Health-care expenses have been projected to increase from 17.7% of the U.S. gross domestic product (GDP) in 2014 to 19.6% in 2024. The unsustainable increase in health-care costs has contributed toward support for value-based health care (VBHC) reform. Contemporary VBHC reform programs relevant to orthopaedic surgery include the voluntary Bundled Payments for Care Improvement initiatives (BPCI and BPCI-Advanced) and the Comprehensive Care for Joint Replacement (CJR) program, a mandatory bundled payment program.

The purported benefits of transitioning from volume-based reimbursement to value-based reimbursement include moving from a fragmented provider-centered care model to a patient-centered model, with greater care coordination and alignment among providers focused on improving value. VBHC models allow innovative strategies to proactively invest resources to promote value (e.g., the use of nurse navigators) while eliminating unnecessary resources that do not promote value. However, major concerns regarding VBHC include the absence of medical and socioeconomic risk stratification as well as decreased access for higher-risk patients.

This article identifies the benefits and potential unintended consequences of VBHC reform, with a focus on joint arthroplasty. We also discuss some potential strategies to promote innovation and improve value without compromising access for vulnerable patients.

预计医疗保健费用将从 2014 年占美国国内生产总值 (GDP) 的 17.7% 增加到 2024 年的 19.6%。医疗保健成本的不可持续增长有助于支持基于价值的医疗保健 (VBHC)改革。与骨科手术相关的当代 VBHC 改革计划包括自愿捆绑支付护理改进计划（BPCI 和 BPCI-Advanced）和关节置换综合护理 (CJR) 计划，这是一项强制性捆绑支付计划。

从基于数量的报销过渡到基于价值的报销的据称好处包括从分散的以提供者为中心的护理模式转变为以患者为中心的模式，提供者之间的护理协调和一致性更专注于提高价值。VBHC 模型允许创新策略主动投资资源以提升价值（例如，使用护士导航员），同时消除不提升价值的不必要资源。然而，关于 VBHC 的主要担忧包括缺乏医疗和社会经济风险分层，以及高风险患者的机会减少。

本文确定了 VBHC 改革的好处和潜在的意外后果，重点是关节置换术。我们还讨论了一些潜在的策略，以促进创新和提高价值，同时不影响弱势患者的使用。