Specialty Provider Shortage Strategies: How Plans Fill Critical Gaps

The Specialty Access Problem

Specialty provider shortages are not a future challenge for health plans — they are a present reality that shapes network adequacy strategy across every MA market. The Association of American Medical Colleges projects shortfalls of up to 86,000 physicians by 2036, and the specialties most affected — psychiatry, neurology, rheumatology, geriatric medicine, and primary care in underserved areas — are precisely the specialties where CMS requires adequacy demonstration and where member access is most clinically critical.

Health plans that wait for the market to solve specialty shortages through organic supply growth are not strategic — they are reactive. Plans that build systematic specialty gap-filling strategies achieve adequacy in more markets and maintain it more consistently over time.

Know Your Gaps Before Outreach Begins

The starting point for any specialty gap-filling strategy is a clear map of where adequacy is at risk by specialty type and county. Not all specialty gaps are equal: a cardiology gap in a county with a high prevalence of heart disease is a different priority than a rheumatology gap in a county with a young, healthy member population. Prioritize gap-filling investment based on:

• Clinical priority: which specialty gaps create the most significant member access risk given your population health profile?
• Regulatory impact: which specialty gaps are most likely to generate CMS deficiency notices or affect Stars measures?
• Geographic concentration: are the gaps clustered in specific counties where a single provider contract would close multiple gaps?
• Market solvability: where are there available providers who are not yet contracted but who could realistically be recruited?

Strategy 1: Hospital System Specialty Clinics

The most efficient specialty gap-filling approach in many markets is contracting with hospital system-owned specialty clinics rather than individual specialist physicians. A single hospital system contract may include cardiologists, neurologists, endocrinologists, and oncologists across multiple clinic locations — effectively closing multiple specialty gaps with one negotiation. Hospital system specialty clinics also provide geographic distribution advantage: systems often operate satellite clinics in suburban and rural communities, providing access points that individual physician practices do not.

The tradeoff is that hospital system negotiations are complex and often slow. Engage hospital system strategic partners early in the network build cycle, and be prepared for negotiations that take longer than physician practice negotiations.

Strategy 2: Multi-State Group Practices

Specialty group practices that operate across multiple states or regions — particularly in behavioral health, radiology, and certain surgical specialties — are valuable network partners for plans operating multi-state portfolios because a single master contract can cover providers across multiple service areas. These groups often have established credentialing infrastructure and standardized contract templates, which can accelerate the contracting and credentialing cycle compared to individual physician negotiations.

Strategy 3: Itinerant and Rotating Specialist Programs

In rural and frontier markets where specialists do not practice permanently, the most effective access strategy is often coordinating itinerant specialist programs — arrangements where specialists travel to rural locations on a scheduled rotation to see patients. This model is well-established in fields like oncology, orthopedics, and certain surgical specialties, and CMS has clear guidance on how itinerant arrangements can count toward adequacy when properly documented.

Plans can play an active role in facilitating these arrangements: convening rural hospitals and specialist groups, providing financial support for travel and logistics, and coordinating scheduling across multiple rural sites to make the visit schedule viable for the specialist.

Strategy 4: Telehealth Specialty Networks

For specialty types where CMS permits telehealth to count toward adequacy — and for building supplemental access that supports waiver applications where it does not — telehealth specialty networks are an increasingly important gap-filling tool. Tele-psychiatry, tele-neurology, and tele-dermatology networks have matured significantly since the pandemic-era telehealth expansion and now offer plan-contracted arrangements that include provider credentialing, scheduling infrastructure, and member-facing access tools.

Evaluate telehealth specialty vendors on provider supply breadth, credentialing rigor, and the member experience they deliver — including technology accessibility for older Medicare beneficiaries who may not be comfortable with video platforms without support.

Strategy 5: Mid-Level Practitioner Utilization

CMS permits certain advanced practice providers — nurse practitioners, physician assistants, and certified nurse midwives — to count toward adequacy in specific specialty type categories. In markets where physician supply is constrained, building a network that includes a deliberate mix of physicians and APPs can achieve adequacy that pure physician recruiting cannot.

Understand which specialty types CMS allows APPs to satisfy, and build your provider recruitment targets accordingly. This is particularly relevant in primary care, women's health, and behavioral health, where NP and PA supply often substantially exceeds physician supply in rural markets.

Documentation and Ongoing Management

Specialty gap-filling strategies produce contracted providers who need to be maintained in the network over time. Specialty providers — particularly those in shortage fields — are highly mobile and have many contracting options. Maintaining relationships, monitoring contract renewal dates, and identifying retention risks before they result in terminations is as important as the initial recruitment effort. Plans that recruit successfully but do not invest in provider relationship maintenance find their specialty networks degrading year over year, requiring constant re-recruitment effort.