Module 3
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.
By the end of this module, you will be able to:
- Explain what the collapse in oncology model participation reveals about voluntary model design
- Describe why kidney models ask a sector to reduce its own core revenue service
- Summarize what the Ambulatory Specialty Model will require and of whom
- Oncology Models Medicare's oncology models went from 122 practices to 23 in one generation. The collapse is the most instructive fact about them. About 6 min
- Kidney Care Models Kidney models pay to prevent the thing that generates the revenue. It is the sharpest test of whether payment reform can override an existing business model. About 5 min
- The Ambulatory Specialty Model The first mandatory model aimed at individual specialists starts in 2027. It scores cardiologists and back pain clinicians on outcomes they share with primary care. About 5 min
Module quiz
Answer all questions to see your score.
1. What does the drop from 122 practices in OCM to 23 participants in EOM illustrate?
Generous voluntary models struggle to save money because support payments consume savings. Demanding ones may save money and attract almost nobody. Mandatory models exist because that middle space kept turning out to be empty.
2. What makes oncology structurally resistant to episode payment?
A practice cannot negotiate what a novel therapy costs, and a single new agent can move a benchmark built from prior-year spending.
3. How does the Ambulatory Specialty Model differ from every episode model before it?
ASM runs 2027 through 2031 for selected heart failure and low back pain specialists. It marks the point at which the specialist stops being only an input to someone else's accountability.