Specialty care makes up a significant portion of healthcare spending, yet accountable care organizations (ACOs) often lack a specialty care strategy to lower costs and optimize specialty care.
This disconnect arises due to distinct payment models that pay specialists separately, alongside care management systems that don’t attempt to integrate ACO primary care physicians and specialists.
Specialists are pivotal to the care continuum and should be fostered as partners in delivering high-quality care rather than mere cost drivers. Below are nine strategies designed to help ACOs align with specialists while enhancing cost management, outcomes and patient experience.
- Aggregate specialty care data.
Specialists can gain insights into costs and outcomes by examining claims data that ACOs have, in combination with their practice data. Together these will reveal factors driving expenses. It's crucial that these data are used constructively, allowing physicians the chance to review and improve without fear of punitive measures, as data are rarely flawless. - Evaluate episodes of care.
Creating episodes that bundle all services provided for a particular procedure or treatment plan enables cost comparisons. This approach allows for analysis of cost variations by provider, procedure components, and alternative therapeutic strategies. By assessing outcomes and costs over time, specialists can identify opportunities to reduce unnecessary expenditures or identify deviations from clinical pathways. - Conduct case reviews.
Engaging specialists in periodic reviews of selected cases encourages them to explore cost variation in their own procedures and treatments. By incorporating these cases into registries with accompanying analytics, ACOs can foster a data-driven coaching process that offers physicians a clearer view of how their care is perceived through the lens of data. - Investigate cost drivers.
Involving specialty practices in scrutinizing key cost contributors—such as anesthesia, pre- and post-operative services and treatment plan decisions—can uncover variations and pinpoint solutions for reducing overall care costs. - Leverage Centers of Excellence.
Centers of Excellence (COEs) within the ACO can serve as hubs for disseminating information on patient risk factors, guiding both specialists and patients toward better-informed decisions. Additionally, COEs can encourage the adoption of standards, like volume thresholds, to enhance long-term outcomes. - Maintain open communication.
Primary care physicians should be kept in the loop with consistent communication by specialists. ACOs can utilize websites, best practice articles and in-person practice visits to review data and engage specialists in the larger care effort. - Facilitate collaboration.
Implement mobile and web-based technologies that streamline referrals, scheduling and the sharing of consultation notes and patient data between primary care providers and specialists, ensuring seamless collaboration. - Incentivize excellence.
Specialists should be rewarded for their contributions to cost management, clinical outcomes and operational efficiency. Incentives can be tied to participation in quality initiatives, involvement in cost review processes, and effective communication with other providers. Under future payment models, CMS may enable ACOs to negotiate rates with specialists, an idea hinted at in recent rules and policy statements. - Share data with primary care providers.
Cost management is a collective effort that includes primary care physicians (PCPs) and specialists. Providing PCPs with access to episode cost data and patient details at the point of referral can lead to more informed decisions, ultimately reducing costs and enhancing patient satisfaction.
Lastly, routinely assessing network membership is key to recognizing and rewarding high-performing specialists. Factors to consider include cost and quality metrics, patient satisfaction, responsiveness to primary care needs and adherence to scheduling guidelines. Successfully engaging specialists benefits everyone—specialists, patients and the ACO as a whole.
CEO and Co-founder of Roji Health Intelligence, Theresa Hush is CEO and cofounder of Roji Health Intelligence. She is a healthcare strategist and change expert with experience across the healthcare spectrum, including public, non-profit and private sectors.