The CMS Innovation Center’s Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 Update

A comprehensive approach to accountable care must account for both primary care and specialty care. Specialty care is a critical part of the care experience and a substantial portion of overall Medicare spending. A 2021 research study shows that Medicare beneficiaries are seeing more specialists and seeing them more often than they were twenty years ago. A 2022 study suggests as many as 40 percent of Medicare beneficiaries receive care that is fragmented, with a mean of 13 visits across 7 clinicians in one year. Another study from 2018 links fragmented ambulatory care to higher rates of emergency department (ED) visits for Medicare beneficiaries with chronic conditions, finding that “beneficiaries with a moderate burden of chronic conditions appear to be at highest risk of excess ED visits and admissions due to fragmented care.”

To drive more person-centered care, specialists must be included on the path to paying for value. To tackle this challenge, the Innovation Center has laid out a comprehensive specialty strategy to test models and innovations that support access to high-quality, integrated specialty care across the patient journey.