Specialty Value Based Care: A 2024 Checklist for Survival and Success

Value based specialty care is essential to address the bulk of total cost of care and quality opportunity that primary care can only indirectly address. Recognizing the need, the Center for Medicare and Medicaid Innovation (CMMI) has established multiple specialty-focused models, including for cancer, kidney disease and bundles for primarily surgical care. Recently added were new models for dementia and severe behavioral health/substance use disorder conditions. Specialty oriented venture-backed companies continue to emerge, offering their products to health plans, employers and directly to consumers. Yet the gap between the promise of these models and broad adoption by patients, payers and employers is still wide. To be successful in this complex environment, high performing models will need to deliver a scalable, seamless clinical infrastructure; a high ROI engagement engine and a compelling payer value proposition.