4.2.2 Specialists: Services and Organization

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From the course by University of Minnesota

Healthcare Delivery Providers

135 ratings

University of Minnesota

Healthcare Delivery Providers

135 ratings

Course 2 of 5 in the Specialization Healthcare Marketplace

Welcome to the exciting world of Healthcare Delivery Providers! This second course in the Healthcare Marketplace Specialization will help you understand the various providers of healthcare across the U.S. delivery continuum. We will explore the unique value proposition of the various providers- from hospitals and clinics to physicians to community based providers. We will dissect this important value chain using various lenses such as- site of care delivery, people who provide the care and payers who pay for care. You will also learn about the challenges facing these providers and the innovations they are creating in order to help transform this important industry. I will use readings such as a case study and videos to make this learning more experiential for you, so that you can see and feel the world of healthcare delivery. I will also explain the various acronyms and specialized terms used in healthcare, so that you become more proficient and familiar with the language. Given the fact that Healthcare is one of the largest industries in the U.S. and growing at an rapid pace, it is critical that current and future leaders understand the internal and external drivers that are shaping this industry. Current and future leaders will need to constantly innovate in order to sustain this industry into the future- by creating value for the end customer and the entire population, as well as increasing engagement of the humans who work within this industry. Get ready to take a deep dive into the complex ocean that is U.S. healthcare delivery- and make sure your oxygen tank is securely fastened!

From the lesson

PHYSICIANS: PRIMARY, SPECIALTY, NEWER SETTINGS & POPULATION HEALTH

In this module I will review the various types of physician practices and clinics. These include primary care physicians and specialty care physicians and their clinics. We will review how the various physicians are organized, how their performance is measured, how they get paid and also what challenges they face and what innovations they are leading. Welcome to the exciting world of physicians!

4.2.1 Overview of Specialty Care6:03

4.2.2 Specialists: Services and Organization7:04

4.2.3 How are Specialists paid?6:18

4.2.4 How is Specialist Performance Measured?6:49

4.2.5 Specialists: Challenges & Innovations7:01

Meet the Instructors

Dr. Rahul Koranne
Faculty
Carlson School of Management, Department of Finance

The healthcare delivery provider is part of the healthcare marketplace

specialization.

This is module 4.2.2, specialty care, services and their organization.

Learning objectives will be to discuss services a specialty care clinic and

specialists provide, and

then review how they are organized inside specialty care clinics and specialists.

So like I did with primary care, I want to give you a visual of what

a multi-specialty clinic or a specialty clinic looks like.

It's very similar to primary care, actually.

So an offsite building, standalone, or part of a hospital, or

a campus where you go in, you get checked in, registered, insurance is verified.

And then the specialist would come out, or the medical assistant, or

the nurse would come out, take you in, get your history.

The specialist would come in, typically a physician, or

their physician's assistant, would take your history, do an examination,

look at your records in the computer, and then diagnose and treat you.

So again very similar to primary care, but sometimes multi-specialty clinics

have many different specialists right in the same campus.

And that is emerging as a model to leverage economies of scale and

scope across different specialties.

Here are some of the services the specialists and specialty care provides.

They provide outpatient care on an ambulatory basis.

They provide consultative visits to diagnose and

treat targeted conditions in which they have been trained.

They do office procedures in their clinics, minor surgeries.

Also similar to primary care, they might do telephone triage.

Also there's this concept of case management and

works called navigators, so these are typically nurses or case managers.

This is a model studied in cancer care, so the navigator would be a person

that would navigate the patient across the care continuum,

and would be an added resource for that targeted specialty diagnosis.

Some of the staff in specialty care clinics are specialty care physicians,

of course, as supported by advanced practice registered nurses and

physician assistants.

And similar to primary care there's a whole clinical team surrounding them and

working with them, so nurses, medical assistants, labs,

other technicians, especially if they're doing surgery or procedures there.

And then the business office to deal with billing, coding, and

the financial aspects of the practice.

As I discussed in the previous lecture,

the specialty care physicians are numerous.

So heart, brain, lungs,

gastrointestinal tract, bones and

joints, urinary tract, those that deal with X-rays,

infectious disease, rheumatologists to look at those conditions, skin,

gynecological conditions, and many, many, many more, and

some of these are also subspecialized.

For example, there might be a pediatric cardiologist, or

a neurologist only specializing in a part of a brain, or

a gastroenterologist specializing in only one type of organ like the pancreas.

So again sub-specialization, and sometimes sub-sub-specialization.

Let's do a short quiz.

Okay, so let's look at a typical clinic of a specialty care physician.

So again, the door with the registration desk and

then the rooms for the specialists to see the patient and examine them.

Usually there is a lab, sometimes there is the X-ray,

there is the billing office, there is the triage or

the nurses, there are other staff and team members that are here.

So again, kind of similar to the primary care clinic,

just that there are more procedures, more equipment, more specialized

equipment that is available for these physicians because they

obviously do more in a targeted fashion for a certain organ or a system.

Let's draw out a multi-specialty clinic, for example.

So this part of the clinic could be cancer care.

This part of the clinic would be congestive heart failure.

This part of the clinic could be social services and case management.

This part of the clinic could be a neurology clinic, and

here could be a primary care physician.

So again, the leveraging the back office functions of the scale and

the scope of the business office.

And also, another reason to maybe do this is if a patient like Harlin comes in.

So Harlin comes in here for congested heart failure,

he does not have to go very far to then go to the case manager and be seen.

And if you read the case study by now, you would realize that that's kind of what

happened, so the case manager and the physician were really collaborating.

And it's easier if you're co-located as well.

Talk about the concept of how one organization employing specialists.

So here's specialist A and

specialist B, and they both sit in this particular clinic.

So this is a specialist clinic, and

how they are exported to some of the other parts of the continuum.

So let's say physician A on Monday sees patients in the clinic,

on Tuesday she goes and sees patients in the ambulatory surgery centers,

on Wednesday she goes and does surgery at the local hospital.

Sometimes she could maybe make virtual visits

at the local skilled nursing facility.

Same thing with B.

Might do three days in the clinic and then the rest of the two days in the hospital.

So as you can see, there's one clinic with specialty providers that cover

the whole gamut of the care continuum by virtue of coverage.

So in summary, specialists and specialty care provides specialized medical care for

very narrow areas of medicine.

And the organization of specialty care is also evolving partly due to

economic reasons, also because of the newer sites of care delivery

where they provide services and due to coordination and

ability to diversify through information technology advances.

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