Research

The next chapter of population health involves specialists. Here’s where to start. (Part 2 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: E-consults

    E-consults are another way to reduce low-value referrals. In fact, multiple executives told us e-consults are a top opportunity when transitioning to value-based care—calling them a “bridge to value.” Short-term, they quicken PCP-specialist interactions on patient care plans, upskills PCPs to manage low-acuity specialty cases, and improve patient access by freeing up specialist capacity for patients who need their care most. Long-term, e-consults help educate referring providers, improving their referral patterns and reducing costs.

    What we mean: Electronic consultations (e-consults) are asynchronous messages sent between providers within a shared EHR or web-based platform. PCPs primarily use e-consults to ask a clinical question, determine necessity of a formal referral, and facilitate diagnostic evaluation.

    What we don’t mean: We do not mean one-off emails or informal conversations between PCPs and specialists that aren’t tracked. E-consult programs should operate systematically.

     

     
    Two imperatives to establishing e-consults that reduce low-value referrals
    • 1. Designate a select group of physicians to own e-consults
    • 2. Provide an incentive
     

    Next up

    In the third and final part of our series, we examine how to establish patient hand-backs from specialty to primary care.

     

    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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    Sources

    Sandberg SF, Shipman SA, and Erikson CE. “Innovations at the Interface of Primary and Specialty Care,” American Association of Medical Colleges, (2016).

    Bhavsar I, et al., “Electronic Consultations to Hepatologists Reduce Wait Time for Visits,” Hepatology Communications, 3, no. 9 (2019): 1177-1182.

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