Specialty Care

Defining key terms:

  • Specialty Care: Health services that focus on a specific area of medicine or a group of patients with specific types of symptoms and conditions. Specialty care providers include doctors as well as other specialists such as nurses and physical therapists.
     
  • Primary Care: Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with patients and advise and treat a range of health-related issues. They may also coordinate a patient’s care with specialists.
     
  • Care Coordination: The organization of an individual’s care across multiple health care providers. Learn more -> 

What is specialty care? 

Specialty care is an area of health care focused on a specific area of medicine or specific types of symptoms and conditions. Specialty care providers (also known as specialists) include doctors as well as other specialists such as nurses and physical therapists. 

Specialty care providers address chronic (ongoing) conditions like heart disease and osteoporosis as well as acute (sudden) conditions like a heart attack or a broken bone. Patients may also see a specialist for certain preventive services, such as a mammogram or colonoscopy. 

Examples of specialty care areas include:

  • Oncology – cancer diagnosis, treatment and prevention
  • Nephrology – kidney disorders
  • Orthopedics – bone and connective tissue disorders
  • Cardiology – heart disorders 
  • Psychiatry – mental health and substance use disorder
  • Endocrinology – health conditions related to the body’s hormones

In some cases, a primary care provider may refer a patient to a specialist. In other cases, patients might seek care directly with a specialist. In either case, research suggests that when a primary care provider and a specialist coordinate care, it results in better health outcomes.

Why specialty care coordination is important for patient health

People often have multiple health issues that require the care of more than one specialist. Moreover, a specialist may only focus on a specific problem and therefore, may not consider how that problem interacts with the person’s other health issues, health-related social needs (such as food insecurity or a lack of safe housing) or lifestyle. That is why care coordination is important for achieving optimal health. Care coordination helps to ensure that all of a person’s health issues are considered and that treatment plans delivered across multiple specialists and a primary care provider will work together. 

The CMS Innovation Center tests Medicare and Medicaid alternative payment models to support better care coordination and reduce the burden on patients to manage their own health. Many of these models focus on the primary care provider, or someone in the primary care practice, serving as the care coordinator; however, some models have a specialist serving in that role, particularly if the person is in more frequent contact with the specialist than the primary care provider.

Read more about care coordination and how it supports patient health.

How coordinated specialty care can help patients: Maria’s experience

The example below illustrates how a person can benefit from coordination between primary care providers and specialists.

When Maria, a 68-year-old with diabetes, visits her primary care provider for a routine check-up, the provider notices her blood sugar levels are high despite taking her medication and exercising regularly. Maria shares that her vision has become worse so that she can no longer drive. She’s relying more on fast-food delivery, rather than preparing her own meals. The primary care provider consults with Maria’s endocrinologist, and, working together with Maria, they update her care plan. The tailored plan now includes adjusting her medication, connecting her to a healthy food preparation and delivery service, and connecting her with a nutritionist for additional, individualized support. Maria also receives a referral to an ophthalmologist and information about local transportation services. The primary care provider and endocrinologist maintain open communication to continue monitoring Maria’s progress, address any complications that arise, and adjust the care plan as needed.

CMS Innovation Center Specialty Care Models

CMS Innovation Center models that focus on specialty care include:

Additional Information

Originally posted on: May 13, 2024

< Back to Key Concepts