Specialist-Led Care: A Selective Advantage in Supply Chain Management, Collaborative Aggregation, and Scale

Current health care strategies trend toward optimizing outcomes and improving cost; the shift from fee-for-service toward value-based care models has enhanced the delivery of medical care to our patients. Value-based care aims to align health care providers in coordinated patient-focused health care rather than an episodic problem-focused response. Meanwhile, episodic care has shifted from hospital-based to outpatient procedures. To achieve these goals, hospital systems and private practices have employed various strategies of cost containment. Prior literature has introduced the concept of specialist-led care. Although focused primarily on orthopedic surgery specialists, the concept of specialist-led care can be broadly applied, whereby surgical specialists, in conjunction with multidisciplinary teams, drive clinical decision-making. Prior literature supports a specialist-led care model that enhances patient outcomes and reduces overall health care costs and physician burnout while minimizing waste. The present article explores the feasibility of achieving a specialist-led care model in orthopedic surgery and in orthopedic or neurosurgical spine practices in the current health care climate. The shifting dynamics and pressures faced by private practitioners and employed physicians, bundled payment and cost containment strategies, and direct-to-employer contracting are examined. By building a collaborative network, a specialist-led care model will drive supply chain decisions, employ direct-to-employer contracts, improve care delivery, reduce health care costs, and assist specialists in maintaining clinical and financial independence.