Specialty care is one of the biggest opportunities in healthcare spending and one of the toughest challenges. Trustees and Fund administrators need to deliver high-quality care to members while protecting Fund assets and preserving benefits for the long term. Surgery, cancer treatment and specialty drugs keep pushing costs higher. Taft-Hartley Funds need strategies that improve outcomes without shifting costs to members.
In a recent webinar with the Massachusetts Coalition of Taft-Hartley Trust Funds, John Corrigan, VP of Labor Union & Trust at Lantern, and Raymond Hwang, MD, Associate Chief Medical Officer at Lantern, discussed how Funds can take a more strategic approach to specialty care. Their message: the most effective strategies start with quality and clinical appropriateness.
When members get the right care from the right provider in the right setting, better outcomes and lower costs often follow.
Specialty Care Puts Too Much on Members
Healthcare is hard to navigate on a good day. When a member faces surgery, a cancer diagnosis or ongoing infusion therapy, it gets much harder. Members are expected to decide which provider to see, whether a recommended treatment makes sense, where to get care and what it will cost. They’re doing all of that while managing work, family and the stress of a serious health condition.
“Nothing about this is sinister. It’s simply the system that we are in, which happens to put all the burden on that member,” Dr. Hwang said.
That burden affects more than the member experience. Without guidance, members may choose a physician based on facility reputation alone, delay treatment or move ahead with a procedure without knowing whether a less invasive option exists.
For your Fund, the goal isn’t giving members access to more providers. It’s helping them make informed decisions while making sure Fund dollars go to the highest-value care. Personalized support helps members avoid unnecessary procedures, complications and downstream costs, and it protects Fund assets too.
Reputation Doesn’t Tell You Who Delivers Quality
Many specialty care programs lean on hospital brand names or broad network designations. Trustees overseeing healthcare spending need more than that. The real question is whether a member is seeing the physician best equipped to deliver the best outcome for their specific condition.
“You really can’t assume quality, even from familiar hospital names or networks. And you certainly can’t assume it based on price,” Dr. Hwang said.
A respected hospital may employ hundreds of specialists, and they don’t all deliver the same outcomes for every procedure. A surgeon who performs a high volume of knee replacements may not get the same results on hip replacements. Quality assessment can include volume by procedure, fellowship training, appropriateness, clinical protocols, complication rates, readmission rates and patient-reported outcomes.
The challenge is finding that information. “The data to assess surgeon quality on a procedure level is out there. It’s just highly fragmented, siloed and difficult to access without expertise and effort,” Dr. Hwang said. That makes quality hard to evaluate for members and for Funds that want to know members are seeing providers with proven expertise. A strong specialty care strategy closes that gap by identifying providers on measurable performance, not popularity or location.
How to Guarantee a Better Surgical Journey for Union Members
The Right Site of Care Is Different for Every Member
Site-of-care optimization is a top priority for healthcare purchasers, but lower cost doesn’t automatically mean better care. Your goal shouldn’t be moving members to the cheapest setting. It’s matching each member to the most clinically appropriate one while avoiding unnecessary spending.
“While a hospital will have more resources and services than an ASC, it is not necessarily the best setting for a given patient and procedure. Ambulatory surgery centers are a great option for many people, but not everyone,” Dr. Hwang said.
The right setting depends on the member’s health status, underlying conditions and the complexity of the procedure. Done well, site-of-care guidance makes care more convenient for members and saves your Fund money without compromising quality.
Infusion Therapy Benefits: a Growing Opportunity for Funds
As specialty drug spending climbs, infusion therapy deserves a closer look. Many therapies once given in hospitals can now be delivered in ambulatory infusion centers or, in some cases, at home. Those settings can save money and are more convenient for members. But site-of-care decisions for infusions should be driven by clinical appropriateness, not cost alone.
“Infusion reactions are a real concern, and we need to ensure patients are stable on their regimen before considering another setting,” Dr. Hwang said.
Some members require additional monitoring or support, which makes the hospital the best option. Others are good candidates for a lower-cost setting without compromising safety or outcomes. Your Fund can build an infusion strategy that balances quality, member experience and affordability.
A Specialty Care Strategy Focuses on the Right Cancer Care for Members
Cancer rarely comes down to a single treatment decision. Unlike many surgeries, treatment involves ongoing decisions about diagnosis, treatment plans, response to therapy, changes in condition and clinical trial options.
“Cancer is a journey. It involves a series of decisions that are unpredictable in both nature and timing,” Dr. Hwang said.
Traditional second-opinion programs offer value, but they capture one moment in time. Cancer keeps changing, so the evaluation has to change with it. An expert-guided approach helps members and their local physicians weigh options throughout treatment, and members can stay close to home when appropriate.
For your Fund, that means members get specialized expertise, and you use Fund resources more efficiently. Better guidance also lowers the risk of unnecessary or ineffective care.
Union Members Need Support Throughout Their Care Journeys
Even the highest-quality network falls short if members don’t know how to use it. Member advocacy belongs at the core of a specialty care strategy, not tacked on. Care Advocates coordinate appointments, collect medical records, explain treatment options and answer questions.
“The concept of picking up the phone and having someone answer who knows your name, speaks your language, knows who you are and what you’re going through really does go a long way,” Corrigan said.
For members facing major decisions, support matters as much as the clinical guidance. It can also help members see when a more conservative approach makes sense.
“Our goal is not to facilitate surgery. Our goal is also not to avoid surgery. Our goal is to facilitate appropriate care so that our members have the best possible outcome,” Dr. Hwang said.
Focusing on appropriate care helps both members and Funds. Better clinical decisions lead to better outcomes, fewer complications and more efficient use of healthcare dollars.
Begin Your Strategy by Focusing on Quality, and Savings Will Follow
Specialty care is about more than managing claims. Taft-Hartley Funds need to protect the benefits for the long term, while helping members get the right care at the right time.
The strongest strategies begin with quality, clinical appropriateness and member support. When members see highly qualified physicians in the right setting, Funds start seeing better outcomes and lower costs.
As healthcare costs keep rising, you can move past traditional network-based approaches and build a specialty care strategy that delivers better outcomes for members, a better healthcare experience and more responsible use of Fund assets.
Centers of Excellence Buyer’s Guide for Labor, Union and Trust
