Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used.
The degree of concern about specialist-generated costs for most ACOs currently depends on the ACO’s structure. ACOs that are hospital-led or formed by multi-specialty health systems or networks may be less apt to look to specialty care for savings, except when the specialists are outside the ACO. Physician-led groups with heavy primary care participation, on the other hand, are more eager to address specialty services. That may be one reason why physician-led ACO performance tends to outstrip hospital-led ACOs.
Regardless of how they are structured, however, all ACOs will move to adopt methods of controlling both costs and patient use of specialty services. Why? Because payers are moving both Medicare and private sector ACOs toward accepting financial risk. ACOs and specialty groups must prepare for the new environment quickly.