Value-Based Care in Endocrinology: Navigating the Transition for Better Patient and Business Outcomes
In the United States, approximately 40 million individuals live with diabetes, and an additional 100 million are prediabetic. The current shortage of endocrinologists means that only a small fraction of these patients can receive the specialized care they require. While many endocrinologists focus on other diseases, those dedicated to diabetes often face overwhelming workloads and inadequate compensation. Moreover, the availability of diabetes-focused endocrinologists who accept Medicaid significantly varies across the country, leading to disparities in access and the quality of patient care. Nonetheless, diabetes patients who are able to consult an endocrinologist typically receive superior care compared to those treated in general practice, highlighting the critical role of specialized expertise in managing this chronic condition.
A recent analysis by Valendo Health of an endocrine practice serving 1,987 Medicare beneficiaries with diabetes in 2022 revealed that a mere 1.4% of the $37.4 million in healthcare expenses was attributed to outpatient endocrine services, averaging $264 per patient.
However, patients who consistently consulted an endocrinologist in this practice incurred $3,605 less in healthcare expenses for Medicare compared to those primarily managed by primary care physicians (PCPs) or other specialists.
Enhancing Specialized Care Through Digital Transformation
Digital and virtual care platforms present an effective solution to the access disparities in specialized diabetes care. By adopting technology, practices can decentralize patient management from physical clinics, thereby prioritizing the care for the most severely ill patients—a crucial step in improving healthcare outcomes. Expanding the reach of practices can also mitigate disparities by ensuring patients in remote or underserved regions receive the same quality of care as those in more accessible areas. This shift towards digitalization not only fosters equitable and efficient healthcare but also enhances the experiences of patients and providers.
Transition from Fee-for-Service to Value-Based Care (VBC)
Equipping endocrinologists with the necessary tools and resources to provide personalized, coordinated care addresses the challenges associated with high workloads and low compensation. The adoption of tech-enabled virtual care solutions can increase revenue under the Fee-for-Service model, and the positive downstream effects, such as improvements in A1C levels and total care costs, lay the foundation for value-based contracting. This approach fosters a more sustainable practice model that emphasizes patient outcomes over service volume, aligning healthcare providers' interests with those of their patients.
Empowering Endocrinologists to Advance Diabetes Care
Integrating value-based care principles into endocrinology has the potential to be transformative. For professionals in the field, embracing this shift towards value-based care offers an opportunity to lead healthcare innovation, improving patient outcomes while addressing the systemic issues of access, affordability, and clinician burnout. As the healthcare sector evolves, it is imperative for all stakeholders to support and expedite this transition, ensuring universal access to high-quality, specialized care.
Written By: Reza Alavi, MD, MHS, MBA and Shreya Jain, MBS at Quintuple Aim.
