Well-managed patients in specialty care create a bottleneck to access for new patients. Yet, it’s rare for provider organizations to establish effective patient hand-backs from specialty to primary care when appropriate. This is due to two mutually-reinforcing challenges: First, it’s easier for specialists to continue to see patients in their panel, rather than shift course. Second, patients themselves may prefer to stick with their specialist and resist hand-back efforts.

What we mean: Once patients are well-managed in specialty care, a hand-back is the process of transitioning patients from specialty to primary care for ongoing care management.

We can’t improve population health without specialists. The three strategies outlined in this series are ambitious, yet feasible behavior changes that work under hybrid financial incentives primarily by addressing the specialist-PCP communication gap. Building avenues for collaboration and a shared culture is at the core of referral considerations, e-consults, and hand-backs—and will remain central to future value-based care work. Focus your efforts here to start engaging specialists.

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Sources

Tuot D, et al., “Increasing Access to Specialty Care: Patient Discharges From a Gastroenterology Clinic,” AJMC, 20, no. 10 (2014): 812-819.

Selvig D, et al., “Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times,” BMC Health Services Research, 18, no. 16 (2018).