Bonitas partnership reduces costs of hip and knee replacements

Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund.

Hip and knee replacements are consistently among the top ten cost drivers for medical schemes and utilisation is increasing every year.

Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund, says that in an environment of escalating healthcare costs, it is crucial that medical schemes implement funding models that address cost drivers while improving quality and outcomes.

To this end Bonitas has entered into an innovative partnership with Improved Clinical Pathway Services (ICPS) to provide its members with high quality hip and knee replacements while reducing the cost of the procedures by an estimated 10%.

“Bonitas’ approach is to deliver value-based, quality healthcare and to enter into strategic purchasing arrangements with selective healthcare service partners who are able to demonstrate excellent clinical outcomes that are cost effective.

“Partnering ICPS is therefore a logical extension of this strategy,” he explained.

ICPS a network of orthopaedic surgeons supported by anaesthetists, physiotherapists and associated hospitals. The group specialises in delivering hip and knee replacements at a lower cost while monitoring and reporting on quality outcomes by following standardised clinical pathways for hip and knee arthroplasty.

These pathways have been developed according to an evidence based, rapid recovery care pathway. A global fee reimbursement model has been structured to ensure all service providers involved in the care pathway are incentivised to deliver quality and cost effective outcomes.

The model is supported by a rigorous clinical governance framework which includes recording and reporting on the clinical outcomes of every case. The reimbursement model also ensures that members do not incur out-of-pocket expenses.

Following a successful pilot project, Bonitas implemented a global fee model for hip and knee replacements from 1 January 2015 for members of Bonitas’ Standard option. Thus far 200 procedures have been carried out following this pathway and the results have mirrored those achieved in the pilot environment.

“Bonitas has seen a reduction of approximately 10% in the costs associated with hip and knee replacements while the clinical outcomes are consistent with international benchmarks.” says Ramasia.

A member survey was carried our which showed members were pleased with both the quality of care they received and the clinical outcomes. There was a marked improvement in functionality, stiffness and pain compared to internationally accepted Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, both before and after the operation.

Dr Grant Rex, Managing Director of ICPS said that 36 orthopaedic surgeons who specialise in hip and knee replacements are currently participating in this initiative.

“The key to the success of this initiative is establishing common objectives between all stakeholders and then working as a team to ensure these are met.”

“We have also identified significant wastage in the delivery of these procedures and the introduction of a standardised care pathway has allowed us to reduce costs while monitoring quality outcomes. This has actually improved quality and patient experience as costs drop,” he said.

Bonitas is upbeat about the future impact of similar initiatives.

“Our relationship with ICPS serves as a blueprint for the collaborative partnerships Bonitas is seeking to develop with healthcare service providers. It involves agreeing on common objectives and actively working together and leveraging off each other’s strengths to achieve those objectives,” Ramasia adds.

As part of its strategic purchasing strategy Bonitas will be also introducing this model into further options in 2016 and similar solutions are currently being explored for other procedures.

This approach will help ensure that member’s contributions remain competitive.

“The beauty of this model is that ultimately the member benefits while the interests of all stakeholders involved are also taken into account,” he concludes.