Electronic Health Reporter

By Lee-Ann Ruf, Senior Vice President of Product, MDaudit.

When the Centers for Medicare & Medicaid Services (CMS) launches its Transforming Episode Accountability Model (TEAM) initiative next year, the aim will be to improve the patient experience by better coordinating care between healthcare providers.

For more than 700 hospitals across the country, it will mean meeting new accountability, cost, outcomes, and quality standards for surgical care.

The five-year, episode-based payment model is one of the boldest attempts yet by CMS to link financial incentives to patient outcomes by focusing on six common, costly procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.

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 hospitals, TEAM success will depend on more than deft surgical skills. It will hinge on using advanced technologies to manage each episode of care from beginning to end.

Greater Accountability

Hospitals will continue billing Medicare fee-for-service (FFS) next year, but those that are part of TEAM will receive a target price for certain surgical episodes. If actual spending falls below that target without sacrificing quality, the hospital may earn a reconciliation payment. But if they are over budget, the hospital may end up paying CMS.

CMS will evaluate TEAM’s impact using statistical and multivariate analyses to examine care quality, access, costs, and patient-reported experiences.

To stay ahead of the curve, hospitals will need to move away from retrospective reporting and embrace real-time performance management. The key to success will be treating data as a strategic asset rather than a compliance responsibility.

The Data Asset

For hospitals that will be a part of TEAM, preparation is key. For many, that means identifying and closing data gaps, modernizing analytic capabilities, and creating an integrated view of cost and quality across episodes of care.

This involves:

• Integrating and standardizing clinical and financial data. Episode-based models require hospitals to understand the full spectrum of care that contributes to cost and outcomes, from pre-operative assessments to follow-up visits. But in many organizations, data is essentially trapped in electronic health records (EHRs), revenue cycle systems, post-acute care organizations, and payer portals. To succeed under TEAM, hospitals will need interoperable data pipelines that integrate clinical, claims, and cost data in a standardized format. They should begin by evaluating whether their data infrastructure supports these functions today and where any integration or data standardization work is required.
• Building advanced analytics and predictive capabilities. CMS will examine which factors drive variation in quality and cost within a hospital. Healthcare providers must mirror this same analytic sophistication internally. Predictive models, for example, can flag patients at high risk of readmission, spot potential cost outliers, and trigger proactive interventions before patient health worsens. Hospitals should use machine learning and AI-driven analytics 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 data governance and team readiness. Analytics are only as effective as the data behind them. Robust data governance programs to ensure accuracy, completeness, and timeliness of data are a must for hospitals that join TEAM. The key is preparing the people who will handle the data, e.g., clinical, financial, and operational teams must understand how TEAM calculates metrics, tracks performance, and interprets dashboards that guide day-to-day decisions. Additionally, investing early in cross-disciplinary education positions hospitals to embed data-driven decision-making into daily practice.

Strengthening Value-Based Care

TEAM participation is mandatory for many hospitals, especially those with experience in bundled payment models, as well as safety-net, rural, and critical access hospitals.

For these providers, TEAM can be a catalyst for broader digital transformation. By building the data and analytics foundation that TEAM will require, hospitals can also create long-term readiness for other value-based care initiatives.

With the beginning of TEAM and with future goals in mind, hospitals 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.

Compliance as a Competitive Advantage

TEAM’s varying risk tracks, which range from no downside risk for some facilities to higher risk and reward for others, will let hospitals ease into full participation. But even those in the lower-risk categories should treat TEAM as more than a mere compliance exercise. It’s a chance to mature data capabilities and unlock future opportunities to improve clinical and financial performance.

TEAM also offers the chance 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.