Skip to content

A Value-Based Model for Managing Specialty Care

Designed to influence the decisions that shape specialty care cost, quality, and outcomes.

A Partnership Model Built for How Plans Operate

Specialty care is one of the fastest-growing areas of healthcare spend and among the most difficult to manage. Many management approaches rely on fragmented networks, disconnected clinical programs, and oversight that occurs after costs have already been incurred. The result is limited influence over outcomes, inconsistent provider engagement, referral leakage, and avoidable spend.

Emboss Specialty addresses these challenges through a value-based specialty management model that aligns provider networks, reimbursement, clinical programs, referral pathways, and specialty drug management around shared performance goals. By connecting these components within a single framework, health plans gain greater visibility, accountability, and influence over specialty care decisions across the entire episode of care.

Our model is designed to adapt to how each health plan chooses to operate. We can assume full clinical, network, financial, and operational responsibility for a specialty, or provide selected services through modular engagements that complement existing internal capabilities.

What remains consistent is the model itself: lower cost, better quality, and strong provider alignment, delivering up to 30% savings.

AdobeStock_596428788_female_provider_female_Patient_general

Four Drivers of Alignment

Icon_People Health Shield

Value-Based
Provider Networks

Aligning reimbursement, quality, and provider incentives to support high-value care.

Icon_Healthcare Hands

Clinical
Accountability

Evidence-based programs that promote appropriate care and consistent outcomes.

Icon_Organizational Hierarchy Chart

Referral
Management

Influencing care pathways to reduce leakage and improve specialty care performance.

Icon_Medicine Pill Bottle

Specialty Drug Management

Optimizing specialty drug utilization through evidence-based pathways.

How Value-Based Specialty Care Works

Value-based specialty care succeeds when provider reimbursement, clinical performance, referral decisions, and utilization management work together rather than independently.

Emboss Specialty creates that alignment through integrated specialty management programs that connect provider incentives, clinical accountability, referral management, and specialty drug strategies within a coordinated operating model. Providers are rewarded for delivering efficient, high-quality care. Clinical programs support evidence-based decision-making. Referral pathways encourage clinically appropriate, cost-effective care settings and specialist engagement. Specialty drug management guides utilization and treatment decisions before unnecessary costs are introduced.

Together, these elements help health plans improve quality, reduce referral leakage, manage specialty spend, and achieve measurable results across complex specialties.

Interested in how this model is applied across eye care, dermatology, therapy, sleep, and other specialties? Explore Our Solutions →

AdobeStock_375834185

A Proven Operating Foundation

At the foundation of our model is a mature operating infrastructure that provides reliability, compliance, and consistency across every engagement.

Credentialing, claims administration, quality programs, provider services, and reporting capabilities are tightly integrated and governed by rigorous accreditation and security standards, including NCQA and HITRUST. These capabilities provide the structure that allows valuebased networks, clinical programs, referral management, and specialty drug strategies to operate as a coordinated system.

This foundation enables health plans to expand specialties, enter new markets, and support growth while maintaining operational control and performance consistency.
iStock-471920449_meetings_group_diverse_adult_exec

HITRUST r2 Certified  •  SOC 1 Type II Compliant  •  NCQA Accredited