Valendo Health

When a person has diabetes, their Endocrinologist is often the most important caregiver they have. And in fact, when a Medicare beneficiary with diabetes is regularly cared for by an Endocrinologist they do better – as evidenced by fewer ER visits and admissions to the hospital, and an average of $3,500 less spending per year on healthcare services. Despite this, Endocrinologists generally collect less than $500 per patient per year in Fee-for Service reimbursement.

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The charts below highlight these points using an Endocrinology practice we’ve done some work with as an example.

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What these charts are saying is:

The practice cared for 1,987 Medicare beneficiaries with diabetes in 2022…
…these patients utilized $37.4 million in Medicare reimbursable healthcare services…
…and the practice collected $526K in FFS reimbursement, or $264 per patient.

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However, patients who regularly saw an Endocrinologist in this practice cost Medicare $3,605 less in healthcare spending than patients who were primarily cared for by a PCP or other type of specialist.

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The goal of Value-Based Endocrinology is to put Endocrinologists more in charge of the care their patients with diabetes, and to negotiate contracts that reward them for the care improvements and cost savings they create. Another key aspect of Value-Based Endocrinology is to surround the Endocrinologist with infrastructure, including things like:

Multi-disciplinary in-person and virtual care teams
Risk stratification capabilities
Care plan development for every patient with diabetes
Data driven patient tracking tools like CGM monitoring, real time EMR and claims data, Admission, Discharge & Transfer (ADT) feeds, and Social Determinants of Health (SDoH) information

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In a recent blog post from Quintuple Aim Solutions, authors Shreya Jain and Reza Alavi, MD, outlined three key themes for navigating the transformation to value-based care in endocrinology. In future blog posts here at Valendo Health, we’ll describe more about the infrastructure required to be successful in Value Based Endocrinology contracts, as well as various options for how to structure these contracts so that Endocrinologists can be successful within these agreements.

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Please reach out anytime you’d like to participate in the discussion or see the data displayed above for your practice.

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Thank you!

Dave Terry

CEO

dave@valendohealth.com

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Read More:

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Value-Based Endocrinology Defined