Nashville, Tennessee – On September 27, 2023, Enlace Health, a pioneer in sustainable healthcare solutions, joined forces with Health Evolution, the leading catalyst for change in the healthcare industry, to delve deep into the complexities of Value-Based Care (VBC) with a spotlight on Specialty Care. With a focus on such complex issues, candid and challenging conversations were required for effective solutions to be explored.
Enlace Health CEO, Bill Nordmark, led two impassioned discussions addressing the critical need for alignment between Accountable Care Organizations (ACOs) and Primary Care Physicians (PCPs), Specialists, and Payers.
During the Deep Dive Session, “Unlock Value: Integrating Specialty Providers into Total Cost of Care,” attendees grappled with the challenge of integrating Specialty Care seamlessly into the VBC framework. The key takeaway: ACOs and Specialists know they need to work together to resolve VBC Specialty Care challenges, but if solutions are not in place, the payers will intervene to close the gap. The crux of the problem lies in defining ownership and strategies for effective collaboration. PCPs want to be involved in the total continuum of care; however, when Specialty Care becomes part of the equation, the complexity increases significantly. The murkiness around costs and appropriate provider selection muddies the water further. Currently, payers contract with ACOs and PCPs for comprehensive care management, yet Specialty Care remains largely unchanged, leading to financial strain on ACOs. Addressing this issue is imperative; otherwise, external forces will dictate the changes.
“As a payer, can you build something that unlocks value and then leave it to the delivery system to solve? Get them to work against these problems and to right-size? That is part of the challenge.”
During the mainstage presentation, “The Next Chapter of Value-Based Care: Navigating the Intersection between Primary and Specialty Providers into Total Cost of Care,” the panelists emphasized the importance of financial models. To drive change, the models must directly impact upside and downside risk. Successful examples in nephrology showcased the effectiveness of well-constructed value-based specialty programs, while musculoskeletal represented an example of Specialty Care’s broad opportunity for new value-based programs.
Shifting from fee-for-service to value-based care is a journey, and while significant progress has been made with PCPs, a great deal of change is needed in Specialty Care.
Health Evolution: Where Change Happens in Health Care
Health Evolution empowers positive change in health care. We convene a curated community of influential chief executives and senior leaders from all sectors of the health care industry. We inspire leaders to embrace new ideas and lead bold change. We foster collaboration that makes our health care system more accessible and affordable, more effective and equitable, and more proactive and personalized.
Enlace Health: Sustainable Healthcare, Delivered.
Enlace Health™ solves healthcare from the inside-out, fixing healthcare at its core and making value-based care a reality. The Connected World of Enlace empowers payers, providers, and patients to participate together in an economically sound environment. The Enlace solution is the only end-to-end infrastructure that bridges the gap between the current, chaotic system and an orderly healthcare world. Enlace always meets clients where they are, creating solutions based on need and maturity in value-based care. Enlace is Sustainable Healthcare, Delivered.
Enlace Health Value-Based Care