Thanks again @Ben Schwartz for an insightful piece. A few years ago I managed a team of internally facing (not patient facing) specialists for a large primary care provider across a dozen states taking full MA risk. Specialty care was the most difficult thing for the organization to manage and costs varied tremendously. We developed several initiatives to bring this care under control. One effort that was very effective at reducing specialist referrals, unnecessary imaging/testing and inappropriate drug prescribing was what we called "curbside consults" just as you describe as point of decision input. PCPs could reach out to our specialist Medical Directors in a variety of ways from synchronous to asynchronous and get valuable input. In the first year our 10 Medical Directors fielded 27,000 curbside consults. This resulted in a reduction in unnecessary imaging, specialist referrals and inappropriate pharmacy spend.
With regard to MSK knowledge gap, most I.M. residency programs provide no formal exposure and F.M. residencies do better but still minimal. Is there no wonder that they feel ill-equipped to handle anything beyond a sprained ankle or the equivalent. This has to be true for other specialties as well.
Great points Ben Thank you for the thoughtful contribution! Note , the same needs/oppys to integrate specialists upstream exist within kidney care, heart failure, derm, rheum, neuro, etc. this is all worth serious consideration if Abe and team want to help us build solutions which crack the hard nut- care coordination, incentives alignment, information blocking and silos. The rapid disappearance of independent physicians is a cofactor we must address if we are going to meaningfully reverse the value and revenue capture which is increasingly by controlled by orgs which have distinct, and often conflicting, financial goals
Ben I need to come and see you for dinner some time and go deeper on this! Loved the read.
Any time!
Great piece and a mandatory read IMO. Ben I think you should take Abe up on his offer!!
Thanks again @Ben Schwartz for an insightful piece. A few years ago I managed a team of internally facing (not patient facing) specialists for a large primary care provider across a dozen states taking full MA risk. Specialty care was the most difficult thing for the organization to manage and costs varied tremendously. We developed several initiatives to bring this care under control. One effort that was very effective at reducing specialist referrals, unnecessary imaging/testing and inappropriate drug prescribing was what we called "curbside consults" just as you describe as point of decision input. PCPs could reach out to our specialist Medical Directors in a variety of ways from synchronous to asynchronous and get valuable input. In the first year our 10 Medical Directors fielded 27,000 curbside consults. This resulted in a reduction in unnecessary imaging, specialist referrals and inappropriate pharmacy spend.
With regard to MSK knowledge gap, most I.M. residency programs provide no formal exposure and F.M. residencies do better but still minimal. Is there no wonder that they feel ill-equipped to handle anything beyond a sprained ankle or the equivalent. This has to be true for other specialties as well.
Great points Ben Thank you for the thoughtful contribution! Note , the same needs/oppys to integrate specialists upstream exist within kidney care, heart failure, derm, rheum, neuro, etc. this is all worth serious consideration if Abe and team want to help us build solutions which crack the hard nut- care coordination, incentives alignment, information blocking and silos. The rapid disappearance of independent physicians is a cofactor we must address if we are going to meaningfully reverse the value and revenue capture which is increasingly by controlled by orgs which have distinct, and often conflicting, financial goals