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Value-based specialty care can help transform care delivery and improve patient experiences and outcomes, so it’s no surprise that it has been major topic of conversation this year. A common refrain heard at healthcare conferences and in industry media is that value-based specialty care is coming, and healthcare organizations can either get on board or get left behind.
Specialty care accounts for roughly 60% of total care costs, which is a testament to the vital role of specialists in achieving positive outcomes. However, dividing up the responsibility for a single patient between primary and specialty care providers often results in disconnected care that tends to worsen as the number of providers involved in a patient’s care increases.
The average Medicare beneficiary sees two specialists (and 30% of beneficiaries see five or more), which makes it clear that truly patient-centered value-based care needs to include specialty care. With care costs continuing to climb, reducing the cost of specialty care and improving long-term health outcomes are a top priority. As a result, alternative payment models (APMs) are expanding beyond primary care and into areas like maternity care, hip and joint replacements, kidney disease, and oncology.
Providers have been slow to embrace value-based primary care. One reason is because they are unwilling to take on additional financial risk; another is the difficulty navigating complex value-based contracts. Above all, providers are hesitant to adopt value-based care because they feel there is a lack of transparency and collaboration from payers.
In order to effectively expand into value-based specialty care, the healthcare industry needs to be prepared to address those issues. Here are a few ways to do it.