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Blue @ Work

Need to know: Knee and hip replacement costs are rising

Ensure your employees receive cost-effective care.

According to a recent Blue Cross® Blue Shield® (BCBS) Health of America Report External Site, adult BCBS members account for $25 million — or 47 percent — of total orthopedic spending in 2017. And, this was a hefty 44 percent increase since 2010.

On top of that, more than 242,000 adult BCBS members under the age of 65 had a planned knee or hip replacement in 2017, and the report suggests this number will only continue to rise. Although the quality and technology of knee and hip procedures have improved, knee and hip replacements still come with a substantial price tag.

Strong networks yields lower costs

With Wellmark’s strong network, knee and hip replacements in Iowa are lower than the national average. As a Wellmark member, you can feel confident knowing your employees have a breadth of options to receive specialized care in the most cost-effective manner.

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Knee replacement national cost is $30,249, cost in Iowa is $19,263.

Hip replacement national cost is $30,685, cost in Iowa is $19,934.

Source: Blue Cross and Blue Shield, Health of America Report, 2018.

"This report reinforces the value of Wellmark's strong physician and hospital network which allows us to help minimize cost increases for our members," said Mike Fay, Wellmark's vice president, health networks and innovation. "We have also made it priority to provide our members with the best care options to make informed decisions based on their needs."

Are your employee benefits designed to leverage either inpatient or outpatient care?

While it may seem obvious to design your employee benefits External Site to receive inpatient care due to the additional supervision for complications or assistance, over a four-year period (2013–2017), outpatient rates have improved by 23 percent for knee procedures and 36 percent for hip procedures (comparable to inpatient settings). And, on a national level, knee and hip procedures performed in an outpatient setting are significantly lower in price than in an inpatient setting with cost savings between 30 and 40 percent.

Outpatient care allows your employees to recover in the comfort of their own home and save thousands of dollars by avoiding the extra nights in the hospital.

How do my employees receive the best, cost-effective specialized care?

When an employee is expecting to undergo a knee or hip replacement, they aren’t going to blindly pick the best surgeon in the area and schedule their surgery date — it’s a much bigger decision than that. Factors like receiving inpatient or outpatient care, facility rating and affordability all come into play.

It’s inevitable that your employees will turn to you — their benefits expert and go-to for clarifying their coverage — to guide them in making the right decision.

As a Wellmark member, your employees have access to Blue Distinction® Center (BDC) facilities that provide a high level of expertise in specialized care and help your employees get well and avoid necessary costs.

  • Employees who choose a BDC facility receive a 24 percent cost savings.
  • In Iowa alone, 19 hospitals have achieved BDC status for knee and hip replacements.

Wellmark makes it easy External Site for your employees to receive the right care, at the right place, at the right cost with the Blue Distinction Facility Finder. Your employees can search by the type of specialized care they need, and the finder will generate results based on need and location.

Questions or want more information about increase of knee and hip procedures and their associated costs? Check out this free BCBS eBook External Site called "Controlling Cost as Orthopedic Procedures Rise," or contact your authorized Wellmark account representative today.

2019 Blue Cross Blue Shield Association. All Rights Reserved. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies.

Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable health care. Each Blue Distinction Center also met cost measures that address consumers’ need for affordable health care. Each provider’s cost of care is evaluated using data from local Blue Plan. Providers in CA, ID, NY, PA and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com External Site. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.