The Transforming Episode Accountability Model (TEAM) is here, and hospitals have a real opportunity in front of them. TEAM is an initiative that the Centers for Medicare & Medicaid Services (CMS) hopes will improve the patient experience by better coordinating care between healthcare providers.
The five-year, episode-based payment model is one of the boldest attempts yet by CMS to link financial incentives to patient outcomes. It will focus on five common and costly procedures:
- Coronary Artery Bypass Graft (CABG)
- Major Bowel Procedure
- Lower Extremity Joint Replacement (LEJR)
- Surgical Hip and Femur Fracture Treatment (SHFFT)
- Spinal Fusion
The government projects TEAM will generate $481 million in Medicare savings over five years by reducing hospital readmissions, shortening recoveries, and more smoothly coordinating care. For the more than 700 participating hospitals, TEAM will mean meeting new accountability, cost, outcomes, and quality standards for surgical care—and success will depend on using advanced technologies for end-to-end management of each episode of care.
Heightened Accountability
Hospitals that are part of TEAM will continue billing Medicare fee-for-service (FFS) next year but will also receive a target price for covered surgical episodes. If actual spending falls below that target without sacrificing quality, the hospital may earn a reconciliation payment. If they are over budget, the hospital may end up paying CMS.
CMS will evaluate the program’s impact using statistical and multivariate analyses to examine care quality, access, costs, and patient-reported experiences. Thus, to stay ahead of the curve, hospitals will need to embrace real-time performance management and treat data as a strategic asset rather than a compliance responsibility.
Eliminating Data Gaps
For TEAM hospitals, establishing a solid foundation for success requires identifying and closing data gaps, modernizing analytic capabilities, and creating an integrated view of cost and quality across episodes of care. This includes:
- Integrating and standardizing clinical and financial data. TEAM hospitals will need interoperable data pipelines that integrate clinical, claims, and cost data in standardized formats. Thus, data infrastructures should be assessed to determine if it can support these functions and integration and/or data standardization should be upgraded as needed.
- Building advanced analytics and predictive capabilities. TEAM facilities should possess the same analytical sophistication as CMS, which will examine the factors that drive variations in quality and costs across participating hospitals. For example:
- Predictive models can flag patients at high risk of readmission, spot potential cost outliers, and trigger proactive interventions before patient health worsens.
- Machine learning and AI-driven analytics can be used to forecast total episode costs, simulate performance across different scenarios, and identify which post-acute care settings offer the best balance of cost and recovery speed.
- Clinical decision support tools, dashboards, and care coordination workflows help translate insights into actions.
- Investing in team readiness and data governance. Robust data governance programs to ensure accuracy, completeness, and timeliness of data are crucial for TEAM hospitals. This includes ensuring the people who will handle the data, e.g., clinical, financial, and operational teams, are fully educated on how CMS calculates TEAM metrics and tracks performance, and how to interpret the internal dashboards that guide day-to-day decisions. Cross-disciplinary education also helps embed data-driven decision-making into daily practice.
Finally, TEAM participation can be a catalyst for broader digital transformation; building the data and analytics foundation required for success under TEAM will also create long-term readiness for other value-based care initiatives. As such, participating facilities should consider:
- Evaluating past bundled payment experience.
- Engaging post-acute and primary care partners early.
- Piloting real-time dashboards and implementing a TEAM “sandbox.”
- Benchmarking and scenario-planning using historical claims data to model potential gains or losses under TEAM’s (and other value-based care) target pricing methodology.
A Competitive Advantage
TEAM risk tracks range from no downside risk for some facilities to higher risk and reward for others, and are designed to let hospitals ease into full participation. However, even those in the lower-risk categories should treat TEAM as more than just a compliance exercise. It’s a chance to mature data capabilities and unlock future opportunities to improve clinical and financial performance.
TEAM also offers the opportunity to establish a strong foundation for sustained success as the next generation of value-based care emerges. Investing in integrated data systems, advanced analytics, and robust data governance will strengthen a healthcare organization’s position within TEAM and elevate its revenue cycle operations in the long term.
By leveraging revenue cycle analytics to comprehensively track procedural charges, evaluate reimbursement trends, and accurately forecast payments, TEAM organizations will enhance financial performance and compliance through data-driven decision-making.
Organizations that make these investments will be in a leading position as the next generation of value-based care begins.
Contact us to learn how MDaudit can support your TEAM goals.
