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Key Takeaways:
After years of hinting that a mandatory bundled payment model was imminent, in August 2024 the Centers for Medicare & Medicaid Services (CMS) finalized the Transforming Episode Accountability Model (TEAM). TEAM is a key facet of CMS’ strategy to support person-centered, value-based specialty care, which was released in late 2022.
TEAM will launch on January 1, 2026, and run for five years, ending on December 31, 2030. The model’s goal is to support people with Medicare undergoing certain surgical procedures by aiming to promote better care coordination, seamless transitions between providers and successful outcomes.
Here we delve into the critical features of the mandatory TEAM model and its potential implications for healthcare providers.
The mandatory, episode-based payment model is broad and far-reaching. Selected acute care hospitals will coordinate care for traditional Medicare beneficiaries undergoing one of the surgical procedures included in the model (i.e., initiate an episode).
In year one, CMS proposes that TEAM focus on five specific procedural episodes:
TEAM will concentrate on payments for a defined episode of care, linking payments for all items and services provided during the initiating procedure, plus a 30-day post-discharge window, inclusive of inpatient and outpatient services. The model also includes a risk-sharing component, holding providers accountable for the quality and total cost of care during the episode.
TEAM is a mandatory program, unlike Bundled Payment for Care Improvement-Advanced (BPCIA), which is voluntary. TEAM will require selected hospitals to coordinate patient care and engage with specialists to enhance quality and reduce costs.
TEAM participation will be based on geographic areas using core-based statistical areas (CBSAs).
Accountability for surgical episodes, including the period following surgery, encourages hospitals to work closely with specialists to implement care pathways and coordinate care across the continuum. These care pathways can consider transitions from the acute to post-acute setting, care management handoffs, post-discharge visits and engaging with a post-acute network of high-value providers and facilities to standardize the care path across episodes. Understanding current episodic cost in the post-discharge timeframe and comparisons to benchmarks can provide insight into care plan modifications and where to focus improvement efforts.
The model will also have an element requiring the connection back to primary care services for longitudinal care management – supporting mutual efforts between Accountable Care Organizations (ACOs) and hospitals participating in TEAM.
Additionally, while the defined quality measures are already used in ongoing programs (i.e., Hospital Inpatient Quality Reporting (IQR) program and Hospital Acquired Conditions (HAC) Reduction program), they now take on importance as a component for success and earning savings in TEAM. Performance across quality measures will determine the adjustment made to the reconciliation amount – making it more crucial for hospitals to be top performers among the quality measures to receive the full positive reconciliation payment in TEAM.
To succeed in the program, participants must develop effective care pathways and protocols as well as have a strong provider engagement strategy – all of which will demand substantial time and resources. Providers should also consider investing in data analytics and other technologies to monitor patient outcomes and measure performance. Understanding and planning for TEAM participation early in the process is key.
Partnering with over 200 hospitals and physician group practices to support voluntary and mandatory bundled payment programs, we see that engagement with the right partners, utilizing actionable data, leveraging best practices and monitoring ongoing progress help providers accelerate success in bundled payment programs and the transition to value.
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