“It is often the specialist who sees the patient most frequently and takes the lead in coordinating overall care,” said Charles Saunders, MD, and CEO of Integra Connect.
Specialist physicians have a unique place in the care continuum. Although they traditionally have provided care with great focus, they are increasingly responsible for much more of the care delivered to individuals and as the industry shifts to a value-based care model they will have an even more important role to play.
That's because specialists oversee the care of the sickest and most costly patients: those confronting chronic illness.
"It is often the specialist who sees the patient most frequently and takes the lead in coordinating overall care in the manner of a primary care physician," said Charles Saunders, MD, CEO of Integra Connect, a specialty care health IT vendor. "Therefore, any effort to tackle quality and cost improvements on a systemic level must engage specialists intensely."
Another key development impacting specialists is the Center for Medicare and Medicaid Services requiring them to participate in the same combination of Merit-based Incentive Payment System and alternative payment model programs as other providers, which is pushing specialists to transform their practices, Saunders said.
"In fact, some specialty alternative payment models have gained considerable traction, such as the Oncology Care Model that has engaged nearly 3,000 providers at 190 practices nationwide in efforts to improve both the quality and cost of episodes of cancer care," he added.
There are various strategies that specialty practices can use to position themselves well for success under value-based care models, experts said. And these strategies may become requirements in the future.
"Healthcare organizations need to invest in insight platforms and advanced analytics to deliver more effective care and consumer engagement," said Kate McCarthy, a senior analyst at Forrester Research who specializes in healthcare. "Value-based care is ultimately about getting patients the right care, at the right time, in the right setting, to deliver high-quality, cost-effective care."
Systems of insights enable healthcare organizations to organize complicated, disparate data sets to enable insight-driven decision making, she added.
"Advanced analytics, prescriptive analytics especially, allow organizations to deliver more effective care," she said. "Though these technologies are not yet widely adopted in healthcare, they are important investments for organizations seeking to deliver true value-based care."
Another strategy specialty practices might consider is starting or joining population health efforts. A well-run population health program can help healthcare provider organizations of all stripes succeed under value-based care models.
In the past, most specialists interacted with patients in the office and around the care of a specific chronic disease, from cancer or congestive heart failure to rheumatoid arthritis. With value-based care, specialists are becoming financially responsible for the whole-person care of these patients, across all of their medical issues and care settings.
"At stake is a plus or minus 4 percent adjustment in 2018 that grows to plus or minus 9 percent in 2022," Saunders said. "Specialists must therefore look to the example of payers, who long ago adopted principles of population health management to successfully control costs."
That means assembling a holistic view of each patient, based on disparate clinical and financial data sources, then using that to identify those at highest risk, Saunders added. Specialty practices can then implement care navigation and coordination programs to improve care quality while avoiding the top drivers of unnecessary cost: inpatient admissions and emergency room visits.