Specialty Healthcare in the US
Many doctor visits involve seeing a specialist at some point in the process. The specialty healthcare system in the United States needs to be improved in order to help patients and doctors alike. Specialists are important in American healthcare.
Almost 9 out of 10 doctors specialize in different areas. They handle a big part of medical visits, cost a lot in Medicare and private insurance, and their role in outpatient visits and overall healthcare costs is increasing. To improve healthcare in the U.S., we need to make specialty care better. We can do this by breaking it down and making the various services offered by specialists work well together.
Core Activities of Specialists
Specialists are problem-focused experts responsible for the care of individuals with specific health conditions. They expand their expertise through a range of core activities, including:
- Consultations (providing advice to fellow clinicians)
- Co-management (sharing the long-term management of a particular issue)
- Principal care (assuming full responsibility for a specific problem)
- Primary care (offering a medical home)
- Procedures
The blend of these activities varies based on a specialist’s field and individual practice. For example:
- Cognitive-based specialists, like endocrinologists and nephrologists, tend to engage in consults, principal care, primary care, and co-management, often with minimal or no procedures.
- Procedural-based specialists, such as gastroenterologists and cardiologists, also partake in consults, principal care, and co-management, in addition to procedures but provide little to no primary care.
- Surgical specialists, including orthopedists and neurosurgeons, primarily engage in consults and procedures.
Challenges of Bundling
In various industries, bundling products and services with multiple components is commonplace to reduce production and distribution costs. However, including elements that some consumers never utilize can lead to increased costs and a potential mismatch with individual consumers’ specific needs. Specialists often employ uniform processes, resources, and business models to deliver widely differing services.
This bundling approach makes specialty care less accessible; for instance, individuals in need of prompt attention may face delays due to specialists’ schedules being occupied by those receiving ongoing care. It also inflates costs for simpler services due to unnecessary overhead, disrupts the patient experience with cumbersome processes, and diminishes effectiveness when resources are insufficient for complex requirements. Additionally, it places undue strain on specialists and their staff, who must frequently shift their focus between highly disparate tasks.
Unbundling as a Path to Improvement
The internet’s influence in reducing distribution costs has allowed many companies to unbundle products and services into stand-alone offerings that are more affordable and cater to specific consumer needs. Breaking down specialist activities into modular components and delivering each with tailored clinical, operational, and business models could potentially make specialty care more accessible, cost-effective, efficient, and patient-friendly. Below are strategies for unbundling the four core services of specialists:
- Consultations: Provide stand-alone consultation services, enabling patients to seek expert advice without committing to long-term care.
- Co-Management: Develop specialized co-management programs for patients with ongoing conditions, streamlining their care without compromising efficiency.
- Principal Care: Offer principal care as an independent service, providing individuals with comprehensive management of specific health issues.
- Procedures: Establish specialized procedure clinics, ensuring that patients receive necessary treatments promptly without delays caused by bundled care models.
In conclusion, revamping the U.S. specialty healthcare system involves breaking down the traditional bundled approach and reimagining specialist services as individualized, efficient, and accessible components. This shift towards unbundling holds the potential to address the existing challenges and enhance the overall quality of specialty healthcare in the United States.
Original article published on hbr.org
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