Leveraging Clinical Registries and Electronic Health Systems to Advance Value-Based Medicine Across Specialties

Value-based medicine provides the potential framework for addressing the escalating costs of health care in the United States. Value includes patient outcomes and cost, and improving quality and/or reducing cost and maintaining quality increases health care value. Enhancing the quality of care for members leads to improved outcomes, reduced costs, and increased value. Implantable device registries and electronic health record systems support value-based medicine through identification of variations in care and clinical best practices, providing feedback on these clinical practices, and measuring the change in patient outcomes and cost savings. This article reviews a US integrated health system's experience with implant registries methods, outcomes, and cost savings. Evidence-based changes in surgical practice across multiple specialties resulted in substantial cost savings and maintained clinical outcomes. Key interventions included lowering allograft rates in anterior cruciate ligament reconstruction, reducing unnecessary use of bone morphogenetic protein in spine surgery, increasing rechargeable battery use in neurosurgery, increasing cemented fixation in hip fracture, expanding same-day discharge for joint arthroplasty, reducing antibiotic-laden cement in total knee arthroplasty, and improving endovascular aneurysm repair care management. These changes collectively saved hundreds of millions of dollars and enhanced and/or maintained quality of care.