In a healthcare system already stretched skinny by rising prices, employees burnout, and fragmented post-acute care, the Facilities for Medicare & Medicaid Providers (CMS) is upping the ante.
Starting January 1, 2026, the Remodeling Episode Accountability Mannequin (TEAM) will grow to be necessary for hospitals in 797 core-based statistical areas (CBSAs) throughout the U.S.
This isn’t one other pilot or voluntary various cost mannequin. It’s the newest in a collection of CMS efforts to tie reimbursement to worth. This time hospitals and their care companions will probably be held accountable for the whole price and high quality of care all through an episode.
Regardless of its scope and implications, TEAM has flown considerably underneath the radar. However with 2026 only a few quick months away, now could be the time for schooling, planning, and partnership.
What Is the TEAM Mannequin?
TEAM is a five-year necessary bundled cost mannequin centered on 5 surgical episodes:
- Decrease extremity joint alternative (LEJR)
- Surgical hip and femur fracture remedy
- Spinal fusion
- Coronary artery bypass graft (CABG)
- Main bowel procedures
Hospitals in chosen CBSAs will probably be held financially liable for all Medicare Half A and B prices related to these procedures – from the preliminary hospital keep by 30 days post-discharge. That features expert nursing, rehab, house well being, doctor visits, and readmissions.
Relying on the participation observe, hospitals could resist 20% draw back threat primarily based on whether or not their whole episode spending exceeds CMS’s goal value and the way they carry out on outlined high quality measures.
Why TEAM issues
Many hospitals have expertise with bundles like BPCI Superior and CJRhowever TEAM provides complexity by tightening the timeline and deepening accountability. It additionally introduces new expectations round main care referrals, fairness reporting, and post-discharge care coordination.
Hospitals that don’t put together threat falling behind – not solely financially, however operationally and clinically. Fortuitously, there are clear actions well being programs can take now to set themselves up for achievement.
1. Perceive your episode threat
Hospitals ought to start by analyzing their historic efficiency throughout the 5 TEAM episodes. Which procedures drive probably the most post-acute spend? The place are readmissions or problems highest? What’s your baseline for patient-reported outcomes?
Hospitals that participated in BPCI-A or CJR could have already got this information. Others might want to depend on inner claims evaluation or work with exterior companions to simulate potential positive aspects and losses underneath TEAM’s pricing mannequin.
Understanding how your efficiency compares to nationwide benchmarks (and the way high quality scores are normalized) is crucial for forecasting monetary publicity.
2. Map your post-acute community
Considered one of TEAM’s central goals is lowering post-acute fragmentation, significantly within the transition from hospital to house. Hospitals should get a greater deal with on what occurs after discharge.
This implies mapping your referral patterns, assessing outcomes throughout post-acute suppliers, and figuring out the place the most important gaps exist. Which SNFs, house well being companies, or rehab services are persistently delivering high quality outcomes? Which of them drive avoidable utilization or readmissions?
Take into account establishing most popular supplier relationships that embrace information sharing and consequence expectations. Briefly, deal with post-acute companions much less like distributors and extra like extensions of your care workforce.
3. Construct (or purchase) episode-level visibility
You may’t handle what you’ll be able to’t see. Success underneath TEAM will rely upon hospitals’ capacity to watch affected person progress in actual time – by surgical procedure, discharge, and restoration.
Hospitals ought to prioritize episode monitoring infrastructure that pulls collectively EHR information, claims exercise, and real-time affected person interactions. This contains the flexibility to flag threat elements, immediate care interventions, and spot delays or deviations from care pathways.
It’s additionally essential to notice that TEAM isn’t nearly price containment. It’s about high quality.
Your system ought to seize and report on TEAM’s core high quality metrics, together with readmission charges, affected person security indicators, and patient-reported outcomes for LEJR episodes.
4. Align and prepare your care groups
TEAM introduces new workflows and accountability requirements that reach past the hospital partitions. Scientific and administrative groups alike should perceive:
- The scope and implications of TEAM
- Their function in documenting and delivering high-quality care all through the episode
- How main care referrals and care coordination have an effect on reimbursement
Hospitals also needs to put together discharge planners, case managers, and navigators for extra lively roles in managing sufferers by care transitions.
5. Don’t wait to interact companions
Lastly, whereas the primary efficiency yr contains an upside-only observe for a lot of hospitals, that cushion will fade shortly. Well being programs that wait till late 2025 or early 2026 to implement modifications threat lacking the chance to course-correct.
Whether or not you associate with care coordination distributors and/or built-in post-acute networks, search for options that improve your inner capabilities.
Your aim needs to be to create a linked, patient-centric method that spans scientific, monetary, and operational wants.
The way forward for cost reform
CMS has made it clear: cost reform is right here to remain. TEAM is a sign that bundled care is now not a take a look at mattress.
For hospitals and well being programs, the problem is steep, however so is the chance. TEAM presents a framework to ship extra coordinated, cost-effective, and patient-focused care. Those that put together now will probably be much better positioned to thrive in a value-based future.
If you happen to haven’t began your readiness planning, now could be the time. TEAM is coming. Will you be prepared?
Photograph: gustavofrazao, Getty Pictures
Kyle Cooksey is Chief Government Officer of Deacon Well beingmain the corporate’s development as a value-based care platform centered on specialty care price containment and improved affected person outcomes. With over twenty years of healthcare expertise, Kyle is a seasoned govt recognized for driving innovation in high-cost, high-need areas. He makes a speciality of aligning operational methods with buyer must ship measurable outcomes. At Deacon, he’s scaling a confirmed, human-centered navigation mannequin to satisfy the increasing demand for specialty value-based care options.
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