The Role of Specialists in Value-Based Care


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The cost of healthcare in the United States has reached levels that are an unsustainable burden on the national economy, and the Center for Medicare and Medicaid Services (CMS) is creating new payment methods that will decrease the cost of care while improving the quality of care and patient satisfaction with that care. CMS has created multiple new payment models that are grouped under Value-Based Care (VBC). These models' primary focus has been primary care, but patients will still need the care provided by medical and surgical specialists. This study reviews the literature on integrating specialists into the various VBC models and makes recommendations on how to continue and improve this integration. Specialists are integral in VBC, and the correct mix of specialists and primary care providers(PCP) will optimize this care. Close communication between the specialist and PCP is becoming even more critical to provide care coordination, ensure that quality care is delivered and duplicated of services, and avoid unnecessary costs. Health information technology will play a vital role in the coordination of care and measurement of quality metrics. Specialists will need to improve access for their patients. Those specialists who provide ancillary services such as radiology and laboratory services will need to determine how these fit into the provision of VBC and contracts with insurers and ACOs.



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