Why Specialty Care and Spending Matter in a Value-Based World

Value-Based Care Statistics

Juliette Price, Chief Solutions Officer, HSG Global

When you look across all lines of business, you see in this category one, which is fee-for-service, we’re still seeing about 40% of that spend is not in any type of value-based arrangement. Category two hangs out at just a hair under 20%. This is where you’re still paying fee-for-service, and there is some link to quality and value. That could be an incentive payment, that could be a withhold, that could be small. Just small stepping stones to value-based payment. But what’s most interesting to us here is that category three and category four, you see category three is broken out into A and B. Essentially just means that there’s no downside risk in these contracts. B means that there are downside risks. So actually providers could lose money if they don’t perform in these arrangements. What this graph is showing you is that for, uh, payments that include downside risk, you’re starting to see about 20% of the overall spend is, is in these advanced value-based arrangements.

Evaluate Practice Performance Metrics for eConsult Programs - Measuring Access to Specialty Care

Evaluate Practice Performance Metrics for eConsult Programs:

Measuring Patient Access to Specialty Care

With considerable time and effort, at-risk practices identify patients at high risk of serious health events. We want to use this same information to develop an eConsult strategy.

To increase patient access to specialty care, consider which specialties have long appointment wait times, higher costs, conditions easily manage by the PCP, or do not require a face-to-face specialist visit. Using eConsults in these situations will drive cost savings, improve outcomes and decrease the risk of:

  • ED use – a costly alternative to a specialist visit.
  • Unscheduled or canceled specialty care appointments.
  • Boomerang appointments to primary care.

Increasing access to specialty care is the goal. Together, we can track and communicate which specialties are most:

  • Needed by the patients you serve
  • Likely to improve outcomes
  • Appropriate for eConsult
  • Valuable to your practice

Identify Specialties with Long Appointment Wait Times

There are many reasons why patients must wait too long to get an appointment with a specialist.

  • Not all specialists accept Medicare and Medicaid.
  • Doctors in many specialty areas are unevenly distributed across the country.
  • Patient referrals are often scheduled by the urgency of the condition.
  • Current patients are prioritized for appointments.

Merritt Hawkins reports that the nationwide average wait time to see an orthopedic surgeon is relatively short – just 16.9 days. However, looking at the average can be misleading.

  • This average is a 48% increase when compared to 2017
  • Getting an appointment with an orthopedist varies tremendously by location – San Diego averages 55 days!

Several factors impact appointment wait times. Not all specialists accept Medicare and Medicaid. Specialists are often clustered in metropolitan areas and unevenly distributed across the county.

Patient’s are less likely to schedule and attend a specialist appointment:

  • When the wait time is extended.
  • Travel distance to the specialist is significant.
  • Cost of the appointment is high — the patient has high-deductible insurance, or the specialist is out-of-network.

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