OMT Additional Strategies

Osteoarthritis Management Toolkit

Benefit Plan Design Approaches: Additional Strategies

Surgery

OA is a long-term chronic disease and the treatment objective is to slow the progression and manage symptoms. When symptoms become severe and other treatment options have failed, surgery is often performed. Surgery is not a cure for people with OA. Some who undergo joint replacement surgery still feel pain in the replaced joint. One study showed more than one in ten people experience this type of pain post-op. Surgery also carries the risk of infection, stiffness and loss of function due to scar tissue. According to a 2018 study conducted by the American Academy of Orthopaedic Surgeons, total joint replacement is one of the most common elective surgeries performed in the US today. It is also the most expensive. Researchers state that this type of procedure is most clinically effective and cost effective in individuals with end-stage arthritis. 

Centers of Excellence (COE)

More employers are implementing COEs for certain procedures to achieve better overall outcomes and lower costs. Providers are selected because of their expertise, outcomes and favorable financial arrangements. Employees and covered dependents are encouraged to seek care at COE facilities that meet specific evidence-based criteria and covered services typically include travel and lodging for the patient and a companion, surgery and inpatient stay, inpatient rehab and durable medical equipment.

Case Study: Learn about the Washington State Health Care Authority’s experience launching a Centers of Excellence Program for knee and hip replacement surgery.

Point Solutions

Providing benefits, tools and resources that support self-management of osteoarthritis is an important part of a patient-centric holistic approach. This often includes helping employees and covered dependents better understand how to use their health benefits and available resources and guiding them to solutions that are most appropriate for them. This can include:

  • Online, digital and App solutions
  • Telemedicine services
  • Advocacy and Navigation solutions (e.g. getting to the right treatment provider)
  • Second Opinion services (for OA treatment, surgery decisions)