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Both the greatest strength and weakness of the ACO shared savings (MSSP) model is its focus on primary care, particularly chronic disease. ACOs have put patients with diabetes, hypertension, and other conditions usually handled through primary care physicians at the center of care coordination, population health, and care management. But as CMS Value-Based Care’s central goal has shifted to cost control, ACOs will need to broaden scope to optimize specialty care. TEAM (Transforming Episode Accountability Model), a large risk-based payment model coming online in January 2026, offers the perfect opportunity to get started.
Specialty services drive about 40 to 60 percent of total health care costs. Without more involvement in specialty care, ACOs won’t be able to expand savings enough to weather the future. As the ACO model incorporates an increased level of downside risk, ACOs will need to address the huge cost of specialty care by making sure they can direct care to specialists with the highest performance. But first they’ll need to identify who those are.
To create incentives for better cost performance, CMS has recently created two payment models to address specialty costs directly and provide tools for ACOs to leverage specialty care. Those tools are evident in two specialty risk models: TEAM and Ambulatory Specialty Model (ASM). Let’s take a closer look at TEAM, which has progressed to the announcement of participants and implementation.