Development of a Comprehensive, Nonsurgical Joint Health Program for People With Osteoarthritis: A Case Report.

Abstract

Existing osteoarthritis (OA) care models often fall short in addressing the many biological, psychological, social, and behavioral characteristics that contribute to disability. As US health care shifts towards value-based payment, there is an increasing need to develop and test scalable, cost-effective, and multi-modal OA care models. This administrative case report will describe the development and pilot of a new, value-based comprehensive care model for OA. The Joint Health Program (JHP) is a physical therapist-led conservative care model for individuals with hip and knee OA. In the JHP, physical therapists with specialized training in cognitive behavioral-theory based strategy function as the central care provider (ie, the primary osteoarthritis provider) who delivers evidence-based, psychologically informed interventions and coordinates care within a multi-disciplinary network of dietitians, behavioral health specialists, and orthopedic providers. The JHP is focused on enhancing patient engagement, shared decision making, self-management and multi-modal patient interaction, and long-term follow-up. A value-based, comprehensive care program for OA led by physical therapists demonstrated feasibility and acceptability within a large, academic health care system, which has led to its early growth. Barriers to development and integration of the program were addressed through effective collaboration among health care providers, program and health system administrators, and executive leadership. The JHP serves as a model for future physical therapist-led, value-based care models that could be developed in other health care systems for OA and other chronic conditions. Future work will identify characteristics that predict program response and compare the effectiveness of this program to existing models of care.