This is a bimonthly column by Les Jebson, administrator of the Orthopedics and Sports Medicine Network at Prisma Health. This is the first installment.
In the orchestration of an efficient orthopedic program, healthcare insurers, patient health status and surgeon scheduling-facility infrastructure represents the essential components to optimization. Each plays a vital role, much like the different sections of a symphony orchestra.
When these elements are harmonized, the result is a seamless, high-performing healthcare experience. Execution of these components (probably through future AI bolt-on solutions for health system EMRs) is the key.
Healthcare payers — the conductors:
The insurer acts as the conductor of this clinical symphony. Just as a conductor sets the tempo, provides direction and ensures that each section of the orchestra stays in sync, the insurer defines the financial framework and advocates that interventional and surgical care is provided in the most cost-effective manner.
Their sheer size and market reach often dictates the requisite administrative guidelines (prior-authorizations/pre-certifications) and reimbursement models. Quality certifications and designations are aimed at endorsements to seek care from specific clinicians and settings.
Patient health status — the music score:
The patient’s health status is akin to the musical score — the sheet music that outlines the specific needs and nuances of each piece being played. Just as every musical composition has its own set of complexities and variations, each patient’s health profile determines anesthesia candidacy and location of care – hospital, ASC etc.
The score dictates how the orchestra (or the healthcare team) will approach the performance, highlighting areas of focus, sensitivity and technical demands. A patient’s medical history, risk factors and individual needs guide the treatment decisions, ensuring that interventions are tailored and precise.
Surgeon scheduling facilities — the instruments:
Finally, surgeon’s scheduling and facility availability is represented by the instruments within the orchestra. Each instrument — whether it’s a violin, trumpet or drum — has its own unique strengths and techniques that contribute to the overall sound. Coordinating multiple surgeons schedules and the types of surgeries they will be performing at given times and locations might be the greatest challenge of all. Just as a skilled musician knows when to play softly or loudly, surgeons coordinating and aligning the availability of each with facility and staffing constraints is not a small undertaking. The bigger the orchestra, the greater the seat assignment challenge becomes.
The elusive perfect harmony:
When all these elements come together — the conductor (insurer), the score (patient health status), and the instruments (surgeon scheduling-facility availability) — the result is a harmonious, highly performing musculoskeletal program. Like a well-rehearsed symphony, the team performs with precision, minimizing discord and ensuring that each patient receives the most effective treatment. The insurer provides the structure and rhythm, the patient’s health status directs the flow of the care and the surgeon ensures the “melody” of the treatment is delivered with the right technique at the right time.
When the conductor, score and instruments are perfectly aligned, the outcome is a seamless performance — optimal care, satisfied patients and a sustainable healthcare system. Finding and utilizing the best baton is the key.
