Readers Write: Rethinking Specialty Care in the Shift to Value-Based Care: Getting the Orchestra in Tune

Rethinking Specialty Care in the Shift to Value-Based Care: Getting the Orchestra in Tune
By Najib Jai, MD

Najib Jai, MD, MBA is co-founder and CEO of Conduce Health.

In a value-based care world, the healthcare system operates like an orchestra that is attempting to perform a symphony. Primary care has led this effort — taking on risk, coordinating care, and striving to keep patients healthier in a more efficient way. Specialty care, however, has historically been left to play its own tune, disconnected from the overarching melody that defines value-oriented models.

This paradigm leaves patients navigating a seemingly divided ecosystem that often struggles to align around what’s best for them. Most visibly, individuals who are living with complex chronic conditions — especially those who are from historically marginalized and underserved communities — are left deserted somewhere in the middle.

As these models mature and we enter into the next frontier of value-based care, specialty care must come into alignment, which will allow every part of the system to contribute to the same score.

One of the biggest challenges that I have experienced, both as a physician and through my work with value-based care organizations, is the misalignment between specialty care and the core value-based ethos that has increasingly guided primary care. Primary care physicians (PCPs) are rewarded for keeping patients healthier and out of the hospital, while specialists often remain in a fee-for-service model, incentivized by the volume of care provided rather than quality and patient outcomes. Akin to a talented violinist who performs a beautiful and isolated solo, this fragmented care may be technically impressive, but is ultimately disconnected from the collective performance.

This issue isn’t just about efficiency or cost control, it’s about equity. Patients from underserved communities, who often face the highest barriers to specialty care access, are disproportionately affected. These patients, who may be burdened by multiple chronic conditions such as kidney and heart disease, require coordinated efforts from primary and specialty care providers. They shouldn’t have to experience the vertigo of moving among different worlds when visiting various physicians. This disconnect can lead to conflicting advice, confusion, and missed opportunities for early and effective intervention.

If we truly want to begin addressing disparities in health outcomes, building bridges between primary and specialty care is a critical effort. Excellence in isolation, much like a disjointed symphony, is jarringly insufficient. Different components must work together seamlessly to create a beautiful melody.

To bring specialty care into the fold of value-based care, we must address the incentive structures that keep it siloed. Specialists need to be rewarded for their contributions to patient outcomes. Bundled payments, shared savings, and capitation agreements are all imperfect tools standalone, but can make a significant difference if implemented effectively.

When incentives align, specialists are more likely to collaborate with primary care teams, contributing holistically to patient outcomes. Much like a symphony, physicians are a part of one group that has the single aim of taking care of patients. Aligned incentive structures solidify this implied connectivity.

Lack of integrated data has become a ubiquitous healthcare challenge and impediment to the symphony of value-based care. Too often, specialists must make decisions without access to the full picture of a patient’s longitudinal medical history and lived experiences. These data silos make it difficult for well-intended physicians to deliver coordinated care. Interoperability remains a buzzword, but true integration is paramount for specialists and PCPs to operate from the same “sheet music.” A cardiologist who is treating a patient without seeing their recent visit notes from their PCP is like playing a solo without knowing the key of the piece. At best, it creates dissonance, and at worst, it causes harm.

While data may present a challenge, it also represents an opportunity. Leveraging data-driven insights to personalize specialty care can ensure that patients are connected with the right specialist at the right time. Instead of generic referrals, predictive models and frictionless workflows can help identify which specialists are best suited for each patient’s nuanced needs while maintaining the clinical autonomy of providers.

Understanding performance through the lens of a patient’s’ comorbidities, social drivers, care preferences, and the specialist’s experience with similar patients unlocks a novel, personalized approach to integrated specialty care. Analogous to an esteemed flutist not playing the cello, specialists have skills and training that positions them to serve certain patient populations better than others. This approach ensures that referrals are not only timely, but also meaningful, leading to better outcomes and a more efficient care journey.

The cultural shift that is required to bring specialists into value-based care is perhaps the most challenging part of this transition. Specialists are highly trained and adroit experts who are focused on their specific area of practice. However, creating a value-driven system means that all physicians must think beyond their individual role and understand how they fit into the broader picture of a population’s health.

This requires fostering a culture of collaboration, where specialists are enabled to see themselves as part of a broader healthcare orchestra rather than isolated soloists. It’s about creating an infrastructure in which their expertise is more clearly seen as one critical component of a larger effort to provide patient-centered care.

If we get this right, the potential for positive change is immense. By aligning incentives, improving data access, and fostering a culture of integration, we can create a coordinated and cohesive healthcare chassis. While simple in theory and challenging in practice, a meaningful opportunity remains – ameliorating a system of incongruous care that so many patients experience, particularly those who are already struggling due to systemic inequities.

It’s time to do away with the solos and grow towards a unified symphony, one that prioritizes the patient’s experience and ensures that every provider is working from the same score. It’s time for “value-based care 2.0” where specialists have a seat in the orchestra.