Although specialty care drives 40% to 60% of medical costs, specialists are often disconnected from accountable care organizations. Their fee and incentive structures are distinct, and too many care management systems don’t try to bring specialists into the fold.
Specialists, however, are critical to care delivery—and they should be viewed as care partners and not cost drivers. Here are nine strategies to help specialists understand and improve their costs, quality and patient satisfaction—and, in so doing, engage them in accountable care organizations.
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1. Perform practice data aggregation. Specialists can better understand their costs via both provider and claims data to indicate what clinical issues are driving cost. (Claims data alone won’t tell you.) It’s important, however, that any data not be used against clinicians. Data are never perfect, and physicians need the opportunity for review and improvement.
2. Analyze episodes of care. Creating episodes that combine all the services given to a patient for a procedure or treatment plan enables you to standardize costs of care. Then you can examine cost variations by provider, components of procedures and similar procedures with different therapeutic approaches. Looking at outcomes and costs over time can help specialists understand options for avoiding excess costs in the future.
3. Undertake case reviews. Asking specialists to review five targeted cases a month engages them in understanding what drives costs in their own patients. These can be loaded into their registries and accompanied by analytics. ACOs can also facilitate a data coaching process to help physicians see how their patient care is seen through data.
4. Investigate cost drivers for all episodes attributed to the practice. Engage specialty practices in examining key cost drivers (including anesthesia and pre- and post- services), their patient selection processes and treatment plan decisions. The aim is to pinpoint cost variations and the solutions to lower cost of care.
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5. Use Centers of Excellence in the ACO to drive transformation. Centers of Excellence (COEs) collect and distribute information on patient risk factors and can be part of a process to help both specialists and patients make better-informed decisions. COEs can also engage specialists in adopting processes and criteria, such as volume minimums for participation, to improve long-term outcomes.
6. Establish regular communications. Don’t leave specialists out of the loop. ACO websites, operational best practices articles and even visits to practices to review data to drive decisions can engage specialists in the broader care endeavor.
7. Make it easy to collaborate. Put in place mobile and web technologies to make it easy to generate and capture referrals, schedule appointments, and create and share consultation notes and patient health data among primary care providers and specialists.
8. Incentivize specialists for cost, clinical, and operational excellence. Reward specialists who participate in specialty-specific quality initiatives, engage in episodes of care cost review processes and use the tools at hand to streamline communications with other providers.
9. Share data with primary care physicians. Addressing cost drivers involves everyone, including primary care physicians. Giving PCPs access to episode cost curves and patient details at the point of referral can lead to better choices—driving down costs and increasing patient satisfaction.
Finally, it’s essential to routinely evaluate network membership to identify and reward high-performing specialists. Factors to consider include cost and quality performance, patient satisfaction levels, primary care responsiveness and patient scheduling guideline adherence. Engaging and incentivizing specialists is a win-win-win for specialists, patients and your accountable care organization.
CEO and co-founder of Roji Health Intelligence, Theresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum, including public, nonprofit and private sectors.