Value-based care has become a buzzword over the past decade with early experiments in Massachusetts, followed by creating Medicare accountable care organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments.
Much of the activity in this space has focused on primary care, particularly for ACOs and ACO lookalikes. Even within multi-specialty groups and health systems, most of the accountability for driving both quality metrics and financial results has resided in primary care. While some specialties, such as orthopedics, are noteworthy for their expanding participation in bundled payment arrangements, very few specialists have experienced the disruptive changes that value-based arrangements have had on primary care practices.