During this session, Partner Jeremy Earl moderated a panel that collected insights on how specialists can participate in value-based care and the unique challenges specialists face in maximizing value-based care opportunities.
Session panelists included:
Marissa Brittenham, Executive Vice President and Chief Strategy Officer, Surgery Partners
David Dempsey, Chief Operating Officer, Heartbeat Health
David Eagleton, Senior Vice President, Oncology Care Partners
Jeremy Earl, Partner, McDermott Will & Emery (Moderator)
Josh Goldenberg, Group Vice President of Payor Partnerships, DaVita Inc.
Top takeaways included:
While some specialists are comfortable in the value-based care world, others have been slow to engage with and adopt value-based care initiatives. Convincing providers who have been paid on a fee-for-service basis their entire career to shift and take on risk can be challenging. These shifts can begin slowly, for example, by offering initial quality bonuses and then building up to longer-term strategies. However, the transition often involves a shift in mindset and can be challenging to accomplish at an organizational level.
Specialists may only have insight into a small portion of a patient’s life, so it can be hard to engage in the patient’s full care journey when specialists are not at the center of care. However, where specialists can provide a service for a fraction of the cost—for example, through site-of-care shifts—specialists can still have a large impact on costs and outcomes.
Different specialties are at different points in the value-based care transformation. The panelists representing ASCs and oncology, cardiology and dialysis providers, for example, generally agreed that kidney-care providers are furthest along in the value-based care evolution, although each of their respective specialties is making strides toward value-based care adoption.
Payers are increasingly becoming receptive to risk-based contracts with specialists. As the growth in specialty-care spend has increased, so too has payer engagement and their willingness to contract. The decision as to who takes on the risk and how the risk is contracted for (e.g., directly or through an MSO) can vary from one specialty to the next. Specialists may be open to different risk arrangements if such arrangements allow them to gain lives in new markets.
Specialists remain focused on high-impact activities that have the potential to drive patient engagement. These can include patient-facing apps that help to track and monitor patients’ symptoms, as well as medication reconciliation, virtual care delivery, healthcare navigators and collaborations with start-ups to identify the appropriate interventions for the right patients.