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eviCore MSK solutions serve more than 40 million unique lives across local, regional, and national Commercial, Medicare and Medicaid organizations. Discover how your plan can benefit from our site of care, implant or other MSK-related solutions.
Driving Evidence-Based Care for Musculoskeletal Conditions
higher costs for knee/hip replacement inpatient vs. hospital outpatient.
average daily cost for
hospital stay; average stay is 4.6 days.
Site of Care
MSK Costs Vary Depending on
Implants Are on the Rise
Use and Abuse of
estimated value of North American orthopedic devices market by 2027.
of cases incurred implant costs, despite no implants used.
Right Care, Right Place, Right Time
eviCore’s site of care optimization programs ensure members and providers are selecting the most clinically appropriate and cost-effective setting to deliver care. For MSK, eviCore offers the following:
Evaluates the medical necessity of both the procedure and the site of care. The site of care determinations include the medical necessity of hospital inpatient, hospital outpatient, ambulatory surgery center, and office for approved elective MSK procedures and services. BEST FOR: Large joint and spine surgery, interventional pain, and physical/occupational therapy.
Our site of care solutions are backed by:
16 years of experience
Confirming Proper Use, Curbing Waste, Recovering Savings
eviCore’s implant management solution addresses the wide variability in quality and appropriateness of implant procedures, promotes transparency and predictability in device spend, and helps lower medical costs for health plans.
The solution includes:
Evidence-based clinical guidelines to detect safety and quality gaps in implant usage
average savings per claim
of cases recovered savings within 90 days
of decisions are appealed
Resulting in more affordable care for patients and plans
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Read Our Blog
The Burden of Musculoskeletal Diseases in the United States. U.S. Bone and Joint Initiative.
Payers Have Room for Improvement in Delivering Pain Care, Study Says. (2018).
ValuePenguin analysis of Kaiser Family Foundation (KFF), Agency for Healthcare Research and Quality (AHRQ) and U.S. Bureau of Labor Statistics (BLS) data.
North America Orthopedic Devices Market Research Report. Market Data Forecast. Jan 2022.
eviCore book of business data
When you consider that one in every two adults in the U.S. suffers from a bone, joint or muscle condition, it’s no surprise that health plans spend more on musculoskeletal (MSK) conditions than any other chronic condition.
eviCore’s comprehensive MSK management solution applies evidence-based guidelines to encourage the utilization of medically necessary, high-value services such as non-surgical treatments, when clinically appropriate, and avoid low-value services that could lead to delays in care for painful MSK conditions and increased costs.
Leading health plans rely on eviCore to manage care, utilization and costs for specialized therapies, interventional pain, and spine and joint surgery. Two equally important areas that many overlook are site of care and implant management.
Proprietary claims review, pre- or post-payment
Advanced data analytics to support key business decisions
Establishment of quality and benchmark statistics
Provider/patient notification of FDA recalls
Procedure and Site Reviews:
Site Only Review:
Evaluates only the medical necessity of the site of care for the MSK procedure/service. BEST FOR: Elective MSK surgeries of the elbow, wrist, hand, lower leg, ankle, and foot.
Integrated provider experience
Extensive evidence-based guidelines
Report Fraud & Abuse
Ethics & Compliance
Member Rights Policy
E-Verify and IER Right to Work
Annual Utilization Statistics
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Site of Care
Managing Site of Care &
Implants for MSK Conditions