Unlocking the Power of Specialty Engagement in Accountable Care
May 27, 2026
Value-based care (VBC) models are rapidly expanding across traditional Medicare, Medicare Advantage, commercial payer, and employer contracts. While years of investment in primary care have delivered meaningful gains, continued progress in value-based care will require strong partnerships with specialty care providers to support teams across the continuum of care.
Specialty care now accounts for a significant share of total cost of care (TCOC) and often determines the trajectory of a patient’s journey. Primary care and specialists must be partners in health care transformation to bolster their central roles in driving value, quality outcomes, and cost efficiency.
Over the past decade, the Center for Medicare and Medicaid Services (CMS) has developed an array of approaches that increasingly emphasize specialty care – from early cardiac and orthopedic bundled payments to more recent population-based models targeting oncology, kidney disease, and chronic conditions. Today, providers are navigating a rapidly growing and increasingly complex landscape of both voluntary and mandatory models while defining and operationalizing what truly patient-centered specialty care looks like.
Defining Patient-Centered Specialty Care
Patient-centered specialty care is coordinated across settings, clinically led, and grounded in evidence-based pathways. It requires specialists to operate as true partners, aligned with primary care and payers, supported by shared data, and engaged through incentives that reflect real clinical impact.
This shift is both structural and cultural. Success depends on peer-led engagement, provider mentorship, and shared vision across clinical and operational leadership. When this work is driven by clinicians and reinforced by shared goals, it becomes scalable across settings, organizations, and programs.
Ultimately, success depends on a shared commitment to solving challenges, reconciling differences, and defining high-value care.
Operationalizing Best Practices
To support this evolution, NAACOS developed the Specialty Engagement in Accountable Care Toolkit, a practical, actionable resource shaped by leaders who are providers, payers, specialists, and operational and analytical experts. More than a framework, this toolkit is designed to share best practices that drive implementation.
The toolkit organizes real-world scenarios into clear care accountabilities and helps organizations clarify priorities, surface barriers, and identify concrete next steps. It also enables stakeholders to co-design incentives that are transparent, achievable, and aligned to meaningful clinical outcomes. Through self-assessments and decision-support tools, organizations can evaluate readiness, assess infrastructure capabilities, and make informed decisions before entering or expanding into specialty care models.
This toolkit is designed for organizations at every stage of readiness, offering adaptable guidance that can be tailored to unique markets, patient populations, and organizational structures. It is designed to equip stakeholders with the tools needed to translate strategy into action.
Improving Specialty Care Model Design to Enhance Sustainability
In some cases, the recent proliferation of new models by CMS has created mounting financial pressure without introducing meaningful opportunities for improvement, ultimately undermining long-term sustainability and engagement.
To move forward, models must evolve and address several areas to strengthen care delivery while enabling sustainable participation:
- Focus on meaningful impact: Models should target areas that truly improve care delivery and patient experience, rather than prioritizing marginal cost reductions with limited clinical value
- Provide a viable pathway to participation: Specialists must have sufficient time to build infrastructure, gain experience, and transition into risk without being exposed to undue financial burden, particularly in safety-net and rural settings
- Ground models in value-based care principles: This includes realistic benchmarks, achievable savings opportunities, meaningful incentives, and quality measures that align with what health outcomes and care specialists can directly influence
- Reduce fragmentation and improve alignment: Models should complement – not compete with – existing value-based care structures such as accountable care organizations and total cost of care arrangements. Greater standardization across models is essential to reduce administrative burden and enable scalable, coordinated care delivery
Seeing a Future for Specialty Engagement in Accountable Care
The opportunity is clear and so is the urgency. As CMS continues to expand models that emphasize specialty care, the path forward requires getting the fundamentals right: alignment, feasibility, and meaningful engagement.
Done well, this is more than a policy shift. It is a transformation that can strengthen care coordination, deepen provider partnerships across the care continuum, and ultimately deliver what matters most – better outcomes and experiences for patients.