North Carolina’s No-Cost Surgery Plan: A Blueprint for Value-Based Care

The North Carolina State Health Plan’s new partnership offering no-cost surgical benefits to members marks an important milestone for both patients and providers. By eliminating out-of-pocket costs for certain procedures, the plan demonstrates a strong commitment to affordability and access. Beyond the headlines, this initiative signals a deeper shift: the move from volume-driven healthcare toward models that measure success by outcomes, value, and trust.

From Volume To Value 

For years, fee-for-service models rewarded throughput and volume. Physicians and hospitals were incentivized to do more—more tests, more procedures, more admissions. This often generated revenue but did not always translate into better health outcomes.

Value-based care asks a different set of questions: 

• Did we deliver the right care, to the right patient, at the right time, in the right setting?
• Did the patient leave healthier, more informed, and more confident in their care? 
• Was the outcome achieved in a way that is affordable for patients and sustainable for providers? 

These questions are simple, but they demand profound changes in how care is structured and delivered. 

A Case Study: OrthoCarolina’s Transformation 

OrthoCarolina began this transition to value-based care years ago. Our 1,600-employee, 39-location practice serves more than a million patients annually across the Carolinas. Remaining independent and physician led meant we could not cling to the old fee-for-service model if we wanted to stay relevant and sustainable.

Some of the steps we took included:

• Divesting ancillary services. We sold our physical therapy and MRI operations, which had been profitable, so we could reinvest in surgical care, ambulatory surgery centers (ASCs), and clinical research—areas where physician expertise has the greatest impact.
• Expanding ASCs. Elective orthopedic procedures are increasingly performed in outpatient settings. Studies suggest that up to 70–80% can be done safely and effectively outside hospitals. By growing our ASC footprint, we lowered costs for patients and payers while maintaining excellent outcomes.
• Investing in research and innovation. Through the OrthoCarolina Research Institute, we lead more than 250 clinical studies annually, prioritizing opioid-free recovery protocols, infection prevention, and patient-reported outcomes. These investments directly improve value for patients.
• Staying physician led. Clinical expertise continues to guide decision-making, ensuring that operational strategies reflect patient outcomes rather than financial returns. This allows us to say “no” when surgery is not the right answer.

Why The State Plan Matters 

The State Health Plan’s no-cost surgical partnership reflects the same priorities. By aligning coverage with value-based delivery, the plan creates a bridge between policy and practice.

• For patients, it means affordability and improved access.
• For providers, it validates the shift toward lower-cost, high-quality sites of service such as ASCs

This initiative also addresses a frequent criticism of value-based models: that they shift costs without truly improving outcomes. By emphasizing both access and sustainability, North Carolina is demonstrating how public payers can play a catalytic role in making value-based care real.

Challenges And Opportunities Ahead 

The transition from policy to practice is not without its challenges:

• Financial tradeoffs. Divesting profitable service lines lowered top-line revenue, but freed resources for long-term sustainability. Other practices will face similar decisions.
• Operational complexity. Expanding ASCs requires navigating regulatory barriers, Certificate of Need laws, and significant capital investments. These are challenges providers face nationwide.
• Equity and access. Value-based care must reach all populations, not just insured or urban patients. During the pilot phase of ASC expansion, OrthoCarolina exceeded charity care requirements, proving that equity can be built into new care models.

A Blueprint For National Reform 

While this announcement is specific to North Carolina, the lessons extend across the country. For policymakers, the message is clear: aligning incentives around outcomes, access, and affordability works. For providers, the takeaway is equally important: value-based care requires more than slogans. It requires restructuring.

Independent, physician led groups like OrthoCarolina can play an important role in leading this transition. By focusing on surgical care, research, and patient education—and by making deliberate, strategic choices about how and where care is delivered—we can achieve better outcomes at lower cost.

Shaping the future of Care 

The future of healthcare will not be defined by how much we do, but by how well we do it. North Carolina’s no-cost surgical benefit is a policy innovation that points the way forward. For providers, it is also a challenge: to take the idea of value-based care and make it real, one patient, one decision, and one setting at a time.

At OrthoCarolina, we believe this future is not only possible—it is already underway.