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Accountable care models serve as the cornerstone of value-based approaches to expand access to well-coordinated, high-quality, and longitudinal care. Specialist engagement in these models is critical given the increasing role of specialists in managing care across the patient journey, the growing importance of specialized diagnostics and early disease interventions (such as biologics and cell and gene therapies), and an increasing array of specialty care capabilities. Yet, despite their critical role in patient care, specialty care providers have had limited opportunities to engage in accountable care models to date.
Improving meaningful specialist engagement in payment reforms is critical to achieving the Centers for Medicare and Medicaid Services’ (CMS’s) 2030 goal to have most Medicare and Medicaid beneficiaries in accountable care relationships, as affirmed by the CMS Innovation Center (Innovation Center) in its 2022 specialty strategy blog. Achieving this vision requires a range of strategies that consider the various ways specialists approach patient care and the practice contexts in which they operate. Specialty care providers interact with patients at different stages in the care continuum and practice in different clinical and organizational environments. The most common type of specialty payment model so far, bundled payments for episodic and acute medical events, reflects only one component of specialists’ impact on patient care. Specialists focusing more on longitudinal condition management—for common cardiovascular conditions, inflammatory bowel disease, or degenerative joint disease, for example—lack alternative payment models that reflect the type of care they provide.