Value based care and technology – an oxymoron or a perfect pairing

Message from David Jacofsky, MD      

Phoenix, AZ

Stuart Simpson

Our work with patients is, by necessity, increasingly focused on the economics of our interventions and not just their efficacy. Like it or not, modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health, and controlling the total cost of care for patient populations from payors to providers. Although new to many physicians, and undesirable to some, the opportunity now exists for providers to gain the increased control over healthcare that we claimed to have wanted for many years. With risk-based, and/or value-based contracting, we see a concomitant shift of autonomy back to providers. Although the rates of adoption of value-based care vary by region, with more adoption seen in the Western and Pacific states, the rate of change is accelerating as alternative payment models (APMs) are almost universally showing success at improving value for both payors and patients1.

One way to potentially help contain healthcare costs is the utilization of technological advances in the operating room2.  Mako Robotic-Arm Assisted platforms may play a role in a value-based care strategy. Robotics can assist in the shift of arthroplasty to the outpatient space by allowing smaller facilities with limited sterilization capacity to perform such cases without disruptive, lengthy, and challenging space and system renovations. More importantly, studies are beginning to show that haptics may be protective of soft tissue5,6,7. Additional recent studies are showing decreased length of stay, decreased pain, and decreased opioid use3,4,8. A decrease in the need for opioids has a large impact on cost and downstream complications. As pure claims and economic studies are becoming more prevalent and relevant, technologies such as robotics are showing an opportunity for cost savings to the convener, payor, or risk-bearing entity.

In our recently published economic study9 we compared robotically-assisted total knee arthroplasty (rTKA) to manual techniques (mTKA). Overall 90-day episode of care (EOC) costs to Medicare for rTKA patients were found to be significantly less than that for mTKA patients ($18,568 vs $20,960), as was length of stay and SNF utilization. Although this study has the clear limitations and biases inherent in all administrative claim studies, further studies on costs, are underway. As focus on economic research increases and as accurate claims data gets tied on a patient level to medical records data and outcomes data, more clarity about the role of technologies and costs will emerge.

These are exciting times in healthcare. As providers, we have little traditional training in economics but are now being asked to not only understand the complexities of actuarial analyses of payor costs, but to become the captain of the ship that may flourish or sink based on economic performance and the ability to drive real value to patients. Cautious optimism and a focus on understanding and proving our value proposition in the health care delivery chain will likely serve us well.


In addition to the downloads below, you may like these other published works on this topic by Dr. Jacofsky:

  • D.J. Jacofsky. Population-based contracting (population health). The Bone and Joint Journal. Vol. 99-B, No. 11, November 2017.
  • D.J. Jacofsky. Episodic payments (bundling) Part I. The Bone and Joint Journal. Vol. 99-B, No. 10, October 2017.


In-depth article by David Jacofsky, MD: “Value Based Care and Technology – An Oxymoron or a Perfect Pairing”
Poster: Michael Mont, MD, et. al.: “A 90-Day Episode of Care Cost Analysis of Robotic-Assisted Total Knee Arthroplasty”
  1. David Muhlestein Robert S. Saunders Robert Richards Mark B. McClellan. Recent Progress In The Value Journey: Growth Of ACOs And Value-Based Payment Models In 2018. Published online August 14, 2018.
  2. Mont MA, Khlopas A, Chughtai M, Newman JM, Deren M, Sultan AA. Value proposition of robotic total knee arthroplasty: what can robotic technology deliver in 2018 and beyond? Expert Rev. Med. Dev. 15(9), 619–630 (2018).
  3. Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty. Bone Joint J. 100(7), 930–937 (2018).
  4. Marchand RC, Sodhi N, Khlopas A et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J. Knee Surg. 30(09), 849–853 (2017).
  5. Hampp EL, Chughtai M, Scholl LY et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J. Knee Surg. 2019 Mar;32(3):239-250 . 
  6. Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic- arm assisted total knee arthroplasty for soft tissue protection. Expert Rev. Med. Dev. 14(12), 925–927 (2017).
  7. Khlopas A, Chughtai M, Hampp EL et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg. Technol. Int. 30, 441–446 (2017).
  8. Kayani B, Konan S, Tahmassebi J, Rowan FE, Haddad FS. Infographic: Robotics are guiding arthroplasties to less pain and faster recovery. Bone Joint J. 2019 Jan;101-B(1):22-23. 
  9. Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res. 2019 Apr;8(5):327-336.