31 Jul HCTTF Recommendations on Specialty Integration in Value-Based Care

HCTTF developed recommendations for the Center for Medicare & Medicaid Innovation (CMMI) to integrate specialty care into alternative care models. This issue brief summarizes current CMMI models that include specialists, shares insights from private-sector specialty arrangements, and recommends opportunities for CMMI to expand these offerings, including:

1. 1. 1. Total Cost of Care Models: Refine existing longitudinal total cost of care arrangements for nephrology and oncology, and launch a voluntary model for congestive heart failure.
      2. Sub-capitation Arrangements for Accountable Care Organizations (ACOs): Support ACO specialty integration by allowing all ACOs bearing global risk to pursue sub-capitation with specialists. In addition, ACO models should include high-needs tracks and patient cost-sharing waivers to improve affordability.
      3. Key elements for All Models: Create consistent frameworks for model participants related to quality measures, benchmarking, risk adjustment, and other key aspects of model design.

The brief includes a flow chart to help payers and risk-bearing organizations tailor value-based arrangements to a given specialty.

View the Policy Brief Here