Specialty Care Models

Specialty VBC activity is clustering around mandatory and bundled-payment designs, with provider groups pushing back on operational readiness: the Texas Medical Association is urging CMS under the Trump administration to delay a mandatory specialty model, signaling continued tension over downside-risk timing, attribution, and specialty-practice infrastructure (Becker’s ASC). At the same time, oncology and kidney stakeholders are emphasizing earlier intervention and actuarially sound episode design—community oncology bundling, oncology VBC modeling, and NKF’s focus on CKDintercept all point to a shift from procedure- or drug-centric payment toward longitudinal specialty management, risk stratification, and avoidable progression/spend reduction (NKF). For ACOs and payers, the through-line is that specialty integration is becoming less optional: success will depend on aligning primary care referral pathways, specialist incentives, and data-sharing around high-cost conditions before CMS or commercial models impose tighter financial accountability.