Demonstrating the Value of Minimally Invasive Surgery to Insurers and Employers in a Value Based Healthcare Environment

John de Csepel, Chief, Medical, Officer, Surgical, Michael Morseon, Senior, Director, Healthcare, Economics, Linda Richetelli-Pepe, Director, Payer, Solutions. Medtronic

It is universally recognized that historical increases in healthcare spending is unsustainable.  All stakeholders are seeking ways to remove costs while improving quality and outcomes due to government regulations and other market pressures.  The pressure is especially acute for employers who, other than the government, pay for the majority of healthcare.  It is also acute for insurers who are responsible for the optimization of the healthcare offerings.  Factors such as potential taxes on benefits deemed overly generous, and State Healthcare Insurance Exchanges which seek to make healthcare insurance affordable, provide significant incentives for insurers and employers to find ways to reduce the cost of care for the beneficiaries and employees they represent. Minimally invasive surgery (MIS) has the demonstrated ability help achieve that goal, however it is still highly underutilized.


The MIS approach results in fewer days in the hospital, fewer post-operative complications, fewer re-admissions, and faster return to work.  Taken together these clinical outcome improvements translate into significant cost savings when compared to open surgeries.  This benefits hospitals whose reimbursement is being increasingly impacted by quality measures and episode of care payments.  However, it is just as relevant for the stakeholders that pay for healthcare, although the benefits are not readily understood by this audience.


To address the challenge to quantify the economic value of MIS to payers and employers, Medtronic engaged Milliman (the world’s largest actuarial firm). Through their collaboration, they developed an interactive actuarial model which demonstrates the per member/per month cost savings associated with transitioning a percentage of beneficiaries or employees from open surgery to MIS.  The cost data which populates the model is derived from the Truven MarketScan commercial claims database (2012 data trended to 2014) and compares MIS to open surgery for the cost of surgery, and all related healthcare costs up to 30 days post-surgery.  It also calculates the economic benefit of reduced workplace absenteeism associated with MIS, a measure not previously well studied.   As an example, given national averages from the MarketScan database, in a population of 500,000, modeling a 20% increase in MIS utilization results in approximately $860,000 savings in healthcare spending, and $485,000 savings in increased employee productivity.


Another challenge is to develop tools which allow payers and employers to engage and educate patients as to their options when they are scheduled for surgery. In a pilot program with UnitedHealthcare, Medtronic employees who were being scheduled for surgery were incentivized to view a treatment decision support on-line animated video (jointly developed with Medtronic), which describes the surgical options available to them including MIS.  In the target population, the results included a 91% increase in awareness of MIS, 27% increase in weighted MIS utilization, and an estimated $300,000 annualized savings in healthcare expenditures and employee absenteeism over 12 months.


The documented, superior outcomes associated with MIS vs. open surgery results in significant savings .  To demonstrate the economic benefit, and to realize these savings, actuarial models and patient engagement tools which highlight the value of MIS should be employed.

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