Spine and orthopedic groups have seen an uptick in prior authorizations and denials over the last several years, and many are looking for innovative ways to sidestep insurers.
During a panel about payer trends at the Becker's 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference in June, private practice leaders shared insights on the current payer landscape and plans to develop new partnerships in the future.
"We are exploring how we can very quickly develop a direct to employer model," said Vishal Mehta, MD, president and managing partner of Fox Valley Orthopedics, based in Geneva, Ill. "We've had some success there and are really interested in that going forward because we think we can demonstrate true value to employers and cut out some of the issues we're having with [insurers as] the layer in between."
Fox Valley is in the position to go directly to employers because the practice has gathered outcomes and cost data. The group can pinpoint value for employers and create an attractive package for companies desiring an alternative to the traditional insurance coverage model.
Adam Bruggeman, MD, CEO of Texas Spine Care Center, said while it's difficult to cut out insurance companies and go direct to employers in most markets, he has seen some movement in that direction, especially as tech companies relocate to Texas.
"Direct to employer [contracts] are definitely something to watch," said Dr. Bruggeman. "The employers are frustrated and they're actually suing the insurance carriers now for basically being bad business partners with them on their insurance products."
Columbia (Mo.) Orthopaedic Group is ahead of the curve for direct employer contracting. The practice launched an insurance product for employers, including coverage by its physicians.
"We went out to the employers and said, 'Hey listen, you can save 40%. Come join it.' The employers are jumping to it pretty quickly," said Andrew Lovewell, CEO of Columbia Orthopaedic Group. "We're trying to cut out the payers in our state because they're just bad news and they're not designed to save anybody any money. They're getting in the way of the economy of medical practices today."
The movement for a more consumer-focused approach to healthcare, coupled with rising costs, could be a boon for independent spine and orthopedic groups willing to fill a clear need within their communities. The demand for orthopedic care will increase in the coming years as the aging population grows and people desire to stay active longer in life.
"The direct to employer route and actually getting down to the consumer level is going to be very disruptive in the future," said Mr. Lovewell. "A lot of employers are sick and tired of paying the insurance companies all this money, and you're seeing a lot of them go after the payers and request their data to figure out what it all means."