Value Based Purchasing
Hip and Knee Joint Replacement
Value Based Purchasing Design (VBPD)
CalPERS and Anthem Blue Cross (Anthem) are working together
to design a hip and knee joint replacement program. Members
who will be scheduling a hip or knee joint replacement should be
aware of this program. It has been designed to keep your overall
out-of-pocket costs down, while limiting the overall increase in
medical costs.
In order to manage this variance, payment will be limited to a
$30,000 threshold for single hip joint replacement or single knee
joint replacement surgeries. CalPERS and Anthem have identified
53 facilities throughout California where these surgeries can
be performed and CalPERS members will have little to no out of
pocket costs beyond the plan’s deductible and coinsurance.
Members need to be aware that they will be responsible for
their deductible and coinsurance, as well as any charges above
the $30,000 threshold for single hip joint replacement or single
knee joint replacement surgeries performed at facilities that
are not identified below.
As a Participating Provider Organization plan member, you
continue to have the option to choose any facility, but if you
seek services from one of the identified 53 facilities, you can
lower your out-of-pocket costs.
Please refer to your Evidence of Coverage booklet for
further details.
Value Based Sites of Care designated hospitals
ADVENTIST MEDICAL CENTER
ALVARADO HOSPITAL LLC
ARROYO GRANDE COMMUNITY HOSPITAL
BAKERSFIELD MEMORIAL HOSPITAL
BARTON MEMORIAL HOSPITAL
CEDARS-SINAI MEDICAL CENTER
COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
DAMERON HOSPITAL
DESERT REGIONAL MEDICAL CENTER
EISENHOWER MEDICAL CENTER
EL CAMINO HOSPITAL
ENLOE MEDICAL CENTER INC
FRENCH HOSPITAL MEDICAL CENTER
FRESNO SURGICAL HOSPITAL
GOOD SAMARITAN HOSPITAL – SAN JOSE
GOOD SAMARITAN HOSPITAL – LOS ANGELES
HEALDSBURG DISTRICT HOSPITAL
Hospitals
highlighted have
joined the California
Joint Replacement Registry
(CJRR) supported by PBGH.
The registry is designed to
collect and share data to provide
credible feedback to orthopedic
surgeons, hospitals and patients
about their treatment decisions, quality
of care, and patient outcomes. CalPERS
recognizes these hospitals and surgeons
for their commitment to the long term goal of
improving treatment decisions and care delivery
for patients receiving joint replacements.
HOAG ORTHOPEDIC INSTITUTE
HUNTINGTON MEMORIAL HOSPITAL
JOHN F KENNEDY MEMORIAL HOSPITAL
JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS
JOHN MUIR MEDICAL CENTER - WALNUT CREEK CAMPUS
KAWEAH DELTA MEDICAL CENTER
LOMA LINDA UNIVERSITY MEDICAL CENTER
LONG BEACH MEMORIAL MEDICAL CENTER
MERCY MEDICAL CENTER – REDDING
METHODIST HOSPITAL OF SACRAMENTO
NATIVIDAD MEDICAL CENTER
O’CONNOR HOSPITAL
PLACENTIA LINDA HOSPITAL
QUEEN OF THE VALLEY MEDICAL CENTER
SAN ANTONIO COMMUNITY HOSPITAL
SAN JOAQUIN COMMUNITY HOSPITAL
SANTA MONICA UCLA MEDICAL CENTER
SANTA ROSA MEMORIAL HOSPITAL
SIERRA VISTA REGIONAL MEDICAL CENTER
SONORA REGIONAL MEDICAL CENTER
ST AGNES MEDICAL CENTER
ST HELENA HOSPITAL
ST JOHN’S HOSPITAL AND HEALTH CENTER
ST JOSEPH HOSPITAL – ORANGE
ST JUDE MEDICAL CENTER
ST MARYS MEDICAL CENTER
ST VINCENT MEDICAL CENTER
STANFORD UNIVERSITY HOSPITAL
STANISLAUS SURGICAL HOSPITAL
THOUSAND OAKS SURGICAL HOSPITAL
TORRANCE MEMORIAL MEDICAL CENTER
TWIN CITIES COMMUNITY HOSPITAL INC
UC DAVIS MEDICAL CENTER
UCSD MEDICAL CENTER
VALLEY PRESBYTERIAN HOSPITAL
VALLEYCARE MEDICAL CENTER
Hospitals highlighted in green are in the process of joining the CJRR.
For more information about the CJRR, please visit www.caljrr.org.
15352CAMENPCL_GG 08/15
anthem.com/ca