While the popularity, efficiency, and effectiveness of hip and knee replacement surgery have grown exponentially over the years, it’s still a major surgery that comes with significant risks and a high price tag. Hospitals and surgeons who specialize in joint replacements and perform the highest volume tend to have the best outcomes: fewer complications, shorter hospital stays, and quicker returns to daily life. When factoring in lower complication and revision rates, these hospitals and surgeons are often more cost-effective than other providers.
In the corporate world, this means companies that provide health benefits to their employees want to find ways to encourage employees and their dependents to get care from these providers to help improve outcomes and save money on insurance claims.
“At GE, we’re constantly challenged to do what we can to control medical costs,” says Ginny Proestakes, who spearheaded the concept of earmarking certain facilities as Centers of Excellence (COEs) for hip and knee replacements for GE employees. These Centers of Excellence are nationally recognized leaders that provide cost-effective hip and knee replacements as part of an all-inclusive package deal with GE.
With these COEs, GE enjoys consistent, stable pricing for hip or knee replacements performed at leading facilities by surgeons who satisfy certain key quality indicators, such as number of annual surgeries and rates of complication, readmission, and surgical revision. Furthermore, the procedures are warrantied; if there’s a surgical complication that arises within sixty days after the patient is discharged, the facility and surgeon take the patient back in and fix it free of charge. In exchange, these hospitals may receive a substantial volume of patients from GE. And with GE covering 100 percent of the cost of the procedure for most members (the exception being members with a health savings account who must meet their deductible first), the hospitals appreciate that they usually don’t have any patient cost-share to collect.
Prior to the creation of GE’s Centers of Excellence program, Proestakes, GE’s director of US benefits, determined that, after maternity care, the number one reason members of GE’s health plans were admitted to the hospital was for hip or knee replacements. However, many of these surgeries were being performed by orthopedic generalists who didn’t have enough expertise in the surgery, thereby increasing the chance of complication. “You want to go to the person who does hundreds of hip surgeries a year, not the person who does it once in a while,” Proestakes notes.
Starting the program in 2013, Proestakes and her team sought the most reputable hip and knee surgeons and their corresponding facilities, resulting in a roster today of seven hospitals that hold the COE banner. With plaudits by US News & World Report and The Joint Commission, these hospitals are staffed by orthopedic experts who are backed by experienced surgical teams. Add in a thorough screening process performed by GE’s nurse-staffed help line to ensure that qualified patients are being referred to the COE providers, and the number of patients now utilizing COE providers has been substantial. Today, these COEs handle 30–40 percent of the hip and knee replacement surgeries performed on GE members, resulting in lower complications, fewer surgical revisions, and lower costs for both the patient and the company.
“Ginny Proestakes and her team have tirelessly challenged the status quo, improving both benefits and health outcomes for GE employees,” says Ed Lagerstrom, senior vice president of industry and network relations at OptumRx. “GE is a valued client, partnering with OptumRx to tackle the greatest challenges in healthcare.”
While GE has Centers of Excellence in New York City, Chicago, Charlotte, North Carolina, and other large cities, they are also located in medium-sized cities like Cincinnati and Cleveland. For Proestakes, it was important to have some local options for GE employees. “One big facility doesn’t work for more rural residents,” she says. “Understandably, some of our employees don’t want to travel.” When they do have to travel, however, GE helps to cover their travel costs to a Center of Excellence.
This kind of creative problem-solving for such a large corporation is part and parcel of Proestakes’ leadership style, who values innovation, creativity, and challenging oneself. Proestakes is a nurse by training who transitioned to corporate medical benefits administration at what is now Frontier Communications, before being recruited to GE. Even at Frontier, she stood out for being unconventional and focusing on innovation. “I worked with some wonderful, experienced nurses who taught me a lot. But I think I probably frustrated them a bit because I was always challenging how things were done and wanting to redesign our programs,” Proestakes says.
At GE, much of her focus is on finding ways to disrupt the marketplace and come up with creative ideas to improve managed care and benefits for employees—whether it’s publishing ratings on hospitals or creating price transparency tools to help patients be more aware of the cost and efficacy of particular procedures. She brings that same sense of inventiveness to her work with her team, which she describes as “filled with industry experts; it’s my own Center of Excellence, in a way.” Working with her team, Proestakes says, is “collaborative and creative—it’s a lot of work, but a lot of fun.”
A mere few years after its inception, the Centers of Excellence model has proven so fruitful that GE has started expanding it into other areas of medical care. In 2016, GE has started five Centers of Excellence for maternal care to provide cost-effective care for pregnant employees. Whether patients need a C-section or normal delivery, a maternity COE program charges the same bundled price. This design has the potential to reduce C-section rates and to lower the incentive for providers and patients to choose early elective deliveries, which organizations like the Joint Commission and March of Dimes have been working to eliminate because of the risks they introduce to mothers and their babies, Proestakes says.
“This could be the future of employer-sponsored healthcare benefits,” Proestakes notes. The practice of providing bundled pricing and warranties for care is becoming an increasingly attractive model for employers.
For Proestakes, seeing the success of GE’s Centers of Excellence has been an immensely fulfilling part of her job. She’s seen the contrast between COEs and other facilities firsthand; she’s seen people have complications with hip surgery outside of the COE environment for one hip replacement, only to have a completely smooth experience for their second one in a COE. They have even worked for Proestakes’s own husband, who got a hip replacement at a COE-approved facility because, as she remarks, “I knew he’d be taken care of.”
MetLife is proud to partner with General Electric’s Ginny Proestakes on her organization’s world-class employee benefits offering. For nearly 100 years, MetLife has proudly provided employee benefits to GE’s employees. MetLife is a global provider of employee benefits and retirement solutions with operations in nearly fifty countries. Visit metlife.com.
Davis Vision from Versant Health is proud to have partnered with GE as their vision provider since 1995. Health plan leaders have enjoyed cost savings and simple administration by relying on Versant Health for vision and eye health solutions that range from routine vision benefits to medical and utilization management. Visit versanthealth.com.