Readers Write: CMS TEAM: What Hospitals Need to Know to Succeed

CMS TEAM: What Hospitals Need to Know to Succeed
By Mary Sirois

Mary Sirois. MBA is managing director of clinical transformation with Nordic

Healthcare reimbursement is undergoing a significant transformation, with the Centers for Medicare & Medicaid Services (CMS) spearheading a decisive shift towards value-based care, cost reductions, and confidence in care quality. At the forefront of this evolution is Transforming Episode Accountability Model (TEAM), a mandatory, episode-based, alternative payment program that is designed to improve the patient experience from surgery through recovery.

With the January 1, 2026 launch date quickly approaching, I strongly encourage healthcare leaders to prioritize understanding and proactively preparing for TEAM now. Without a strategic and well-executed plan that addresses topics such as EHR integration, clinical and operational workflows across the continuum of care, data infrastructure, change management, governance, and more, organizations risk compromised patient outcomes, competitive disadvantage, and financial instability.

Patient-centered care and financial sustainability: Unlocking TEAM’s potential

TEAM will advance the CMS Innovation Center’s prior work on episode-based alternative payment models, including the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models. TEAM is designed to improve care coordination and outcomes for Medicare beneficiaries undergoing any of the following five episodes of care, which begin with the “event” (admission or surgery), extend throughout 30 days, and include both hospital and ambulatory care:

• Lower extremity joint replacement.
• Surgical hip femur fracture treatment.
• Spinal fusion.
• Coronary artery bypass graft.
• Major bowel procedure.

The assessment and payment structure under TEAM is based on a retrospective analysis of the total cost of care for each episode. CMS sets target prices based on historical data and benchmarks, and providers are accountable for managing costs within these targets. If the actual cost of an episode is below the target, providers may share in the savings.

Conversely, if costs exceed the target, providers may face financial penalties. This risk-sharing arrangement incentivizes providers to optimize care pathways, reduce unnecessary services, and improve patient outcomes. Key opportunities for healthcare organizations include:

• Leveraging Intersocietal Accreditation Commission data.
• Mitigating financial penalties.
• Aligning with ongoing population health/value-based care work.
• Improving care coordination across the continuum of care and partnerships.
• Reducing unnecessary readmissions.

Navigating CMS TEAM: Assessment, collaboration, monitoring, and strategic partnership

To effectively prepare for CMS TEAM and strive under the program, healthcare leaders should focus on three core areas:

1. Comprehensive assessment and playbook development. Begin with a thorough current state assessment, evaluating financial projections, risk stratification, care setting optimization, provider alignment, discharge planning, care coordination, outcomes management, quality measures, and model readiness. This assessment will inform the development of a strategic playbook, outlining specific strategies to improve performance and ensure compliance with TEAM requirements.

2. Strategic collaboration and technology integration. Foster collaborations with providers across the continuum of care (many of whom are not directly aligned to the healthcare system, such as post-acute, skilled nursing facilities, and home care) and payers. Evaluate and implement technology solutions that enhance data sharing and care coordination. Prioritize patient engagement and education, empowering them within the episode-based care model.

3. Continuous monitoring and adaptation. Establish a robust monitoring system, tracking performance against key indicators and implementing continuous quality improvement initiatives. Proactively adapt to evolving CMS guidelines and industry best practices. Create alerts for early identification of and response to care pathway deviations.

Given the complexities of TEAM and the critical need for urgency, hospitals and health system leaders can benefit from partnering with experienced, healthcare-focused consultants who can help identify potential challenges and areas for improvements. Through high-level performance reviews, strategic recommendations, and implementation considerations, partnership enables hospitals and health systems to take a strategic and clinically driven approach to TEAM compliance that harnesses the power of data and technology to enhance patient and clinician journeys and optimize performance.

CMS TEAM: Seizing this pivotal moment for healthcare excellence

As our industry stands on the cusp of the TEAM launch, I see this as a pivotal shift towards a more efficient, cost effective, data-driven, and patient-centered healthcare system. By embracing the principles of value-based care, taking proactive steps to prepare, and engaging in meaningful partnerships, healthcare leaders can ensure their organizations comply with TEAM requirements, deliver the highest quality care, and thrive in the evolving healthcare landscape.