CASE STUDY: SUMMIT MEDICAL GROUP
TEAMING UP WITH SPECIALISTS TO IMPROVE CARE
Understanding that quality care hinges not just on the PCP’s care, but also on specialty care, Summit Medical Group’s Executive Medical Director, Dr. Eric Penniman, works with Humana’s Care Decision Insights data to refer Summit patients to better-performing specialists.
Care Decision Insights is a consultative service for Humana network physicians that uses claims-based, episodes-of-care data to look at specialty care outcomes and costs (effectiveness and efficiency). By reviewing this data, Dr. Penniman and his colleagues at Summit can look at the performance of specific specialties—such as ophthalmology, orthopedics and oncology—to determine the best referral option for all of their patients.
Utilization such as repeated medical office appointments, emergency department visits, lab tests, hospital readmittance, or highcost prescriptions, can affect costs and care outcomes, and are of particular importance to a PCP group in a value-based agreement, such as Summit. Armed with this type of data, Dr. Penniman is able to review Summit’s referral trends to identify opportunities to strengthen the collaboration between PCPs and specialists to reduce unnecessary costs, deliver better care and create a better experience for the patients and physicians alike.
Specialists value the relationship with the referring PCPs and meet regularly to review the data to more deeply understand what improvements can be made on both sides. In the new value-based care paradigm, no practice— whether primary or specialty care —can operate in a vacuum.
“PCPs sometimes feel at the bottom of the totem pole,” Dr. Penniman said. “But, they may not realize that with the shift to value-based relationships, the PCP is the quarterback for patient care. Today, these physicians are in a position of influence and can work closely with other health care providers to promote the right care, at the right time, in the right place.”