The healthcare industry is undergoing significant changes, primarily driven by the shift from fee-for-service to value-based care models. At the forefront of this transformation is the Transforming Episode Accountability Model (TEAM), a mandatory initiative by the Centers for Medicare & Medicaid Services (CMS). Scheduled to launch on January 1, 2026, and run through December 31, 2030, TEAM aims to reshape how care is delivered and financed in the U.S., especially regarding surgical procedures.
TEAM is designed to enhance care coordination and reduce healthcare costs by holding acute care hospitals accountable for the entire episode of care. Unlike previous models that focused on 90-day post-discharge periods, TEAM centers around a 30-day episode timeframe, covering specific procedures like lower extremity joint replacements, spinal fusions, and coronary artery bypass grafts. Under this model, hospitals will receive a target price for each episode based on Medicare Parts A and B expenditures, adjusted for patient risk factors including social determinants of health.
The initiative intends to:
Hospitals are categorized into three participation tracks based on their financial risk tolerance:
A composite quality score (CQS) will determine financial reconciliation, allowing CMS to assess hospitals on their performance while emphasizing quality care delivery.
Under TEAM, the scope of surgical episodes includes various anchor procedures, ensuring that hospitals can focus on best practices applicable to these treatments. By streamlining care around specific surgeries, practitioners and administrators will have the opportunity to share resources effectively.
A notable aspect of TEAM is its focus on social determinants of health. The model includes variables such as housing stability and food security to determine target pricing. Addressing these factors allows hospitals to engage in proactive care strategies tailored to the needs of patients, especially those in underserved communities.
Health equity remains a primary focus within TEAM. CMS aims to improve maternal health outcomes for non-Hispanic Black and Native American women and address systemic barriers affecting these populations. The maternal mortality rate for non-Hispanic Black women was approximately 69.9 deaths per 100,000 live births in 2021.
The Decarbonization and Resilience Initiative aims to create a more sustainable healthcare environment. Participants will be encouraged to implement green practices to reduce their carbon footprint.
One of the practical implications of TEAM is that it aligns financial incentives with outcomes that matter to patients. Instead of rewarding volume, the model seeks to compensate providers based on their ability to deliver effective care.
Through quality measures reported by patients, known as Patient-Reported Outcomes (PROs), the reimbursement rates will reflect the quality of care received. Hospitals participating in TEAM must evaluate their performance metrics through two specific measures: the Hybrid Hospital-Wide All-Cause Readmission (HWR) Measure and the Hospital-Level THA/TKA Patient-Reported Outcome-Based Performance Measure (PRO-PM).
By focusing on these healthcare outcomes, providers can better manage resources, tailor interventions, and reduce the need for extensive post-surgical care or hospital readmissions.
As healthcare evolves, the integration of technology and AI will play an important role in navigating the challenges posed by TEAM. Automation and digital advancements enhance communication and patient engagement, which are key aspects of effective care coordination.
For example, AI-driven solutions can automate appointment scheduling, notify patients of follow-ups, and assist in collecting vital health information prior to surgical procedures. This improves efficiency for healthcare staff and ensures accurate patient data management.
An efficient front-office phone automation service can manage patient inquiries, streamline call routing, and ensure that practitioners have access to important messages in real-time. Timely communication is essential in the context of TEAM, where it can impact surgical outcomes and overall care coordination.
Hospitals will be required to submit regular quality measure reports under TEAM. Integrating AI and data analytics into workflows will enhance the accuracy and efficiency of these submissions. Predictive analytics can help identify patterns in healthcare utilization and patient outcomes, enabling proactive adjustments to care models.
Automation tools can facilitate ongoing quality improvement initiatives by emphasizing performance metrics. These technologies can support collaboration among care teams to analyze patient outcomes in real-time and adapt protocols based on the results.
Engaging with patient feedback through automated tools can enhance the patient experience and boost satisfaction ratings, aligning with TEAM’s goals. Additionally, tracking episodes of care through a centralized dashboard can allow administrators to identify bottlenecks and areas needing attention.
With the impending launch of TEAM, healthcare administrators and IT managers should prepare for a shift in care delivery and reimbursement methods. The emphasis on value-driven care is becoming non-negotiable, and organizations must adjust their operational strategies accordingly.
Administration teams must prioritize training and educating staff about value-based care principles and the specifics of TEAM. Standardizing care delivery aligned with these outcomes ensures compliance while promoting patient safety.
Integrating clinical decision support systems that enhance adherence to best practices will improve overall care quality and reduce unnecessary complications. These systems can remind providers of protocols and document patient interactions seamlessly.
The importance of collaboration among stakeholders cannot be overstated. Engaging physicians, nurses, support staff, and administrators in discussions about new workflows will lead to a cohesive approach to care delivery.
Collaboration with community organizations to identify patients’ social determinants of health is crucial. By partnering with local agencies, hospitals can implement outreach programs, ultimately addressing barriers that affect access to care.
The transition to TEAM presents challenges. Medical practice administrators need to manage costs, ensure staff readiness, and secure training related to new care pathways. Setting financial goals aligned with TEAM’s expected outcomes will guide decision-making.
A cultural shift in how healthcare providers view their roles is underway. With the emphasis on delivering value rather than volume, all stakeholders—physicians, administrators, and patients—are aligned in a common goal: better health outcomes at lower costs.
Through increased accountability, hospitals can expect to see an enhanced reputation and patient trust stemming from their commitment to patient-centered care. As TEAM evolves, evidence will showcase the model’s effectiveness and influence future healthcare policies.
The Transforming Episode Accountability Model has the potential to transform care coordination and financial strategies within hospitals. As administrators, owners, and IT managers in the United States prepare for its implementation, aligning operational structures with TEAM’s principles will be important in achieving success in healthcare delivery.
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