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CalPERS program helps lower costs of member hip and knee replacement surgeries
Date:6/23/2013

ed facilities that met quality requirements and charged less than $30,000 for each knee and hip replacement surgery.

To qualify for the list, hospitals had to have already contracted with the network of WellPoint's California affiliated health plan, which manages a robust credentialing process. Participation includes requiring all participating hospitals maintain accreditation by at least one of several nationally renowned accreditation organizations. In addition, hospitals had to perform enough procedures to ensure results could represent credible measurement that positively demonstrated the hospital's skill in the surgeries.

Members were able to either choose from 46 facilities on the list that would result in them paying little to no out-of-pocket costs beyond deductible or pay the difference if they chose to use another facility that charges more than $30,000.

The result was that CalPERS health plan costs dropped significantly by 19 percent from $35,408 to $28,695 largely made up of lower prices on procedures from those who went to non-designated facilities. Out-of-pocket costs did not increase. CalPERS members also used designated facilities 21 percent more than they did in the previous year.

"We were not surprised to find that the program caused overall reductions in cost for CalPERS members," said Li. "However, it was amazing to see how costs fell for CalPERS members among the facilities that were not part of the original designation list. This demonstrates that a program used by a group with considerable buying power can influence costs at facilities not originally part of the intervention."

Outcomes for the CalPERS group were slightly better in some areas and equivalent in others for those using designated facilities. The study compared post-surgery infection, complications and hospital readmission rates. When comparing plan members to non-members, CalPERS members had significantly lower 30-day infection rates and lower 30-day co
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Contact: Lori McLaughlin
lori.mclaughlin2@wellpoint.com
317-407-7403
HealthCore
Source:Eurekalert

Page: 1 2 3

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