BlueCross, Tennessee Orthopaedic Alliance and Ascension Launch Total Joint Replacement Bundle

Program helps lower costs, increase clarity for members with "all-in-one" payment for surgery and recovery

NASHVILLE (Dec. 16) - BlueCross BlueShield of Tennessee (BlueCross) and Tennessee Orthopaedic Alliance (TOA) launched a program with Ascension Saint Thomas designed to lower costs related to planned total joint replacement surgery and help make it easier for eligible BlueCross members in Middle Tennessee to understand and plan for their part of those costs.

The new "bundle" tightly coordinates care and streamlines claims and pricing for members covered by plans in Blue Networks P and S whose cases meet clinical guidelines established by BlueCross and TOA providers.

Eligible members who receive care under this program can expect to receive a single claim and a single bill for their portion of the costs for surgery and related services at one of four Ascension Saint Thomas surgery centers, as well as post-operative care and equipment delivered within 90 days of the procedure. This approach helps deliver savings for members because all the costs are predetermined and care is delivered in a high-quality, less expensive setting.

"Over the past year, TOA and BlueCross have collaborated to implement a program offering transparent, bundled, fixed-rate pricing for total joint replacement within a value-based care framework, effectively balancing cost efficiency with high-quality outcomes," said Rob Simmons, Tennessee Orthopaedic Alliance CEO. "We value our work with BlueCross and extend our gratitude to their team and everyone involved in this initiative, especially TOA's specialized team of total joint surgeons, therapists, nurses and administrators."

Marc Barclay, senior vice president of provider network management for BlueCross, added, "Typically, there could be multiple claims for a joint surgery, each with different bills going to the member - making it confusing and hard to plan for. We're grateful to work with TOA and Ascension Saint Thomas and hope to expand this model to add transparency and help make life easier for our members who need these services."

For eligible shoulder, hip, knee, and ankle replacements, TOA will issue one claim to BlueCross that covers:

• Surgeon and surgeon's assistant services
• Ambulatory surgical center fee
• Implant cost
• Incidental supplies and items
• Anesthesia and anesthesiologist coverage
• Outpatient therapy
• Durable medical equipment needed for recovery
• Post-operative clinic visits
• Post-operative x-rays

BlueCross will evaluate the claim based on the member's plan details, including how much of their annual deductible and out-of-pocket maximum have been met. Then the member and BlueCross will each pay their share of the costs.

"This achievement marks a notable advancement in our efforts to develop enhanced care models, designed to provide employers and BlueCross members with predictable costs and a concierge-level experience throughout their orthopaedic healthcare journey," Simmons added. "We're eager to see where this collaboration will lead in the coming years and look forward to the positive outcomes it can have for the BlueCross-insured patients we serve."

Fahad Tahir, president and CEO of Ascension Saint Thomas noted, "This program reflects our shared commitment to innovate on behalf of patients. Through this bundled approach, Ascension Saint Thomas is helping simplify the surgical experience, enhance outcomes, and bring greater cost transparency to the communities we serve."

BlueCross members who are interested in learning more about the program can reach out to Tennessee Orthopaedic Alliance for information and eligibility criteria. For more information about BlueCross, visit bcbstnews.com.

About BlueCross®

BlueCross BlueShield of Tennessee is a taxpaying, not-for-profit health plan serving more than 3.3 million members in Tennessee and around the country. The Chattanooga-based company was founded in 1945 and has brought peace of mind to its members and local communities for 80 years. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company's news center at bcbstnews.com or visit the company's website at bcbst.com.

About Tennessee Orthopaedic Alliance

Tennessee Orthopaedic Alliance (TOA) physicians provide comprehensive orthopaedic care with expertise including sports medicine, joint replacement, spine, hand, wrist and elbow, foot and ankle surgery, shoulder surgery, pediatric orthopaedics, physical medicine and rehabilitation, and arthroscopy and trauma care. Founded in 1926 in Nashville, TOA is the largest orthopaedic surgery group in the state. For more information, visit toa.com.

About Ascension Saint Thomas

Ascension Saint Thomas is a faith-based, nonprofit health system with a 125-year history of delivering personalized care, with special attention to those most vulnerable. The system includes 18 hospitals and 320 sites of care across 45 counties in Tennessee, including affiliated joint ventures, medical practices, clinics, and specialty facilities. With more than 13,000 associates, Ascension Saint Thomas serves millions of patients annually. It is part of Ascension, one of the largest Catholic health systems in the U.S., with approximately 99,000 associates, 23,000 aligned providers, and 121 hospitals. In FY2024, Ascension provided $2.1 billion in care for those living in poverty and other community benefit programs. Visit www.ascension.org.