At the 2025 Meriplex Healthcare Summit, OrthoCarolina's CEO, Dr. Leo Spector, presented on how independent practices are shaping the future of MSK care by taking ownership of the entire patient journey and aligning incentives across employers, clinicians, and patients.

“Orthopedics has the volume, cost profile, and predictability to lead in prospective bundles. Own the patient relationship, standardize the pathway, and use technology to make it scale.”  - Leo Spector, MD, MBA

Below are the key takeaways from Dr. Spector's talk and what they mean for independent orthopedic groups:

• Specialist-led Bundles + Direct-to-Employer contracts yield Predictable, Value-Based Orthopedic Care at Scale

• The Importance of Owning the MSK Patient Relationship

• Technology is Key to Scaling Bundles

• How Bundles Align Incentives

Executive Summary

1. Specialist-led Bundles + Direct-to-Employer contracts yield Predictable, Value-Based Orthopedic Care at Scale

Orthopedics is a top-three cost driver in U.S. healthcare—characterized by high volume, high variability, and high spending. Precisely why it’s also the best candidate for bundled payments. “Cardiac, cancer, and orthopedics are the big three for bundles,” Dr. Spector said. Orthopedics bundles are leading the market as “They’re predictable, they’re measurable, and they can be standardized.”

Prospective bundles, in which the practice receives a single upfront payment for an entire episode, allow orthopedic groups to take control of outcomes and costs while maintaining independence.

The most significant breakthroughs are happening where bundles meet direct-to-employer (DTE) contracting. By partnering directly with employers or aggregators, orthopedic groups are bypassing traditional health plan design constraints, securing predictable patient volumes, and delivering measurable value.

Add "specialist-first" Centers of Excellence (COE) programs on top, and the model gets even stronger. COEs reward high-quality, high-volume practices with preferred steerage and patient incentives—helping employers reduce costs while giving patients choice and confidence.

2. The importance of owning the MSK patient relationship

 

Dr. Spector challenged one of healthcare’s most overused terms—“value-based care.” Instead, he offered a more actionable framework, moving from "Transactional to relational care."

“We’ve got to own the patient relationship,” he emphasized. “If we don’t, administrators and insurers will.”  In orthopedics, “owning the relationship” means leading the full MSK episode—not just performing procedures. It’s about connecting the dots between evaluation, surgery, rehab, and long-term outcomes. When physicians build those relationships directly—with patients and employers—they control quality, predictability, and the sustainability of their practices.

3. Technology is the Key to Scaling Bundles

When OrthoCarolina began experimenting with bundles, their process was entirely manual—managed by one person and a set of “bundle books.” It wasn’t scalable or sustainable.

“You can scale with people, but you’ll have turnover. You’ve got to embrace technology,” said Dr. Spector.

That’s where technology platforms like Health Here come in.By automating the financial and administrative workflows that underpin bundles—member benefit checks, patient and downstream participating provider payments, and episode analytics—technology turns a boutique experiment into a repeatable, scalable business model.

For OrthoCarolina, automation has:

• Reduced reimbursement times from months to weeks

• Simplified downstream payments to physicians and participating provider partners

• Improved accuracy and transparency in cost data

• Enabled faster deployment of new bundles and DTE contracts

Simply put: without technology, bundles can’t scale.

4. How Bundles Align Incentives

Every stakeholder wins when incentives align:

• Patients gain affordable, predictable care.

• Practices maintain autonomy and profitability.

• Employers see reduced costs and improved employee satisfaction.

The formula is simple but transformative: Direct-to-Employer + Centers of Excellence + Bundles = the future of value-based orthopedic care.

Dr. Spector’s closing thought summed it up:

“Orthopedic doctors can’t just be proceduralists. We need to own the full continuum of musculoskeletal care.”

The Bottom Line

Independent orthopedic practices are uniquely positioned to lead this change. The opportunity lies in:

• Building standardized, data-backed care pathways

• Partnering directly with self-funded employers and aggregators

• Leveraging technology to make bundles efficient and scalable

The practices that do these three things will define the next decade of MSK care.