Course
Specialty Care and Episodes
The course for the audience value-based care has served least: how episodes are designed and priced, the mandatory TEAM model now running in selected markets, the oncology and kidney and ambulatory specialty models, how specialists are paid inside population arrangements, and what running an episode program actually requires.
By the end of this course, you will be able to:
- Analyze an episode model by its trigger, window, inclusion rules, and accountable party
- Trace a reconciliation from spending through quality adjustment to the stop-loss and stop-gain limits
- Describe what TEAM requires of hospitals, surgeons, post-acute providers, and ACOs in the same market
- Compare the oncology, kidney, and ambulatory specialty models by what each asks a specialist to do
- Evaluate an episode program's savings claim against the known mechanism and its known limits
Episode Design and Economics
Trigger, window, inclusions, and accountability are separate choices. How target prices are built, how reconciliation actually computes, and what the evidence says bundles achieve.
TEAM and Mandatory Episodes
The largest mandatory episode model in Medicare's history began January 2026 in selected markets. What it requires, how quality moves the money, and who else it affects.
Condition-Specific Models
Oncology, kidney care, and the first mandatory model aimed at individual specialists. Three attempts to make condition management, not procedures, the unit of accountability.
Specialists Inside Population Models
Most specialists in an ACO are still paid for volume the ACO pays for. The arrangements that close that gap, the referral as the real lever, and why specialist measurement is so hard.
Running an Episode Program
Post-acute management is where the savings are and where the harm would be. Plus the cost accounting most hospitals lack, how savings get distributed, and an honest scorecard.