Specialists Are Central to Patient Chronic Condition Care: Medicare ACOs Must Adapt to This Reality

The accountable care organization (ACO) model centers around primary care providers (PCPs) and undervalues the central role that specialists play for many beneficiaries with chronic conditions. This assumption informs beneficiary attribution methods for Medicare ACOs, which prioritize assignment of cost and quality accountability to PCPs over specialists. Yet in 2023, many traditional Medicare beneficiaries with chronic conditions did not have a PCP as their predominant provider of care, limiting ACOs’ ability to engage many beneficiaries with specialists as their predominant providers of care. To better engage specialists delivering chronic condition care, we recommend updating ACO policies to assign greater accountability for beneficiaries with chronic conditions to specialists.