In order to be successful as a risking-bearing entity (RBE), you must possess three key characteristics:
1. High-quality primary care
2. High-quality specialty care
3. Integration layer between the two
In this piece, we’ll focus on the third bucket, and technologies used by clinicians and entities to integrate primary and specialty care. To identify high-quality, low-cost specialists, certain RBEs will employ multiple full-time employees (FTEs) in each market to call provider practices, confirm demographics, and call-in for new patients to be accepted. Even if there are specialists accepting patients in the area, lack of specialists aligned toward value-based incentives can lead to lower-quality and higher-cost specialty care. In solving this problem via technology vendors, risk bearing entities have two types of vendors to chose from.
Examples: CareJourney, Stellation Care, Garner, J2 Health, and more
Simply put, referral management analytics vendors help primary care doctors decide which specialists patients should be referred to. These vendors aggregate data through public and proprietary sources to examine the cost, quality, and availability of specialists in a particular geographic. These tools can also be built internally and are often provided to practices by their partner enablers (i.e., Aledade, Pearl, etc.). A key value driver for these vendors is getting the data, and many of them apply for certain certifications (via the CMS Virtual Research Data Center) that allow them access to more Medicare / Medicaid data from CMS. There could be a whole piece on the topic of datasets but just know that not all data are created equal.
CareJourney’s data set, one of the best in the game
CareJourney’s data set, one of the best in the game
Examples: RubiconMD, AristaMD, ConferMED, Hyka, Modern Ritual Health, PicassoMD, ReferralMD, Sevaro Health, Sitka, Thea Health, Quantum Health, Accolade, and more
There are many more real-time clinical decision support orgs that will support practices via eConsults, or virtual consultations for PCPs and specialists. In essence, eConsults are an upskilling platform, helping providers to practice at the top of their license. These platforms can be generalized or specialized for certain specialties. For example, Quantum started with Oncology, then moved to MSK and behavioral health; Accolade is focused on MSK; Included Health on oncology, MSK, and diabetes; Concert Health on behavioral health.