Specialty care & healthcare spending
Specialty care plays a critical and indispensable role in managing complex health conditions that require not only advanced expertise but also cutting-edge technology and specialized equipment. As the demand for these highly specialized treatments continues to rise steadily, healthcare spending in this sector has significantly increased over recent years. Efficient and effective management of specialty care expenses is essential for both patients and healthcare providers to ensure timely access to high-quality services while simultaneously controlling and containing overall healthcare costs. Customized health insurance solutions, designed to meet individual needs, can help strike a balance between these competing demands by offering coverage that supports necessary specialty care without compromising financial sustainability for either party.
Specialty care is rapidly becoming the leading contributor to healthcare spending
Specialty care is rapidly becoming the leading contributor to healthcare spending due to the increasing demand for complex treatments, advanced technologies, and specialized medications. As chronic conditions and rare diseases require more targeted interventions, the costs associated with specialty care continue to rise, outpacing other areas of healthcare. This trend places significant financial pressure on patients, insurers, and healthcare systems, highlighting the need for innovative solutions and efficient management to balance quality care with cost containment.
Strategies to address specialty-care spending
To succeed in the evolving specialty-care landscape, specialists and the companies that support them with enablement services must adapt their capabilities and business models to manage spending while addressing patient needs and ensuring high-quality care. We have observed four distinct specialty VBC player archetypes in the industry to date, each of which has a different effect on sources of value.
Site-agnostic wraparound services. Players in this area offer comprehensive care coordination, proactive patient engagement, and social support (together known as “wraparound services”) across all settings, including inpatient, ambulatory, and home care, and they save money by preventing complications. Successful organizations tend to focus on data integration to obtain a comprehensive picture of the patient’s clinical and social situation (for example, through access to electronic medical records, the integration of health information exchange, and direct patient engagement), and specialty-specific risk stratification to triage and direct patients to the appropriate care. We have observed that adoption of this strategy has accelerated rapidly in the past two to three years, especially in cardiology and oncology, where longitudinal patient engagement and support are critical to preventing high-cost complications.
Outpatient-focused integrated care. Players pursuing this approach use a convenience-driven, decentralized footprint to optimize patient access to lower-cost sites of care, generating maximum site-of-care savings. Successful organizations often also employ oversight of patient ambulatory journeys to realize savings from reducing diagnostic variability and preventing high-cost utilization in specialties such as nephrology.
Treatment pathway navigator. These players focus on aligning care planning and treatment pathways with high-value diagnostics and therapeutics such as orthopedics, cardiology, and oncology care. They see the largest cost savings from reducing variability in diagnostic testing and treatment selection. This strategy represents an evolution of traditional utilization-management approaches by incorporating more-holistic care pathways and integrating with providers to support decision-making.
Digital health innovator. These organizations employ digital technologies to enable proactive and continuous patient engagement, monitoring disease progression remotely to reduce preventable complications and subsequent utilization. Trust and ongoing communication with patients allow these entities to direct patients to the most appropriate site of care. This strategy is often seen in orthopedic care (such as remote physical therapy) and women’s health (fertility and maternity apps). It is also increasingly used in cancer care (symptom management apps), where continuous patient engagement and monitoring can be critical.
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