Accountable Care Organization Initiatives to Improve the Cost and Outcomes of Specialty Care

Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have made significant investments in primary care, practice-based care management infrastructure, enhanced care transitions, and post–acute care management. However, relatively few have undertaken comprehensive initiatives to improve the cost and quality of specialty care. For example, one early study of ACOs found little attention devoted to surgeons or surgical care. As ACOs mature, they are paying more attention to managing specialist services. Specialists account for approximately 70% of spending for outpatient office visits in the US, and they frequently prescribe expensive diagnostic services, procedures, and drug regimens.