At Lantern, we’re always looking for new ways to grow our network and support members. Our new exclusive partnership with the Global Appropriateness Measures (GAM) Consortium marks an exciting step for us. This collaboration enhances our already rigorous process for vetting surgeons, adding new layers of data-driven insights to ensure we continue building a nationwide network of top-tier specialists.
To understand what this means for Lantern, we spoke with Raymond Hwang, MD, Lantern’s VP and Medical Director, about what’s next for our growing network.
Q: Can you talk a little bit about appropriateness and its growing prominence in conversations about healthcare?
Dr. Hwang: In the context of healthcare quality, the concept of appropriateness is still relatively new. That’s because it’s considerably more difficult to measure. Traditionally, quality has been assessed through clinical outcomes, for example, whether a bone fracture has healed, if function improved or if complications occurred.
Another common way to evaluate quality has been through process measures, for example, whether preoperative antibiotics were given or medications to prevent blood clots were provided postoperatively. These approaches to quality primarily focus on whether the intervention was executed well. Such measures are relatively straightforward to capture and certainly have value. But perhaps a more impactful question is whether the general approach to care was appropriate: not just was the surgery executed well but were the clinical decisions leading up to a potential surgery evidence-based and consistent with best practice guidelines?
Q: What does appropriateness look like from the patient’s perspective?
Dr. Hwang: When patients seek care, they are looking to regain function, reduce pain and/or improve their quality of life. But they may not always know the best path to get there. They rely on their surgeon to help them with those care decisions. Appropriateness measures the application of best practice, evidence-based medicine in the delivery of that care.
Take a patient with moderate to severe knee arthritis, for example. The most appropriate approach would generally prioritize well-researched non-surgical treatments first—physical therapy, medications, injections, and weight management—before considering surgery. If those options fail to provide sufficient relief, then surgery becomes a much more appropriate choice, particularly when function and pain are limiting. On the other hand, an inappropriate approach might be prematurely pursuing surgery for mild arthritis or performing procedures that have been shown to be low value, like arthroscopic meniscectomy followed quickly by a knee replacement.
Q: How does GAM use data to score appropriateness?
Dr. Hwang: GAM takes a unique approach. They have developed hundreds of specific appropriateness metrics tailored by specialty and subspecialty. Using comprehensive data—including all Medicare data and about 70% of commercial claims—GAM assesses how surgeons perform against these metrics. Each surgeon receives a score from 0 to 5 based on appropriateness, patient satisfaction, and cost. Rather than prescribing specific care pathways, GAM measures adherence to evidence-based best practices, scoring providers based on how consistently they follow these guidelines.
This partnership is incredibly valuable. It provides exclusive access to this market-leading data, which we can leverage to further enhance our Network of Excellence and quality of care.
Q: What does our new partnership with GAM mean for how we’ll evaluate our surgical network in the future?
Dr. Hwang: Lantern’s original approach to evaluating our network aligned with how many savvy stakeholders think about surgical quality—focusing on the experience and skill of the surgeon and facility, perioperative optimization protocols, patient education, outcomes, complications and costs. While these factors are absolutely important, they focus heavily on the surgical episode itself and less so on the broader management of the patient.
With our new partnership with GAM, we’re enhancing our current model by adding a new dimension—appropriateness. GAM’s expertise and data help us ensure Lantern providers are following best practices and evidence-based guidelines when creating care plans for our members. This gives us additional confidence that our high-quality surgeons are not only performing technically excellent surgeries and perioperative care, but also that the members for whom surgery is appropriate are being recommended surgery.
Q: What role could GAM play in evaluating pre-surgical decision-making?
Dr. Hwang: The treatment decisions made before a potential surgery are as important as the surgery itself. Maybe even more so. GAM provides insights into the practice patterns of surgeons, giving us a picture of their longitudinal adherence to best practice and evidence-based guidelines. This includes appropriateness of conservative management leading up to a potential surgery, the types of surgeries performed and postoperative management.
Q: Can you elaborate on how partnering with GAM will improve patient outcomes?
Dr. Hwang: The choice of treatment is critical, and that decision may lead to surgery—but often, appropriate nonsurgical care can avoid surgeries. For example, we see a 30% surgical avoidance rate for orthopedic surgery within our Network of Excellence. Understanding how surgeons manage patients preoperatively is critical to evaluating their overall quality.
With the addition of the insights provided by GAM, we have a much more comprehensive view of surgeon performance, which allows us to further enhance the quality of our network and enrich the personalized matching of members with surgeons based on their condition and surgeon practice patterns.
Get to Know GAM
Want to learn more about our new partnership? Check out our announcement.
