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Healio
ByCasey Tingle
Fact checked byMindy Valcarcel, MS

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April 23, 2025
6 min read
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Q&A: Longitudinal Patient Experience allows specialists to enhance overall care pathway

ByCasey Tingle
Fact checked byMindy Valcarcel, MS

Key takeaways:

  • The Longitudinal Patient Experience was proposed to combat challenges faced by hand surgeons.
  • Instead of a fragmented patient journey, the Longitudinal Patient Experience provides structured pathways for care.

For more than a decade, CMS has aimed to improve patient outcomes and reduce the overall cost of care by implementing value-based care models.

Although it has been believed that primary care should lead value-based care initiatives, musculoskeletal care is a significant driver of higher costs, and previous initiatives focused on total joint arthroplasty have shown reduced cost when the specialist alongside a multidisciplinary team align on optimized protocols and care pathways. However, unforeseen consequences, such as low reimbursement, pricing differences between facilities, non-reimbursed administrative burden and documentation, have created a lack of enthusiasm among orthopedic surgeons.

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But a tool within value-based care, known as the Longitudinal Patient Experience (LPE), may provide both patient-centered care and cost savings with the specialist at the forefront of clinical decision-making. According to the literature, an LPE is “a holistic, dynamic care plan that documents important disease prevention and treatment goals and standardizes workflows.” An LPE creates a better cost of care model by working backward, starting with aligning the patient care team around the patient’s goals and preferences with the specialist at the helm.

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Healio spoke with Dana Jacoby, MBA, president and CEO of Vector Medical Group, and Marney F. Reid, CEO and founder of Marney Reid Consulting LLC and executive committee board member of the Foundation for Physician Advancement, about how the implementation of an LPE may improve the delivery of health care in orthopedic hand surgery.

Healio: How have health care delivery models been impacted in recent years?

Jacoby: In recent years, health care delivery has undergone significant transformation, driven by COVID-19 as well as increased mergers and acquisitions among physician groups, hospitals and private equity platforms. These shifts have fundamentally altered care logistics, and yet patient care models have not been streamlined for optimized continuity of care.

Primary care has been positioned as the gateway to the health system, guiding patients through their care journey. However, specialists — who drive the highest-cost interventions — have been tasked with implementing value-based care models without the proper support, infrastructure and financial incentives that adjusting protocols and care pathways have required. While value-based care sounds promising at a high level, its execution has placed considerable strain on the system. For effective implementation, specialists need to be at the forefront of care to ensure that cost management strategies align with real-world clinical practice.

Healio: Are there any areas in orthopedics specifically being impacted by value-based care?

Reid: I would say the first group that made a true impact were the hip and knee arthroplasty surgeons. When the Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement models were implemented, that may have been the first time surgical specialists were asked to look at the whole episode of care. The results demonstrated huge variability in care and costs, and that a lot of waste could be extracted simply by changing previous standards of care. This was a great thing, and when surgeons led cohesive multidisciplinary teams for the betterment of patient care and cost reduction, value-based care had a big win. Then spine surgery followed to an extent. However, spine pathology is much more complex than hip and knee replacements. In spine surgery there are many ways to treat the same patient and pathology that standardized pathways are not as easy to define as hips and knees.

Healio: What is an LPE and how may it improve the delivery of health care?

Jacoby: An LPE is a comprehensive, dynamic approach to patient care that integrates disease prevention, treatment goals and ongoing management across the entire care continuum. Unlike static clinical guidelines, an LPE focuses on the patient’s overall health objectives while aligning provider goals and addressing gaps in communication from initial intake through follow-up care.

For orthopedic hand specialists, this model is particularly important. While electronic medical records facilitate documentation, true longitudinal care depends on the active participation of the right providers at each stage so everyone can play at the top of their licensure. By analyzing key patient touchpoints and working backward, an LPE can enhance care coordination, improve patient outcomes and, ultimately, contribute to a more cost-effective health care model.

Healio: How can an LPE be implemented in a practice?

Reid: What we are seeing now, especially with value-based care and with large primary care provider groups in at-risk models, is they manage that covered life for all disease states, whether that be hand or knee arthritis or spinal degenerative diseases. When we look at an LPE, we put the specialist back into the driver’s seat alongside a cohesive multidisciplinary team. The specialist participates along the entire care continuum even if the patient is not immediately indicated for surgical intervention. An LPE also promotes proper reimbursement to the physician and other care team members for the adjustment in their pathways and enhanced outcomes provided through this care.

I think many surgical specialists would implement an LPE if current reimbursement models did not make this time and cost prohibitive to the care teams.

Healio: What should be considered during implementation of an LPE care plan?

Jacoby: Successful implementation of an LPE requires optimizing care teams and ensuring that each provider operates at the top of their licensure. Transparent, bidirectional communication is critical, allowing every member of the care team to identify inefficiencies and advocate for needed adjustments. Specialists, in particular, play a central role, and if administrative pressures are misaligned, the burden cascades downstream, affecting nurses, medical assistants and, ultimately, patient care. Compressed consultations and rushed intake processes will erode the quality of the patient experience.

A truly effective LPE model follows patients throughout their entire care journey, using both virtual tracking and data-driven insights. By analyzing these touchpoints retrospectively, health care teams can refine processes for long-term efficiency and consistency. However, achieving this requires a bottom-up approach rather than top-down mandates. Imposing rigid efficiency models without provider buy-in leads to resistance and workarounds, undermining the intended benefits.

Building an LPE the right way takes time but yields lasting improvements in both cost and communication. When specialists lead care team coordination with transparent, open communication, the system becomes more sustainable, enhancing both patient outcomes and overall health care efficiency.

Healio: What advice would you provide to specialists when implementing this practice?

Reid: It takes a lot of investment in technology and someone stepping back from it all to look at the patient and pathology from a holistic picture instead of fee-for-service model, which a lot of specialists are still ingrained in. The administrative aspects of running a business have put a lot of pressure on clinical providers and their support staff who have been hit with many different changes, such as EMRs, the rise of labor costs, the decline in reimbursement, the shortage of medical supplies, global pandemics, etc. Where we are seeing LPE care pathways and specialist-led care win is in practices with the capital, technology, dedicated staff and other needed resources to look at and fill the gaps around the patient care pathway.

The best advice we can give to specialists is to put yourself into a position where you are in a group or have a partner that sees the big-picture benefits of investing in these resources and making the change now, so you can set yourself up to continue being at the front end of patient care, instead of continuously pushed down and almost commoditized, which is the way value-based care is going now.

Healio: Are there other ways that delivery of health care could be improved?

Jacoby: Starting off with increasing transparency across all aspects of the system and ensuring that every provider operates at the highest level of their licensure is a good start. Workforce shortages, physician burnout and financial pressures have driven large-scale mergers, but addressing these challenges requires more than consolidation. Retention and support for health care professionals must be prioritized, with better access to models and resources that enhance efficiency and well-being. In addition, fostering innovation is key. Health care operates within rigid systems, and truly disruptive models need time to take effect. By allowing innovation to reshape outdated structures, the industry can create meaningful, lasting improvements in care delivery.

References:

For more information:

Dana Jacoby, MBA, can be reached at djacoby@vectormedicalgroup.com.

Marney F. Reid can be reached at reidmarney1029@gmail.com.

Sources/Disclosures

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Source:

Healio Interviews

Disclosures: Jacoby and Reid report no relevant financial disclosures.

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patient care
value based care
 

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