The Centers for Medicare and Medicaid Services (CMS) will deploy the Transforming Episode Accountability Model (TEAM) on January 1, 2026. The purpose of this compulsory, episode-based payment model is to enhance the quality and affordability of care for certain surgical procedures, such as:
- Joint replacements in the lower extremities
- Treatments for hip femur fractures through surgery
- Fusions of the spine
- Grafts to bypass the coronary arteries
- Major intestinal operations
30 days after the TEAM Model CMS release will be held responsible for the quality and cost of treatment, promoting better patient outcomes and effective resource management.
What is the TEAM Model by CMS?
The TEAM model signifies a substantial departure from conventional fee-for-service models and a move toward value-based treatment.. Key features include:
- Required Involvement: Hospitals located in certain Core-Based Statistical Areas (CBSAs) are required to participate.
- Specific Actions: Five frequent surgical procedures account for 15% of Medicare’s authorized inpatient expenses; pay close attention to these operations.
- Episode Duration: From the first surgery or admission to 30 days after discharge, each episode covers hospitalization, discharge planning, and post-acute care.
- Financial Accountability: Financial incentives or penalties are dependent on how well hospitals perform against a target price that covers all associated costs.
Strategic Imperatives for Healthcare Providers
Healthcare providers need to concentrate on a few key aspects to succeed under the TEAM model CMS:
Data Capture and Analysis
Effective clinical and financial data collection and analysis are essential. As a result, providers can:
- Find strategies to save money without losing the quality of care.
- Improve patient outcomes by leveraging data-driven insights.
- By following patients throughout their care journey, you can guarantee continuity of treatment.
- Compare performance against national and regional benchmarks.
Episode Identification and Management
Actively recognizing and controlling episodes enables:
- Prompt action to avoid problems
- Enhanced cooperation between care teams
- Improved results and patient satisfaction
Cost Optimization
Cutting wasteful spending without sacrificing excellent treatment entails:
- Examining spending trends to find inefficiencies
- Using evidence-based procedures to expedite the provision of services
Leveraging Technology for Success
Strong digital health platforms that provide the following are necessary for navigating the TEAM model’s complexities:
- Integrated Data Infrastructure: Makes it easier to gather and analyze financial and health data.
- Advanced Analytical Tools: Helps identify high-risk patients for focused therapy and supports risk classification.
- Care Coordination Tools: Improves communication between care teams to guarantee care continuity.
- Performance Benchmarking: Permits comparison with regional and national standards, encouraging ongoing development.
Persivia’s Role in Supporting the TEAM Model CMS
Persivia is in a unique position to help healthcare businesses navigate the TEAM model because of its more than 15 years of expertise in the field. Our all-encompassing strategy consists of:
Full Program Orchestration
To facilitate well-informed decision-making, better treatment, and cost control, we set up a strong data infrastructure for the collection, analysis, and interpretation of clinical and financial data.
Proactive Care Planning
We enable early intervention and improved care coordination by determining whether patients are eligible for episodes at the moment of admission.
Advanced Analytics
Our AI-powered technology enables multi-layered risk classification, resulting in individualized treatment regimens that improve patient outcomes while cutting expenses.
Continuous Patient Tracking
By following patients during their anchor and post-anchor stays, real-time care alerts help to ensure continuity of care and minimize treatment gaps.
Evidence-Based Care Pathways
We optimize every stage of the patient experience by creating evidence-based, patient-centered care pathways that cover the full episode of treatment.
Seamless Care Transitions
Transitions between hospitals, post-acute care institutions, and home health agencies are seamless because of our robust network of top-notch providers throughout the care continuum.
Digital Tools and Patient Involvement
Digital solutions for patient communication, telemedicine, and remote monitoring encourage active patient participation and improve the quality of care.
Benchmark Comparison
To assist companies in identifying areas for development, we offer tools for comparing performance against regional and national standards.
Responsive Service and Flexible Platform
Our platform is made to change with the healthcare industry, providing responsive services that are customized to meet the unique requirements of every company.
Takeaway
The CMS TEAM Model, which emphasizes episode-based therapy to improve patient outcomes, optimize costs, and improve care coordination, represents a revolutionary change in healthcare finance and delivery. A data-driven and technologically informed strategy is necessary for success in this scenario.Persivia is a partner for companies navigating the TEAM model because of our demonstrated track record of using state-of-the-art technology to improve healthcare results. Hospitals can guarantee they have the resources and assistance required to succeed in this advanced payment model by working with Persivia, which will eventually improve the standard and affordability of patient care.