Fast Company Executive Board member Julian Flannery, founder and CEO of Summus, explains that virtual care is an integral part of a value-based care model, connecting patients to the right specialists at the right time.
For individuals working outside of the healthcare industry, the term “value-based care” may seem ambiguous. One might wonder, “Shouldn’t all care be based on value?” Or, “How does that value impact costs? For whom does this value exist?”
Julian Flannery, founder and CEO of leading virtual care company Summus, is very familiar with this confusion. Traditional models of care in the United States, Flannery explains, are largely based on “fee-for-service”—meaning, a fee attached to every procedure or service. In such a model, clinics or other providers are economically rewarded for performing the greatest possible number of services per patient. “There are misaligned incentives in the fee-for-service model,” Flannery says. “We know doctors want to do the right thing for their patients, but they need to be economically rewarded for quality care that improves outcomes.”
The problem of misalignment is ideally solved by value-based care—which, as Flannery explains, involves decoupling incentives from procedures or services, and instead “tying them to patient outcomes, quality and equity,” he explains.
A significant part of that value, Flannery says, is based not only on getting patients the care they need without over-burdening them with costs, but also on helping them avoid the wrong care. The goal is “to make sure patients aren’t, for example, getting readmitted to the hospital, because they went to the wrong place for care, saw the wrong doctor for their condition, or didn’t understand what they were supposed to do when they got home,” he says. Incorrect care results in an array of problems: overburdened clinicians and hospital systems; surging healthcare costs; and most importantly, poorer patient outcomes.
To compound these issues, the average wait time for a specialist consult (once a patient is correctly directed) can be as long as 47 days. “A lot can happen in 47 days,” Flannery says, noting that patients’ health can deteriorate when they face delays in care. “That’s the problem Summus solves: Getting people into the right care settings, with the right access, so they can get answers in a timely fashion. And, finding a way to accomplish that in rural communities, or other areas with limited access to specialty care.”
Delivering Value, Virtually
Offering patients the highest quality care—and by extension, the best outcomes—depends heavily on patients being connected expediently with the right specialist. This is a problem today for general practitioners, whose patient loads are often stretched to capacity. Too often, Flannery explains, primary care doctors are left with no other option than to recommend a patient see a certain type of specialist—without necessarily knowing who is in their insurance network, how much this will cost them out of pocket, whether such a specialist is geographically accessible, or how long wait times will be.
Summus addresses this problem in a two-fold way: The first is Summus’ direct-to-patient solution, which leverages virtual technology to quickly connect patients with high-quality sub-specialists—people who are going to understand a patient’s diagnosis, know what to do about their healthcare, and be familiar with their holistic care journey. Due to the speed of access to specialists, Flannery says, patients are able to avoid misdirected referrals, redundancy, and wasting time meandering through the complexities of specialty care. According to Flannery, when virtual specialist visits and consults are fully implemented, up to 40% of in-person specialist visits can be eliminated. Additionally, by connecting quickly with high-quality specialists (versus enduring long wait times), patients will make better decisions about their care, resulting in better outcomes.
Summus also enables clinicians to connect with specialists using its peer-to-peer platform across the continuum of care to support better outcomes for patients, Flannery explains. Many times, a primary care doctor will have built a strong relationship with a patient but be unsure what the best treatment or medication is for a particular condition. In these situations, primary care doctors can pose questions using the platform and receive an answer within a few hours, or connect directly with a specialist for a quick consult. Having specialty expertise at clinicians’ fingertips, Flannery says, drives a trifecta of value: Patients achieve better outcomes, doctors are able to provide better care for patients, and everyone obtains a continuing education of specialized care along the way. “We’re promoting access, driving quality, and supporting primary care doctors to make better decisions about their patients,” Flannery says. “All of that is tied to the objective of value-based care.”
A Win for Employers and Their People
Employers are increasingly looking to value-based care (and away from fee-for-service) as the preferred model for their employees. “At the end of the day, employers care about two things: They care about creating a positive and impactful healthcare experience for their employees, which drives better outcomes. And they care about overcoming the ongoing trend of rising healthcare costs,” Flannery says. In the wake of the pandemic, healthcare utilization was low, with many patients not seeking or obtaining care; as a result, many patients now need even more care, and payers are increasing costs. “Employers are saying, ‘I can’t pass on that level of cost increase to my employees,’” Flannery says. More than ever, they need affordable, streamlined solutions, without delays or wasted costs associated with unnecessary or incorrect services. They need a means of helping their people access the right care, quickly.
Summus’ platform is offering these employers a way forward. And for the end-users, patients—particularly those facing new diagnoses—the opportunity to access the right specialist in a clear and timely process is nothing short of transformative. “When patients first receive a diagnosis, many are asking, ‘Where do I go? Who do I see? What do I do next? What questions should I ask?’” Flannery says. “Summus provides them the time, access, and unfettered opportunity to find those answers in just hours or days.”
This opportunity doesn’t just align with the objectives of value-based care, but also delivers better, more impactful health experiences. “We have fantastic member stories that people have shared with us saying, ‘I’ve been looking for an answer for this problem for my child for five years, and nobody has been able to help me until I talked to your team and learned that we were going to the wrong kind of specialist,’” Flannery says. “We hear all the time about our ability to help people get access to the right care at the right time, and how that has made a huge difference, from the patient’s perspective.”