VBPO

Joint replacement care with a value-driven approach.

The challenge

Hip and knee replacement surgeries are becoming a growing public health concern, with the number of total knee arthroplasties (TKAs) steadily increasing in Europe over the past few decades. [1] In 2019, several European countries reported significantly higher surgery rates compared to other OECD countries. For example, Denmark recorded 203 surgeries per 100,000 people, France had 185, and Spain recorded 138, compared to the European average of 132. [2]

This increase is part of a global trend driven by factors like an ageing population, higher rates of diabetes, and decreasing levels of physical activity. [1] Another key factor is the rising number of surgical revisions (repeat surgeries). Unfortunately, these revisions are not always successful – 20% of patients report dissatisfaction – and they come with high costs. In France alone, revisions were estimated to cost €2.3 billion in 2015. [3]

By 2050, the number of surgeries in Europe is expected to rise even further. To address this challenge, it’s crucial to reduce the need for surgeries by focusing on what matters most to patients in medical practices.

The solution

The consortium proposes an innovative Value-Based Purchasing Orthopedics (VBPO) model to tackle the growing challenges in joint replacement surgeries. Unlike traditional approaches that focus on volume and price, this model emphasises value by linking payments and reimbursements to patient outcomes. The goal is to ensure that healthcare systems prioritise treatments that deliver the best results for patients, improving satisfaction and reducing costs.

Currently, clinical and patient outcomes are not adequately considered in healthcare procurement, and manufacturers lack incentives to focus on the value their products provide. To address this, the consortium proposes a procurement model based on Volume × Price × Value, where compensation is linked to patient-centered outcomes, such as functional recovery. These outcomes are measured through metrics like CROM (clinician-reported outcome measures), PROM (patient-reported outcome measures), and PREM (patient-reported experience measures) scores. enabling healthcare professionals to gain valuable insights and make informed decisions.

At the heart of this initiative is Orthense, a SaaS platform developed by the French company Digikare. Orthense is specifically designed for the orthopedics and traumatology market and serves as a critical tool in implementing the VBP model. It offers free access to registries for knee, hip, and shoulder joint replacements and evaluation tools to measure patient outcomes and experiences.

Digikare currently has 9 million records, 60,000 care tracks, an average patients’ participation rate of 65%, and over 15% of French surgeons onboard.

The VBPO project aims to scale Orthense into three countries – France, Denmark, and Spain – spanning three different healthcare systems (national vs. regional) and payment models. This expansion will demonstrate the platform’s ability to standardise the collection and analysis of real-life data while adapting to diverse healthcare systems.

Key benefits include:

• Uniform evaluation of patient outcomes across countries.
• Greater comparability of surgical practices on a global scale.
• Empowering healthcare systems to adopt routine outcome evaluations for continuous improvement.

The project is structured around two main components: data collection (registries) and the organisation of workshops. They will be fueled by real-life patient data gathered throughout the project that will lead to the development and operationalisation of a VBP model adapted to each country and each healthcare system.

Expected impact

The project aims to achieve:

1. Enhanced patient satisfaction: From approximately 5000 patients from Denmark, Spain, and France, gauged through assessments of patients in the participating hospitals.
2. Increased cost efficiency: From 8% to 20% by implementing robust supply chain strategies and optimising supplier base pricing, yielding a saving of €300 million in the initial countries involved.
3. Advancement in surgical practices: Through peer-to-peer knowledge exchange, refinement of techniques, and enhancement of clinician working conditions
4. Fostering opportunities in the medtech sector: For companies, incentivising them to prioritise outcomes and value, thereby promoting value-driven approaches and fostering market differentiation.

External Partners

• DIGIKARE (France)
• Region of Southern Denmark (Denmark, Scandinavia)
• Registre National des Implants et de l’Observation des Pratiques et des Pathologies chirurgicales de l’appareil locomoteur (RENACOT, France)

References

[1] Le Stum, M., Gicquel, T., Dardenne, G., Le Goff-Pronost, M. , Stindel, E., Clavé,A, ‘Total Knee arthroplasty in France: Male-driven rise in procedures in 2009-2019 and projections for 2050’, Orthopedics & Traumatology: Surgery & Research, Volume 109, Issue 5, September 2023, Pages 733-739, doi.org/10.1016/j.otsr.2022.103463

[2] OECD– Health at a Glance: Europe 2022: State of Health in the EU Cycle

[3] National Health Insurance Fund proposals for 2015 to improve the quality of the health system and control expenses – “Améliorer la qualité du système de santé et maîtriser les dépenses – Propositions de l’Assurance Maladie pour 2015” (Caisse Nationale d’Assurance Maladie)