Specialty Care

The Specialty Care Reform Pathway:  
Developing Data Infrastructure, Measures, & Payment
Models to Support Accountable Care 

Specialty care providers, with training and focus in specific areas of medicine beyond primary care, are increasingly playing a major role in managing care across the patient journey. However, they currently have limited opportunities to engage in accountable care models. Improving specialist engagement in accountable care reform and adoption is critical to innovation, increasing access and affordability, and delivering better quality and health outcomes. 

556k

1. 566,000: number of active specialty clinicians in the U.S.  

70%

2. 70%: share of health care expenditures attributed to specialty care  

28%

3. 28%: share of Americans who face barriers accessing specialty care 

60%

4. 60%: approximate share of specialty clinicians participating in value-based care payment models 

Citations: 

1. Number of active specialty physicians in the U.S. in 2025, by field of specialty 

2. Current Value-Based Care Models Need Greater Emphasis on Specialty Care 

3. Barriers accessing specialty care in the United States: a patient perspective 

4. Who participates in value-based care models? Physician characteristics and implications for value-based care 

Advancing Value-Based Specialty Care 

The Accelerator aims to expand opportunities for specialist participation and engagement in accountable care. Efforts will focus specifically on cardiovascular (CV) and musculoskeletal (MSK) care, who comprise a significant portion of Medicare spending and often play a critical role in managing chronic conditions. We aim to advance CV and MSK care in Medicare Advantage and Traditional Medicare by strengthening primary-specialty care collaboration, improving patient outcomes, and increasing accountability in providing guideline-concordant care. The initiative prioritizes:  

Assessing the challenges and successes with currently integrating specialists in total cost of care models. 
Identifying solutions to challenges that prevent CMS and other payers from engaging specialists in accountable care.  
Collaborating with key stakeholders to gradually build transparent, standardized specialty care models that enable effective data sharing. 
Developing a clear, stepwise policy approach to build trust, align incentives, and encourage adoption of accountable specialty care among key stakeholders.