Closing Gaps and Integrating Specialists: The Future of Value-Based Care

For more than 15 years, value-based care (VBC) has transformed healthcare by shifting the focus from volume to outcomes. Initially, this shift focused almost exclusively on primary care, recognizing its role as the front door to the healthcare system. But as models mature, it’s clear that meaningful progress toward high-quality, cost-effective care requires deeper integration of specialty care.  

A study from 2024 revealed physician specialty was highly predictive of overall participation in VBC models, with hospital-based physicians, medical specialists, psychiatrists, and surgeons all being less likely to participate in VBC models than primary care physicians (PCPs).

The American Medical Association (AMA) had similar findings in a 2022 study, where physician practices with some PCPs were more likely to participate in commercial, Medicare, and Medicaid Accountable Care Organizations (ACOs) compared with practices that had only specialists.² 

With so much at stake, health plans must find a solution that can meet their record retrieval needs, simplify the MRR process, and maintain accuracy under growing regulatory pressure.

Specialists: the missing link in the continuum of care

Medicare beneficiaries are seeing more specialists and experiencing more fragmented care. The next frontier in VBC is specialty care, where the cost of services is steep and the opportunities for patient impact are just as significant.

Involving specialty providers is no longer optional. To truly close care gaps, improve outcomes, and manage costs, both primary and specialty care providers must be engaged across the continuum. This means meeting providers where they are and equipping them with data specific to their roles, patients, and performance measures. 

From one-to-one to one-to-many

In today’s healthcare landscape, a single patient may be seen by a variety of providers during a single episode of care, including their PCP, a specialist, a surgeon, and various physicians for follow-up and physical therapy. Better care coordination requires a shift from a one-to-one provider-member model to a one-to-many attribution approach. This requires a nuanced understanding of how to assign credit and responsibility across multiple providers working together to close care gaps. 

Enter multi-provider attribution

Inovalon’s Converged Provider Enablement™ enables accurate, timely assignment of care activities across providers with its multi-provider attribution feature. Whether it’s a PCP providing routine care or a specialist managing a chronic condition, this capability ensures that every touchpoint counts. 

This is critical for health plans aiming to improve program performance and outcomes. It also allows providers to be recognized and rewarded for their contributions in shared care models, further aligning incentives across the care team. 

The future of value-based care: better care, not just better scores

Ultimately, value-based care isn’t about checking boxes. It’s about the patient experience, improved outcomes, and making care work — for patients and providers alike. That means aligning programs with provider priorities, building trust, and delivering tools that reflect the realities of today’s healthcare delivery. 

Learn more about how Converged Provider Enablement can engage your specialists and elevate your value-based care program.

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