With the rise of value-based care, payers increasingly require specialists to take on financial and holistic accountability for patients with some of our healthcare system’s most complex – and costly – diseases, from diabetes and congestive heart failure to cancer.
This has precipitated a significant shift in what many healthcare stakeholders considered specialists’ traditional responsibilities. In the early days of capitation and ACO models, specialists were often treated as the “spokes” of patient care, radiating out from primary care “hubs” or gatekeepers. Now, specialists are called on not only to optimize care for diseases they treat but to assume accountability for the total cost of care for defined treatment episodes across all co-morbidities and care settings.
Leading-edge specialty practices, recognizing that they are assuming the role of risk-bearers, are actively transforming their practices to adjust to this new reality. They are embracing new approaches and tools that were once the primary domain of payers – under the umbrella of population health management. They seek to optimize the holistic quality, cost, and experience of care delivery in an identified patient cohort.