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2024 marks the third year of progress on the Center for Medicare and Medicaid Innovation (Innovation Center) strategic refresh, and one of its aims is to have 100 percent of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030. Accountable care means that a doctor, group of health care providers, or hospitals take responsibility for improving quality of care, care coordination, and health outcomes for a defined group of patients based on a series of population-based metrics and cost based on a financial benchmark. Expanding accountable care will reduce care fragmentation and unnecessary costs for patients and the health system, but doing so also requires increased access to coordinated and integrated specialty care. When primary and specialty care providers collaborate across care settings, together they can deliver accountable care that best meets patients’ needs and preferences.
A comprehensive approach to accountable care must account for both primary care and specialty care. Specialty care is a critical part of the care experience and a substantial portion of overall Medicare spending. A 2021 research study shows that Medicare beneficiaries are seeing more specialists and seeing them more often than they were twenty years ago. A 2022 study suggests as many as 40 percent of Medicare beneficiaries receive care that is fragmented, with a mean of 13 visits across 7 clinicians in one year. Another study from 2018 links fragmented ambulatory care to higher rates of emergency department (ED) visits for Medicare beneficiaries with chronic conditions, finding that “beneficiaries with a moderate burden of chronic conditions appear to be at highest risk of excess ED visits and admissions due to fragmented care.”