Healthcare reform efforts over the last five years have brought progress in many areas, but a long road remains ahead. Most notably, specialty care providers have the potential to play a much bigger role. Until recently, specialists have been too often overlooked as an effective vehicle to drive system transformation as primary care physicians (PCP) were widely regarded as the most natural quarterbacks of patient care. This is best illustrated by the emphasis that legacy healthcare IT giants put on building technology for PCPs in response to the EHR boom triggered by the HITECH Act. 2017, however, will continue an industry-wide shift in perception that recognizes the specialist as a key player in value-based care (VBC) initiatives as they preside over patients with the most complex and costly health conditions, who effectively see their specialists as their de facto PCP.
Specific large scale industry drivers contributing to an increased emphasis on specialists in 2017 and beyond, include:
These elements are contributing to an environment where the traditional PCP-centric model for care coordination is not the appropriate path for a growing number of patients. In fact, for millions of patients – especially those living with chronic conditions – having their specialists in the driver’s seat is not only the most effective model, but it is the reality of their day-to-day care.
As the industry seeks out the best strategies to improve the health of high-risk populations while containing costs to the system, the expertise of specialists will be a central piece of the puzzle. This sentiment is evidenced by the advent of Alternative Payment Models (APM), such as the Oncology Care Model (OCM), for which success is dependent on the delivery of evidence-based, cost-effective and high-quality care by specialists. By leveraging specialists’ in-depth knowledge of the most appropriate care protocols and treatments for these high-risk cohorts, the industry can accelerate population health returns and put best practices into action for better outcomes.
Today, specialists should feel more empowered than ever to drive system transformation as new leaders are emerging that have built solutions specifically to help them better manage populations and perform optimally under value-based reimbursement models. With recent MACRA legislation, bundled payment programs and patient-centered medical homes all aiming to improve the quality of high-value episodes of care, broader recognition of specialists’ central role will only accelerate.
However, delivering care under these new specialty APMs, such as OCM, will require specialists to perform new functions, adopt new technology tools, and transform the culture:
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