The evolution of value-based care in the specialty care space has been dominated by the emergence of episode-based payment models. Although some of these episode-based models have demonstrated cost savings, their standalone and payer-specific nature poses challenges for cohesive health system planning. They often lead to ineffective referral management, a lack of coordination, and dysfunction among members of the care teams. To achieve real accountable care for patients, strategies to align incentives across both primary and specialty care in a payer-agnostic manner and achieve true care coordination is a necessity. Specialty care providers now have the opportunity to manage the total cost of care for their patients leading to more affordability and improved care quality, especially for patients with comorbidities. Despite the proven outcomes, standing up these models aren?t without hurdles, fee-for-service is a hard habit to break. Further, technological barriers, bureaucratic mazes, and data interoperability issues pose significant challenges. These specialty care leaders are feeling risky, so bring on the challenge!