Engaging Specialists In Accountable Care: Tailoring Payment Models Based On Specialties And Practice Context

Health Affairs December 21, 2023
Katie Huber, Jonathan Gonzalez-Smith, Sherrie Wang, Mark Japinga, Frank McStay, Mark B. McClellan, Robert S. Saunders

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,...

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