but also be,
23:56
- looking at populations
23:57
- at the same time. That ability to dial
24:00
- the thermostat, if you will, down to the
24:02
- individual and to the population
24:04
- is something that we're known for. But I
24:07
- think, in my view, that's a requisite to,
24:10
- to be able to,
24:12
- scale these programs and have them be as
24:14
- successful as we have been over the last
24:16
- decade or so.
24:18
- I love that. Doctor Scalise, thank you so
24:20
- much for joining us on the podcast today.
24:22
- This has been such a fascinating conversation. I
24:24
- I really appreciate learning more about HOPCO, some
24:26
- of your recent growth, and then looking into
24:28
- the future where you really see, some of
24:30
- the big opportunities
24:32
- in ways that orthopedics can become a more
24:34
- value based specialty. Thank you so much for
24:36
- your time, and I look forward to connecting
24:38
- with you again soon. Absolutely. My pleasure. Thank
24:41
- you.