October 3, 2016

Meet the newest physician specialist: the extensivist. What does an extensivist do, and why might you need one?


What Is an Extensivist?

Perhaps extensivism is not so much a specialty as a new approach to patient care. Primary care physicians, hospitalists, nurse practitioners and other advanced practice nurses have all taken on the extensivist role.

As the name implies, an extensivist extends and intensifies the usual focus of patient care. The extensivist emphasis is on complex patients with multiple illnesses, frail elderly patients, other high-risk patients, or those who may otherwise require hospitalization. These patients receive extended and more frequent visits of an hour to a day. The goal is to keep patients healthy and out of the hospital, and to ease care transitions post-hospitalization by providing concentrated care continuity during hand-offs.

Specific emphasis varies by the provider program. For example, one early adopter of the model, a medical group in the southeast, developed an extensivist program as an alternative to hospitalization when referring physicians would otherwise direct their patients to the emergency room. Meanwhile, CareMore Health System, a subsidiary of Anthem, provides an entire extensivist team, led by a hospitalist, to a panel of approximately 100 high-risk older patients. The hospitalist provides inpatient, post-acute, and outpatient care to these patients to ensure appropriate, continuous, and coordinated care.

Do You Need an Extensivist?

If you have high-risk or complex and chronically ill patients, an extensivist can help keep them healthy and out of the hospital. But under fee-for-service reimbursement this specialty will not pay for itself. Fee-for-service health plans don’t pay more for extended primary care visits, but they do pay for hospital admissions and other high acuity care.

Under value-based payments, however, extensivists are a great fit. If fully deployed, a recent report from management consultancy Oliver Wyman estimates they could save 6% of avoidable U.S. healthcare spending. Why? They:

  • Improve outcomes by providing quality care in both inpatient and outpatient settings,
  • Reduce costs from avoidable hospitalizations and other high-acuity care,
  • Increase clinician satisfaction through a focus on improved patient care, and
  • Boost patient satisfaction through in-depth provider relationships and continuous comprehensive care.

How to Provide Extensivist Care Affordably

Providing an entire extensivist team to identify and follow your high-risk patients on a regular basis can get expensive. But by leveraging existing technology that uses predictive analytics and sophisticated patient-provider communication, you can deploy the extensivist model affordably.

First, you can identify patients who have—or consumers who are at high risk for—diabetes, congestive heart failure, COPD, or asthma. Next, you can determine how best to communicate with them (mail, email, texts, mobile app) and what messages they will be most receptive to. Finally, you can use automated inter-visit solutions to educate them about their conditions, remind them of upcoming appointments, and find out how they are doing. A new Healthgrades solution even empowers your physicians to have large-scale ongoing personalized conversations with their patients about their health. It encourages manageable dialogue that builds trust and optimizes outcomes.

What is extensivism? It’s a combination of people and technology that makes sure your high-risk patients get the right care at the right time in the right setting.

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