Specialty care — like oncology, cardiology, and other chronic health conditions — is one of the most complex and expensive parts of the healthcare system. It’s also where the future of value-based care will be decided.
In a new Health Affairs article titled, “Payer–Provider Partnerships For Specialty Care Must Use Health Outcomes As Their North Star,” Blue Shield of California leaders Dr. Deneen Vojta, executive vice president of healthcare quality and affordability, and Dr. Ravi Kavasery, senior vice president and chief medical officer – along with co-author Dr. Amol Navathe – state that improving specialty care requires a fundamental shift in how healthcare payers and providers work together.
Today’s “pay-for-performance” models are a step up from “fee-for-service” systems, but have mostly been adopted by primary care and still leave more to be desired. This has Dr. Vojta and Dr. Kavasery calling for “pay-for-outcomes,” where patient care remains first priority and success is measured by meaningful results — better health, faster recovery, and improved quality of life — for specialty care.
This shift is especially critical in specialty care, where clinical decisions have the greatest impact on patients’ health and costs are the highest. It’s where risk, complexity, and outcomes converge. And it is also where value-based care will ultimately succeed or fail.
To get there, Dr. Vojta and Dr. Kavasery outline several priorities:
- Measure what matters. Focus on outcomes that reflect real improvements in patients’ health, not just activity.
- Align incentives. Give providers the flexibility to invest in care that drives better results.
- Share accountability. Payers and providers must jointly manage cost and quality — not operate in silos.
- Use data as a foundation. Outcomes data is quickly becoming the currency of healthcare partnerships, shaping how organizations collaborate and compete.
Most of all, Dr. Vojta and Dr. Kavasery share that incremental change isn’t enough. A shared focus on outcomes — especially in specialty care — can create stronger partnerships and better results for patients.
Read more insights from Drs. Deneen Vojta and Ravi Kavasery here.