Revolutionizing Healthcare: The Specialty Care Paradigm

It’s a continuous theme – healthcare faces the urgent need for change as costs continue to rise.

The biggest driver of cost is associated with specialty care, yet there are only a few initiatives that have moved the cost-quality needle. Primary care has made meaningful progress with programs. Now specialty care needs to actively participate.

To truly create change, specialty programs need to align incentives, identify and reward high-performing specialists, support primary care collaboration, welcome evolving technology, and prioritize patient-centered care.

If we understand the landscape, why hasn’t healthcare made the significant changes needed in specialty care to drive value-based programs?

Three Core Challenges:

  1. Lack of meaningful financial incentive models
  2. Program complexity often makes adoption a daunting task
  3. Data needs to be converted into actionable guidance and education

Meaningful Financial Incentive Models

At the center of the specialty care challenge is finance. Fee-for-service remains the dominant financial model in which specialty care operates. Until we have key changes in risk and reimbursement models, specialty programs will lag.

Risk-based specialty models need to identify, promote, and reward high-performing specialists with fair contracts that provide transparency, clear metrics, and a distinct path to successful adoption. With so many costs associated with downstream providers, models need to go beyond a single event and address the total cost of care. Additionally, models must promote integration between primary care providers and specialty providers. For this integration to be successful, physicians must be financially supported to make necessary decisions and to help fund the changes that will need to occur within that physician group.

Program Adoption Can Be A Daunting Task

Risk-based programs for specialty care have been introduced, but the complexity of deploying and managing programs makes it difficult for practices that are already overloaded. Patient volume, contract volume, new technology, new CMS rules – these dominate the attention of most specialty practices and limit the reception for new programs.

The path to trial and adoption begins and ends with a concerted effort to support and educate specialty practices. Once providers have the ability to understand and leverage information correctly, they will be empowered, and rewarded, to employ the best care pathways at the right time for the right patient.


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