The current state of the U.S. specialty health care system is in need of improvements. Being that a large percentage of medical visits are for specialists, the efficiency of the system could be improved for the sake of customers and physicians. Continue reading for four potential solutions and the challenges that could follow.
Specialists dominate the U.S. health care system. Nearly nine in 10 physicians are specialists. They perform most health care encounters, are responsible for the bulk of Medicare and commercial spending, and account for a continually increasing share of outpatient visits and total expenditures. To improve U.S. health care, specialty care must get better. Specialists can achieve this by unbundling and optimizing the various services they provide.
Specialists’ Core Activities
Specialists are problem-focused experts who care for individuals with specific health conditions. They extend their expertise through several core activities: consultations (sharing advice with another clinician), co-management (sharing long-term management of a particular problem), principal care (assuming total responsibility for a specific problem), primary care (providing a medical home), and procedures.
Each specialist’s specific blend of activities varies based on his or her specialty and individual practice. Cognitive-based specialists who perform few, if any, procedures such as endocrinologists and nephrologists provide a mix of consults, principal care, primary care, and co-management. Procedural-based specialists such as gastroenterologists and cardiologists also perform consults, principal care, and co-management plus procedures but provide little or no primary care. Surgical specialists such as orthopedists and neurosurgeons mostly perform consults and procedures.
How Bundling Can Limit Performance
To reduce production and distribution costs, companies in other industries often bundle products and services with multiple components regardless of whether their customers use all of them. However, including elements some consumers never use increases costs. And focusing on mass markets may miss individual consumers’ specific needs. Think newspapers, music albums, and the traditional television networks.
Similarly, specialists routinely use the same processes, resources, and business models to deliver very different services. This bundling makes specialty care less accessible. (For example, those needing quick input must often wait too long because specialists’ schedules are filled with those receiving ongoing care.) It increases costs when simpler services involve unnecessary overhead. It tarnishes patients’ experiences when processes are too cumbersome. It reduces effectiveness when resources are inadequate to address more complex needs. And it strains specialists and staff who must continually switch attention between very different tasks.
Unbundling Specialty Care May Improve It
By reducing distribution costs, the internet has allowed many companies to unbundle products and services into stand-alone offerings that are cheaper and better meet specific consumer needs. Think newsfeeds, Spotify, and Netflix.
Similarly, unbundling specialist activities into modular components — and delivering each with specific clinical, operational, and business models — may make specialty care more accessible, affordable, effective, and pleasant. Here are ways to unbundle specialists’ four core services.
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