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The next chapter of population health involves specialists. Here’s where to start. (Part 3 of 3)

    Introduction to the series

    Involving specialists in value-based care is hard. Not only is specialty care a more diverse space, but it's also more tied to traditional fee-for-service reimbursement and episodic care delivery. We’ve previously discussed how engaging specialists in accurate HCC capture is a ‘no-regrets’ opportunity in this hybrid financial incentive state—but what ambitious, yet feasible behavior changes remain for specialists? In this series, we discuss the three you should start with.

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    This expert insight series is sponsored by Episource. Advisory Board experts wrote the post, conducting the underlying research independently and objectively.

    The future of value-based care

    Medicare and Medicaid risk is progressing (slowly) — but commercial risk will determine whether the industry tips toward a new cost and quality standard.


    The strategy: Hand-backs to primary care

    Well-managed patients in specialty care create a bottleneck to access for new patients. Yet, it’s rare for provider organizations to establish effective patient hand-backs from specialty to primary care when appropriate. This is due to two mutually-reinforcing challenges: First, it’s easier for specialists to continue to see patients in their panel, rather than shift course. Second, patients themselves may prefer to stick with their specialist and resist hand-back efforts.

    What we mean: Once patients are well-managed in specialty care, a hand-back is the process of transitioning patients from specialty to primary care for ongoing care management.


    Two imperatives to establish appropriate hand-backs from specialty to primary care
    • 1. Establish guidelines for when to consider a hand-back to primary care
    • 2. Train specialists on how to have the conversation with patients

    Parting thoughts

    We can’t improve population health without specialists. The three strategies outlined in this series are ambitious, yet feasible behavior changes that work under hybrid financial incentives primarily by addressing the specialist-PCP communication gap. Building avenues for collaboration and a shared culture is at the core of referral considerations, e-consults, and hand-backs—and will remain central to future value-based care work. Focus your efforts here to start engaging specialists.


    About the sponsor

    Episource reinvents risk adjustment program management across healthcare organizations with an integrated platform. We empower the most recognizable names in healthcare with end-to-end risk adjustment solutions. From risk adjustment analytics, retrospective chart reviews, in-home assessments, encounter submissions and quality reporting, Episource simplifies healthcare with elegance and innovation.

    Learn more about Episource

    This expert insight series is sponsored by Episource, an Advisory Board member organization. Representatives of Episource helped select the topics and issues addressed. Advisory Board experts wrote the post, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.

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    Tuot D, et al., “Increasing Access to Specialty Care: Patient Discharges From a Gastroenterology Clinic,” AJMC, 20, no. 10 (2014): 812-819.

    Selvig D, et al., “Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times,” BMC Health Services Research, 18, no. 16 (2018).

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