I Know How Specialists Feel

I was speaking with an ACO executive last month about the challenges of bringing specialists on-board to the “value-based” manner of thinking.


“When we tell them they have to shave another $500 off of every episode of care, they get angry, then abusive and then they tune us out.”


I bet!


When I was first figuring out how our total-risk Medicare Advantage contract worked, more than twenty years ago, I tuned out our insurance executive too.


She was talking about “episodes of care” and “care costs.” It was hard enough to deliver good healthcare, let alone do it while worrying about how much it costs.


I tuned them out—until I experienced an epiphany.


I didn’t have to count pennies, I just had to do my thing.


Deliver great care, efficiently. Free of all the distractions of prior authorizations and care guidelines. Just do what I was trained to do, and my care costs dropped like a stone.


That’s why it made my heart sink to hear the ACO executive tell of communicating with specialists on a cost-of-care basis. I have felt the fear, anger and frustration that those specialists felt.


They’re smart enough to realize that in a value-based world, their services are cost-centers—and they are simply vendors.


But that is exactly the wrong way to approach specialists in value-based care systems.


Rather, compensate them on what actually creates value—efficient collaborative care.


Give them skin in the game in the form of their own piece of your value-based payment pie.  Make participation in those monies dependent on how well they collaborate with the primes.


And absolutely forget about evaluating the “value” of the services they provide based on price.


Costs do not reflect the value they generate—either for patients or for you.


Availability, efficiency, excellence—that’s what drives cost reduction in value-based care.


Reward them for it.


And instead of resistance—you’ll find them going all in.