Help clients control high-cost care: The value of cardiac and MSK utilization management
Blue Cross and Blue Shield of Kansas City (Blue KC) is supporting our commercial clients in managing healthcare costs while maintaining access to high-quality care. In collaboration with TurningPoint Healthcare Solutions, Blue KC is enhancing the way we approach cardiac and musculoskeletal (MSK) services — drawing on our partner’s expertise to strengthen utilization management (UM), prioritize payment integrity, and foster meaningful provider engagement.
Why this program matters
On average, cardiac and MSK procedures are among the most expensive and commonly performed interventions. Without oversight, these procedures can lead to:
- Unnecessary spending due to inappropriate settings or coding practices
- Clinically questionable care that may not align with best practices
- Limited transparency into provider behavior and outcomes
In partnership with TurningPoint, our cardiac and MSK UM program is designed to address these challenges, offering a clinically rigorous and cost-effective-minded solution that’s already delivering results in our fully insured book of business. Now, self-funded clients can opt in to the same program.
Four ways our cardiac and MSK UM program delivers value
- Site of care redirection – TurningPoint works in collaboration with providers to shift procedures from inpatient settings to outpatient or ambulatory surgical centers (ASCs) when clinically appropriate, resulting in opportunities for meaningful savings, particularly for MSK procedures.
- Coding review edits – TurningPoint aims to ensure only appropriate codes are approved, helping prevent overbilling and inflated claims.
- Clinically inappropriate care prevented – The program aims to identify and prevent procedures that aren’t the best clinical option, guiding providers toward more appropriate alternatives. This not only improves care quality but also reduces unnecessary costs.
- Provider voluntary withdrawn codes – TurningPoint helps provide additional savings and improved care alignment by identifying codes during their review that are not clinically necessary.
What this means for your clients
TurningPoint reviews a broader set of procedures than standard prior authorization programs, offering deeper oversight and more opportunities to reduce waste.
For self-funded employers — This cardiac and MSK UM program in partnership with TurningPoint is a strategic solution that helps employers spend smarter, helps their employees receive the right care at the right time, and offers a strategic way to manage high-cost procedures with confidence and clinical integrity.
