Increasing Specialty Care Emphasis in Value-Based Care Strategies to Improve Future Outlooks for Health Plans

Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models.

Industry advancements in value-based care (VBC) have resulted in a meaningful restructuring of health plan and provider organizations, processes and capabilities. However, common outcomes are emerging across the industry—traditional value-based payment models are experiencing plateauing growth and financial return for health plans and providers are declining—forcing industry innovation on two fronts.

1. Health plans and providers need to evolve existing primary care physician (PCP) led programs to achieve greater impact and efficiency. This evolution will require a greater push towards risk via creative risk sharing models and strategic partnerships.
2. Employers and health plans need to diversify value-based portfolios to engage specialty providers under value-based incentive models. The concepts included in this whitepaper will help health plans to frame strategies in specialty value-based care.

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