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Specialty Care

The Specialty Care Reform Pathway

Developing Data Infrastructure, Measures and Payment Models to Engage Specialists in Accountable Care 

Specialty care providers, with training and focus in specific areas of medicine beyond primary care, play a major role in managing care across the patient journey and account for a majority of health spending. 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. 

By The Numbers

566,000

number of active specialty clinicians in the U.S., far outnumbering primary care physicians at fewer than 270,000 ¹

70%

share of health care expenditures attributed to specialty care  ²

28%

share of Americans who face barriers accessing specialty care ³

60%

approximate share of specialty clinicians participating in value-based care payment models ⁴

  1. Number of active specialty physicians in the U.S. in 2025, by field of specialty; Number of primary care providers in the U.S. in 2022 

  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 

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Advancing Value-Based Specialty Care 

The Accelerator aims to expand opportunities for specialist participation and engagement in accountable care, with a focus on particular specialty areas including 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. 

Duke-Margolis Project Team 

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Rachel Bonesteel, MSc

Senior Policy Analyst

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Inga Morken

Policy Research Assistant

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Frank McStay, MPA

Assistant Research Director

West Health Project Team 

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Mark Japinga, MPA

Associate Director, Health Policy

Interested in our work?

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