Revitalizing Musculoskeletal Healthcare: A Strategic Approach to Value-Based Care

Abstract

Background: Value-based care (VBC) emphasizes patient outcomes over service volume, representing a significant shift in health care delivery. Musculoskeletal (MSK) health care, with over $300 billion in annual expenditures, has lagged behind other specialties in adopting VBC. Key barriers include misaligned incentives and fragmented care delivery. This article explores strategies and models to advance VBC in MSK care.

Methods: A review of VBC frameworks, including Centers for Medicare & Medicaid Services initiatives such as Value-Based Enterprises (VBEs), the Transforming Episode Accountability Model (TEAM), and mandatory Patient-Reported Outcome Measures (PROMs), was conducted. These models were evaluated for their ability to improve care coordination, outcomes, and cost efficiency.

Results: VBEs demonstrated improved coordination between primary care physicians and specialists, reducing unnecessary procedures and hospitalizations while enhancing outcomes. TEAM, launching in 2026, focuses on interdisciplinary collaboration to improve quality and reduce costs for surgical episodes. PROMs, mandatory for total hip and knee arthroplasty beginning in 2024, emerged as essential for capturing patient-centered outcomes. Challenges remain, including misalignment of professional and technical fees and slow adoption of VBC by orthopaedic surgeons in private practice.

Conclusions: Advancing VBC in MSK health care requires realigning incentives, fostering interdisciplinary collaboration, and prioritizing patient-centered care. Frameworks like VBEs, TEAM, and PROMs hold promise but depend on active participation from health care professionals, especially orthopaedic surgeons. Addressing systemic barriers will not only improve patient care but also reduce provider burnout and promote sustainable health care delivery.

Keywords: Centers for Medicare & Medicaid Services (CMS); musculoskeletal healthcare (MSK); orthopaedic surgeons and interdisciplinary teams; patient-reported outcome measures (PROMs); transforming episode accountability model (TEAM); value-based care (VBC).