5-Minute Summary: Value-Based Care: Orthopaedic Surgeons Are a Paradigm Shift Away From Enabling a Specialist-Led Care Model

Musculoskeletal (MSK) care sits at the center of the shift toward value-based care. As one of the highest-spend and highest-variation categories in healthcare, MSK represents one of the largest remaining opportunities to meaningfully reduce total cost of care and enhance patient outcomes. Orthopaedic and spine surgeons (specialists) stand at a critical inflection point: They can either lead the redesign of MSK care delivery across the entire patient journey or be relegated to procedural technicians within systems designed by others.

Recent federal policy signals, including CMS’ TEAM, ACCESS, and Ambulatory Specialty Care models, make it clear that specialty-driven accountability is no longer optional. These models accelerate the shift from fee-for-service and surgical episode-centric decision-making toward population-level clinical governance and at-risk accountability.

This commentary argues that Specialist-Led value-based Care is a sustainable path forward for MSK care. Surgeons possess unique episode-level insight, clinical authority, and the ability to influence both upstream and downstream utilization and long-term patient outcomes. When supported by data transparency, aligned incentives, and infrastructure, MSK surgeons can drive meaningful improvements in quality, access, and affordability.

Conversely, failure to lead this value-based care evolution could result in solutions that erode specialist autonomy, fragment care, and diminish the specialist’s unique MSK expertise. The window of opportunity is narrow, but the potential impact is profound: Orthopaedic and spine surgeons are one paradigm shift away from solidifying their leadership role in the future of MSK care delivery.