{"id":11402,"date":"2025-09-26T10:36:12","date_gmt":"2025-09-26T15:36:12","guid":{"rendered":"https:\/\/www.bluekc.com\/blueprint\/?p=11402"},"modified":"2025-09-30T09:14:49","modified_gmt":"2025-09-30T14:14:49","slug":"cardiac-msk-utilization-management-program-helps-control-high-cost-care","status":"publish","type":"post","link":"https:\/\/www.bluekc.com\/blueprint\/employers\/community-employers\/cardiac-msk-utilization-management-program-helps-control-high-cost-care\/","title":{"rendered":"Cardiac, MSK utilization management program helps control high-cost care"},"content":{"rendered":"\n<p>Blue Cross and Blue Shield of Kansas City (Blue KC) is supporting your organization with help 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 \u2014 drawing on our partner\u2019s expertise to strengthen utilization management (UM), prioritize payment integrity, and foster meaningful provider engagement.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Why this program matters<\/strong><\/h2>\n\n\n\n<p>On average, cardiac and MSK procedures are among the most expensive and commonly performed. Without proper oversight, these procedures can lead to the potential for:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unnecessary spending&nbsp;due to inappropriate settings or coding practices<\/li>\n\n\n\n<li>Clinically questionable care&nbsp;that may not align with best practices<\/li>\n\n\n\n<li>Limited transparency&nbsp;into provider behavior and outcomes<\/li>\n<\/ul>\n\n\n\n<p>Our cardiac and MSK UM program, in partnership with TurningPoint, is designed to address these challenges, offering a clinically rigorous and cost-effective-minded solution that\u2019s already delivering results for our fully insured clients. Now, self-funded clients can opt in to the same program.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Four ways our cardiac and MSK UM program delivers value<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Site of care redirection \u2013&nbsp;<\/strong>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.<\/li>\n\n\n\n<li><strong>Coding review edits \u2013&nbsp;<\/strong>TurningPoint aims to ensure only appropriate codes are approved, helping prevent overbilling and inflated claims.<\/li>\n\n\n\n<li><strong>Clinically inappropriate care prevented \u2013&nbsp;<\/strong>The program aims to identify and prevent procedures that aren\u2019t the best clinical option, guiding providers toward more appropriate alternatives. This not only improves care quality but also reduces unnecessary costs.<\/li>\n\n\n\n<li><strong>Unnecessary codes identified and withdrawn \u2013&nbsp;<\/strong>TurningPoint helps provide additional savings and improved care alignment by identifying codes during their review that are not clinically necessary.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What it means for you<\/strong><\/h2>\n\n\n\n<p>TurningPoint reviews a broader set of procedures than standard prior authorization programs, offering deeper oversight and more opportunities to reduce waste.<\/p>\n\n\n\n<p>For self-funded employers, this cardiac and MSK UM program in partnership with TurningPoint is a strategic solution that helps you spend smarter, helps employees receive the right care at the right time, and offers a strategic way to manage high-cost procedures with confidence and clinical integrity.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong><strong>Program launch<\/strong>&nbsp;<\/strong><\/h2>\n\n\n\n<p>For cost plus and local ASO customers, the program officially goes into effect January 1, 2026, or at a group\u2019s renewal date. Importantly, this is an&nbsp;opt-in program&nbsp;for cost plus and local ASO customers. That means employers can choose whether to adopt the new model or continue using Blue KC\u2019s current prior authorization process for cardiac and MSK services. For groups that have already received their 2026 renewal, Blue KC will continue providing its existing prior authorization until the group opts into TurningPoint at a future renewal. This approach gives employers time to evaluate their options and make decisions that best fit their population health goals.<\/p>\n\n\n\n<p>The program has already launched for&nbsp;fully insured groups:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MSK services&nbsp;began on&nbsp;August 1, 2024<\/li>\n\n\n\n<li>Cardiac services&nbsp;began on&nbsp;September 1, 2024<\/li>\n<\/ul>\n\n\n\n<p>JAA, FEP, and National Alliance business segments are excluded from this rollout.<\/p>\n\n\n\n<p>Please connect with your&nbsp;broker&nbsp;or&nbsp;Blue KC representative&nbsp;to learn more about the program, explore the benefits, and determine the best path forward for your organization.<\/p>\n\r\n\t\t\t<div id=\"daexthefu-container\"\r\n\t\t\t\tclass=\"daexthefu-container daexthefu-layout-side-by-side daexthefu-alignment-left\"\r\n\t\t\t\tdata-post-id=\"11402\">\r\n\r\n\t\t\t\t<div class=\"daexthefu-feedback\">\r\n\t\t\t\t\t<div class=\"daexthefu-text\">\r\n\t\t\t\t\t\t<h3 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In collaboration with TurningPoint Healthcare Solutions, Blue KC is enhancing the way we approach cardiac&#8230;<\/p>\n","protected":false},"author":26,"featured_media":11403,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_helpful_status":1,"_analytify_skip_tracking":false,"footnotes":""},"categories":[8,47,12],"tags":[60],"post-on-community-impact":[],"class_list":["post-11402","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gated-employers","category-community-employers","category-employers","tag-employers-all"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.1.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cardiac, MSK utilization management program helps control high-cost care - The Blueprint<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.bluekc.com\/blueprint\/employers\/community-employers\/cardiac-msk-utilization-management-program-helps-control-high-cost-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cardiac, MSK utilization management program helps control high-cost care - The Blueprint\" \/>\n<meta property=\"og:description\" content=\"Blue Cross and Blue Shield of Kansas City (Blue KC) is supporting your organization with help managing healthcare costs while maintaining access to high-quality care. 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