Total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure within the USA and is estimated to reach 3.48 million procedures annually by 2030. As value-based care initiatives continue to focus on hospital readmission rates and patient satisfaction, it has become essential for health care providers to develop and implement a multidisciplinary approach to enhance TKA outcomes while minimizing unnecessary expenditures. Through this necessity, clinical care pathways have been developed to standardize, organize, and improve the quality and efficiency of patient care while simultaneously encouraging the collaboration among various medical care providers. Here, we review several systems based programs and specialty care practices that can be adopted into the standard orthopedic practice.

The original architects of Medicare modeled the payment system on the existing fee-for-service (FFS) structure that historically dominated the health-insurance market. Under the FFS paradigm, health-care expenditures experienced an exponential rise. In response, the managed care and capitation models of health-care delivery were developed. However, changes in Medicare reimbursement, along with an increasing volume of orthopaedic procedures and escalating implant costs, call into question the cost-effectiveness of this service line. The success of the Medicare Acute Care Episode (ACE) Demonstration Project proved the feasibility of value-based care and ushered in a new era of bundled payment initiatives.

* With the shift toward value-based patient care, greater emphasis has been placed on improving patient outcomes, reducing complications, and minimizing hospital costs. Optimal care therefore requires a multidisciplinary approach for perioperative patient optimization and episode management. * Here we review the case of a 48-year-old woman with symptomatic osteoarthritis of the left hip and multiple medical comorbidities. We present appropriate optimization guidelines from a panel of multidisciplinary experts in their respective specialties. * Continued clinical research is critical with regard to perioperative optimization and disease episode management as part of population health initiatives and will enable us to better identify at-risk patients early in the process. This will promote the development of improved evidence-based screening criteria and guidelines allowing for the optimization of patient outcomes, safety, and satisfaction following total joint arthroplasty. * Historically, surgical risk stratification methods have emphasized the appraisal of non-modifiable risk factors. Consequently, this has incentivized surgeons to operate on healthy, low comorbidity burden patients, while avoiding surgical intervention on unhealthy, high-comorbidity patients. Only recently has the medical optimization of high-risk candidates undergoing total joint arthroplasty demonstrated improved outcomes by reducing hospital readmissions when patients undergo total joint arthroplasty after optimization.