Managing Specialty Care Costs in a Value-Based World


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

Juliette Price, Chief Solutions Officer at HSG Global

The move to value-based contracting across all lines of business has placed increasing importance on how primary care providers manage their relationship with specialty care—for many; this is the first time they’ve explored how their specialty care relationships support (or run against) their care, quality, and cost goals. Learning to understand the value of specialty care within value-based contracts and how to best manage these relationships is critical for an organization’s success in value-based payment. Learn more about why at this session with HSG’s Chief Solution Officer.

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Juliette Price

Juliette Price

Chief Solutions Officer at HSG Global

Juliette serves as Chief Solutions Officer at HSG Global, bringing creative problem solving and strategy to deliver breakthrough results for her clients. She believes that solutions to our most complex issues can be designed through systems thinking, collaborative problem solving, creating data-informed solutions, and bringing concepts and processes across sectors. She advises a wide variety of clients including providers & provider groups such as ACOs and IPAs, and payers.

Value-based healthcare transition challenges - specialty care and spending

What Challenges are Driven by the Value-based Health Transition?

With the transition to value-based health come challenges. Primary care practices, particularly smaller ones, must significantly upgrade their technology. Both to be sure that when they are referring a patient, the patient stays in-network and that the specialist is available to provide care. With the ongoing shortage of specialists, this remains a challenge that puts specialty care and spending in focus for PCPs.

Challenges to value-based healthcare typically fall into four categories:

  1. Interoperability
  2. Data & Workflow
  3. Financial Risk


Interoperability has been a challenge in healthcare for many years. To control costs under a value-based payment model PCPs must communicate the appropriate patient information when referring to a specialist to:

  • Ensure that an appropriate diagnosis is made.
  • Prevent duplication of diagnostics that increase the cost.

Unfortunately, most EHRs do not ‘talk’ to each other, and even when two providers are on the same EHR, the ability to share information between two practices is often difficult. Appointment scheduling platforms are not always connected to the practice’s EHR and are rarely connected to the scheduling platform of a specialist receiving a referral.

EHRs and scheduling systems don’t have all the information necessary to validate a patient’s health insurance to determine if prior authorization is required or which specialists are in-network for a particular patient’s health insurance.

Keeping patients in-network when referring to a specialist is critical to reducing the cost of care and ensuring those needing specialist advice attend the appointment. Tracking down this information often takes time. Time is the enemy of scheduling a referral.