The clinical and financial landscape for specialty practices continues to evolve at a rapid pace, and 2018 looks to be no different for providers specializing in oncology, rheumatology, gastroenterology, and other specialties. The challenge for practices will be identifying the trends that will have the biggest impact on the delivery of patient care and knowing how to take advantage of those trends to remain competitive in their local markets.
Here are four trends that I see reshaping the market for community-based specialty practices in the year ahead, along with some ideas about how to make those trends work for practices and their patients.
1. Exponential growth in drugs and other therapies will expand treatment choices and decisions
The number of drugs, particularly drugs to treat cancer, in the therapeutic pipeline is tremendous. The Pharmaceutical Research and Manufacturers of America recently reported that nearly 10,000 drugs are in clinical trial.¹ From February through November 2017, the FDA approved 41 new oncology and hematology drugs alone.² The FDA approvals included the first gene therapy – a CAR T-cell immunotherapy drug – for children and young adults with leukemia.³
While the full pipeline is great news for patients, it creates challenges for specialty practices. One is staying on top of the latest research, drugs and treatment options. A busy community-based oncologist who sees 15 to 25 patients each day doesn’t have the time to go to a virtual library in between patients to remain up-to-date. Another is being aware of and then enrolling eligible patients in clinical trials. The solution is the adoption of clinical decision-support tools that collect information on new treatment options and available clinical trials and serve up that information to providers as part of their daily workflow.
2. Use of big data and advanced analytics will be necessary to measure and report performance
Big Data and advanced analytics will be put to use in the clinical decision-support tools I described. These tools make it possible to comb through volumes of information on new drug therapies and clinical trials in real-time, match that up with specific patients and provide that information at the point of care to specialty providers.
But big data and advanced analytics will become equally important in the year ahead as tools to collect, analyze and report clinical and financial performance data to practices and payers. We’re starting to see more value-based reimbursement contracts that create two-sided risk for specialty practices. Not only can practices receive bonuses for high performance, they can be penalized for poor performance.
Practices can’t wait until the end of a quarter to know if they’re hitting quality and cost targets. It may be too late to reverse problems and avoid penalties. With analytics capabilities, a practice can monitor its performance continuously, immediately identify a problem, take action to mitigate the problem and stay on track to meet their performance benchmarks.
3. Engaged and connected patients will challenge practices to improve the patient experience
Performance benchmarks also include patient experience measures. That may be softer metrics like patient satisfaction, appointment wait times, or how patients were greeted by staff.
Patients’ service expectations are growing. They have more choice of where to seek care; online tools to compare outcomes and costs of competing providers; can research their own conditions and treatment options; and post online reviews of doctors and health care services provided.
For community-based specialty practices, engaged and connected patients are opportunities to grow their businesses in 2018. Practices can add customized online portals to serve engaged patients. They can be transparent about treatment options. And they can be transparent about treatment costs. Successful practices will involve patients in decision-making about their own care, jointly weighing the clinical and cost benefits of each treatment option. Forward-looking practices will add the capabilities and competencies to enable that new relationship with their patients.
4. The expanding needs of practices and patients will expand the composition of the care team
Value-based care models demand that specialty practices improve outcomes and lower costs. Practices can accomplish that goal by selecting the most efficacious treatment options, using advanced analytics to maximize reimbursement and minimize operating expenses, and engaging patients in their own care. They can also accomplish that goal by increasing the time specialty providers spend on direct patient care and by reducing their time spent on routine clinical or administrative functions.
To increase the time specialty providers spend on direct patient care in 2018, practices can expand their care teams by adding advanced practice providers (APPs) like nurse practitioners and physician assistants. APPs can safely and effectively perform many routine clinical tasks, such as providing evaluation and management services and ordering diagnostic tests.
Practices also can expand their teams with non-clinical staff. These positions can be navigators, social workers and financial counselors. Navigators can help patients manage health benefits and coordinate care with other providers. Social workers can help patients with social determinants of health, like food security and transportation. Financial counselors can help patients with their treatment costs, whether that’s insurance eligibility, payment plans or patient assistance programs.
Compared with the past few years, 2018 will be an interesting combination of headwinds and tailwinds for specialty practices. I would characterize the four trends as tailwinds that forward-looking practices can ride to improve clinical outcomes for patients and business outcomes for themselves.
Related: Read more about Web2pro’s solutions and services for specialty practices.