Specialty Care Rationalization

Specialty care rationalization

Limited access to specialty care is a common complaint from providers and patients alike. But surprisingly, the problem often doesn’t stem from a shortage of specialists.

In most cases, an inefficient referral process and misuse of specialist resources are to blame. In fact, the overuse of specialists can lead not just to higher costs but to a lower quality of care. The HMA team of experts can help you better align specialty care with patients, improve quality of care and lower costs. Our expertise includes:

  • Developing models, methods and tools to decrease variability and overutilization in referral behavior and applying expertise in analyzing referral behavior and changing low value patterns through the use of electronic referral tools, workflow changes and monitoring methods that decrease inappropriate referrals
  • Fashioning a single referral pathway with embedded, evidence-based decision supports that are designed to be used by virtually all providers seeking consultation. Screening referrals for consistency with evidence-based criteria can then be accomplished, referrals can be reliably tracked and patterns analyzed
  • Planning and evaluating adequacy of specialty resources and support staffing, including analysis and redesign of specialty scheduling and using benchmarks to determine the needed specialty capacity to meet a population’s needs
  • Enhancing primary care capabilities through support of co-management with a specialist and an enhanced relationship between PCP/team and specialist staff; Electronic consultation can be used to answer the clinical management questions that are the reason for almost a third of referral requests
  • Introducing care coordination and care navigation, completion of care plans and implementing value-based payment, all of which is at the core of specialty care transformation; subspecialty model of care is changing and faces risk sharing and episode of care payments; HMA has developed assessment and training resources to help specialty care practices do this
  • Working with physicians and other clinicians to understand and redesign specialty care; HMA staff includes dozens of experienced physicians, advanced practice nurses and behavioral health clinicians who work with specialists to understand and improve their practice experience and gain their buy-in