The Evolving Role of the Specialist in Value-Based Care

Traditionally, primary care physicians (PCPs) have been the designated coordinators of care and the place where the rubber meets the road in population health and accountable care programs. However, for 40% of the American population that suffers from chronic medical conditions, it is often the specialist that is taking the lead. Specialty care often requires a different clinical approach in the face of the dominant medical conditions that have a significant influence on a patient’s treatment.

Value-Based Care Requires Specialists to Adapt.

Health plans and health systems are now recognizing the central role of the specialist and the differences between specialty-driven and PCP-driven care, as evidenced by specialty-specific bundled payments, like OCM and LEJR, whose success will eventually influence other specialties.

These Value-Based Care (VBC) programs and related requirements are pushing specialists to be accountable for entire episodes of care and to adopt many of the principles of population health for the first time.

In order to take this more holistic approach to managing their patients’ care and be successful under VBC programs, specialists will need to completely transform from an operational, clinical and financial perspective. As such, it will require them to develop new competencies, such as: stratifying high-risk patients, developing clinical pathways to establish processes that improve outcomes, deploying care management to decrease health risks and costs, and engaging patients throughout with interventions that improve patient communication/behavior.

Value-Based Care Reimbursement Solutions.

In this time of massive change, specialists should hone in on a few key value-based care solutions areas to focus their efforts, including:

• Practice transformation in totality – physicians need to enlarge the scope of operations to successfully manage patients across all conditions and settings, requiring new knowledge, skills, tools and processes to keep speed with developments in value-based care.
  
  
• Revenue cycle management that expands beyond the traditional scope of reducing denials and improving collections to forecast out and support execution of VBC contracts.
  
  
• Advanced population health analytics and real-time performance monitoring to understand status and implement clinical and financial improvement activities.
  
  
• Upgraded electronic health records (EHRs) must include specialty-specific features, such as integrated pathways and reporting components.
  
  

Integra Connect Facilitates Adoption of Value-Based Care for Specialty Practices.

With this in mind, Integra Connect provides the first comprehensive solution to help oncology and urology practices succeed under VBC reimbursements, bringing proprietary solutions together to help improve care quality and efficiency in a market segment that presides over the most complex and costly health conditions. With our Practice Transformation Services offerings, we provide the right guidance to facilitate the adoption of value-based care in specialty practices.

To learn more, check out our solutions or get in touch with an expert from our team!