Specialty Payment Models
Expert articles and analysis related to specialty payment models.
AI Summary — Last 30 Days
CMS specialty-model strategy is shifting toward more mandatory or risk-bearing episode and condition-specific designs—especially CJR-X, TEAM, Kidney Care Choices, and the new LEAD ACO model—while stakeholders are pressing for clearer financial methodology, stop-loss protections, and alignment with MSSP before committing capital and participant TINs. The immediate strategic tension is that ACOs and specialty partners must decide whether LEAD’s prospective, higher-risk design offers a better path than MSSP, even as kidney-care results from Interwell and Strive reinforce the case for earlier identification, multidisciplinary care, and risk-aligned specialty enablement. Orthopedic episode models are also moving back to the foreground, with hospitals and conveners preparing for CJR-X and TEAM using data-driven cost, quality, and discharge-management strategies while urging CMS to address underpayment and measurement burden (Wakely on LEAD risk choices; Premier on TEAM and CJR-X).
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