In the challenging landscape of healthcare, where numerous pressures such as rising costs and staff burnout persist, the Centers for Medicare & Medicaid Services (CMS) have announced a formidable shift. With the upcoming mandate of the Transforming Episode Accountability Model (TEAM), starting from January 1, 2026, hospitals and healthcare systems across 797 core-based statistical areas (CBSAs) in the U.S. face a new paradigm. It is no longer a matter of choice but a necessity—will hospitals be ready to meet the challenges head-on?
A New Era of Mandated Payment Models in Healthcare
The mandatory status of the TEAM Model marks a significant departure from previous voluntary payment models like the Bundled Payments for Care Improvement (BPCI) Advanced. This shift signifies a firm commitment by CMS to integrate value-based care throughout the delivery system. The model targets five core surgical episodes and holds hospitals accountable for both the cost and quality of the care provided. This drive for accountability aligns with larger healthcare trends, such as cost containment and quality enhancement, signaling a pivotal turn in reimbursement strategies.
Recent trends highlight an increasing geographical and financial impact, placing substantial importance on readiness. Hospitals must align with shifting models that focus on accountability and seamless care coordination throughout patient treatment episodes.
Dissecting the TEAM Model’s Core Elements
TEAM encompasses five surgical episodes: lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. Challenges lie in meeting heightened accountability standards on cost, quality, and continuity of care that follow these procedures. Lessons drawn from models like BPCI Advanced underscore the importance of preparing for such mandates and recognizing potential pitfalls. Recognizing past missteps can guide effective preparation and strategic alignment with the outlined directives of the TEAM Model.
Expert Perspectives on Healthcare Transformation
Healthcare leaders underscore TEAM’s potential transformative impact on payment reform. In various discussions, experts point to bundled payment models as a pivotal mechanism for promoting cost-effective, high-quality care. A conversation with a hospital administrator already preparing for TEAM revealed significant shifts underway in operational strategies to embed the model’s principles into daily practices. Their experience has been marked by proactive engagement and forward-thinking strategies leading to a seamless transition into TEAM, underscoring the importance of early involvement.
Strategic Preparations for TEAM Implementation
Preparation for TEAM is multifaceted, requiring proactive, strategic actions to meet the model’s demands. Hospitals can start by analyzing their historical performance and identifying procedural pain points. Establishing firm partnerships with post-acute providers ensures continuity and care quality throughout patient recovery. Infrastructure upgrades are equally crucial; real-time tracking and monitoring solutions enable visibility into patient care episodes, aiding hospitals to efficiently manage resources under new mandates.
Additionally, synchronizing care teams with the model’s expectations through comprehensive training and engagement is integral to success. Hospitals should embrace technology that enhances care coordination, allowing them to adapt to dynamic healthcare landscapes effectively.
Paving the Path for Value-Based Care
CMS’s focus on payment reform heralds a considerable evolution in healthcare delivery, emphasizing integrated, cost-effective care. TEAM represents a critical turning point in this vision, empowering hospitals and healthcare systems to redefine care models that align with value-based principles. The learning opportunities and strategic initiatives adopted in readiness for TEAM facilitate a smoother transition into this framework, ensuring hospitals can thrive in the increasingly value-driven future of healthcare.
