Myth vs Fact: Choosing the Right Specialty Care 

Short on time? Here’s what you need to know: 

• There are many common misconceptions about specialty care, usually based on member assumptions about the capabilities and quality of facilities 

• Choosing a specialist is more than meets the eye – the biggest name or the most convenient may not always lead to positive employee health outcomes 

• A dedicated referral coordination solution is the key to guiding your workforce to the highest-value specialty care 

Finding where to go for specialty care can be a confusing and stressful process. Whether your workforce lives in a rural town with minimal options, or a metropolitan area with too many to choose from, picking the best facility might feel like a gamble. The truth is, not all care is created equal, and even the best facilities for certain procedures aren’t great options for every procedure. Many might even cost more for the same or lower-quality care, even in the same area. 

In this blog, we’ll look at common misconceptions around specialty care, their impact, and what you as an employer can do to guide your people to the best care possible.

Myth #1: The biggest health system is always the best option.

Fact: Well-known heath systems aren’t always the best option for every type of specialty care. How can this be? Think of it this way: just because a facility is well-regarded for a colonoscopy, that doesn’t necessarily mean they would also be a top choice for a knee replacement. It’s simply not realistic for a facility to offer unparalleled specialty care for every type of procedure.

Many of the most well-known hospitals in the nation have low-quality, high-cost ratings for certain procedures; much of this can be attributed to market share and high overhead costs of large health systems that get passed onto the member. The reality is: many lower-cost providers consistently outperform more expensive ones in both safety and member satisfaction, leading to less unnecessary spend and better health outcomes.

Myth #2: Any specialist can treat my condition equally well.

Fact: Specialization within specialty care absolutely matters. For instance, a general orthopedic surgeon may not have the same experience with complex spinal procedures as a surgeon who exclusively performs spine surgeries. When specialists have a deep understanding of an exact condition or procedure, it tends to lead to better health outcomes. In other words, it’s not just about finding a specialist, it’s about finding the right specialist for the specific issue at hand. Choosing care based on this level of specialization can mean fewer complications and shorter recovery periods.

Myth #3: I must go to the specialist my community provider recommended.

Fact: While community primary care providers (PCP) are trusted guides, their referrals may be based on habit, proximity, health system affiliation, or limited network knowledge, not necessarily on specialty-specific performance data. If a community PCP always refers members with a specific type of condition to the same specialist, that doesn’t automatically mean it’s the highest-value option available. Defaulting to a recommended specialist without additional information can lead to poor health outcomes and future additional care that could’ve been avoided with the right match from the start. 

How Employers Can Help Their People Find the Best Care

A dedicated referral coordination solution can help guide your workforce to high-value care without extra work for your members. Using cost and quality data, care navigators connect members with the specialist that’s the best fit for their needs, while helping primary care providers streamline referrals. Even better, care navigators handle all the in-between, including scheduling, follow-ups, and record transfers. Why is this so important? When members get the right care from the start and are supported along the way, they tend to spend less, get better faster, and come back to work happier. Overall, this leads to large savings for the organization and an improved member experience they can be proud to offer their people. 

At Premise Health, our referral coordination solution is called care navigation. Through our dedicated care navigators, members can feel secure knowing they’re being guided to the highest-value option for their care with support along the way. Ready to help your workforce find the right specialty care? Learn more about care navigation here or contact us.