How can providers succeed in CMS TEAM?

Nearly 750 hospitals recently began their mandatory participation in the CMS Transforming Episode Accountability Model (TEAM). As this represents the first time taking on risk under a CMS model for many participating organizations, some leaders have expressed concern about their readiness to succeed. 

TEAM, which is expected to last five years, pays participating hospitals bundled payments for five types of surgical episodes that begin with a hospital inpatient stay or hospital outpatient procedure. An episode ends 30 days after the patient leaves the hospital and participants must refer patients to primary care services to enable continuity of care and positive long-term health outcomes. 

Provider readiness ranges widely. While some health systems have years of experience with value-based models, many smaller hospitals are taking on two‑sided risk for the first time. 

CMS continues onboarding participants and providing support, and hospitals are entering two-sided risk in staggered phases, so participants still have time to build a healthy foundation. 

Now is the time for providers to prepare for risk under the program. Below are common questions about TEAM and best practices for providers participating in the program. 

Who should own TEAM at my organization?  

Ownership often sits within the nursing department due to the importance of care management and discharge planning. In larger, more sophisticated organizations with a strategy, case management, or population health department, these teams may be more likely to take the lead. 

Like many other challenges addressed in this article, there isn’t one right approach—it’s going to depend on the size, structure, and sophistication of your organization—as well as your experience with episodic payment programs.  

Regardless of structure, a single accountable leader should oversee TEAM model performance and convene a cross-functional task force of clinical and operational departments that influence outcomes under the program. This task force could also include care coordinators within primary care offices who can monitor patient outcomes, remain connected with hospital clinicians regarding surgical episodes, and take responsibility for patients who end up in the emergency department. 

How can I align my partner network with my vision for success?  

Build a preferred network of high-performing post-acute care providers and primary care clinicians that will commit to your overall strategy:  

• Monitor length of stay and make sure post-acute partners are aligned with your clinical standards and best practices for avoiding readmission 
• Discuss with post-acute leaders how you’d like them to flag problematic cases and consider setting up weekly huddles with care management and primary care leaders to discuss patients in their care 
• Build clinical and utilization standards into agreements  

Transitional care and follow up is crucial. While still in the hospital, patients should be prompted to schedule a follow-up visit with their primary care physician or relevant specialist within 7-10 days of discharge. A follow-up phone call a few days after discharge should be standard. These preventive measures can go a long way in identifying issues before they become serious.  

Physicians serve as essential partners in maintaining quality and improving health outcomes. Consider an incentive model that trickles down savings from the program to doctors who are able to keep their patients out of the hospital. Integrate physicians directly into weekly huddles with network partners and give them access to comparative performance data at both the patient and population levels. 

How do I balance post-acute and hospital care? 

Determining the optimal balance between hospital days and post-acute care utilization requires analysis of an organization’s patient acuity, cost structure, and post-acute partner performance. Episode-level cost data, readmission patterns, post-acute utilization metrics, and length of stay variation are all critical metrics. Understanding your partners’ metrics and benchmarking performance against other providers can help your organization develop a winning strategy. 

What strategies will help improve cost and spend?  

While success under CMS TEAM depends on a number of variables, it comes down to a focus on limiting clinical variation and controlling drivers of higher spend. Data and analytics are critical in this effort, and a predictive analytics platform powered by AI can simulate both the financial and clinical outcomes of various care pathways to get ahead of adverse outcomes like readmissions. Successful organizations keep a close watch on spending, both at the patient and population levels, and have processes and tools in place that allow them to adjust care processes in real-time to maintain performance. 

Standardizing care best practices and reducing unwarranted clinical variation requires an eye for what’s happening on the front lines of care, so TEAM participants should develop a plan for engaging frontline staff about their goals under the program. Through their daily interactions with patients, care providers implement the care delivery changes that directly impact cost, quality, and overall outcomes.  

The behavior and decisions of frontline staff are often overlooked in implementation efforts, despite their significant impact on population health outcomes. Organizations that make providers aware of their impact, offer incentives to correct variation, and listen to provider feedback will be best positioned to create sustained behavior change. 

How can I take lessons I’ve learned under TEAM and apply them to other value-based models?  

Discipline built in TEAM doesn’t just improve performance under this program. Providers that find their winning strategies will be able to apply these concepts across multiple patient populations including Medicare Advantage, commercial, and Medicaid value-based arrangements.  

If TEAM proves successful, CMS may apply its best practices to other mandatory models, including the Ambulatory Specialty Model (ASM). ASM launches next year and focuses on specialist episodes for heart failure and lower back pain.  

For many organizations, especially those newly exposed to accountability for cost and quality outcomes, these capabilities represent some of the most durable, transformative, and long-term returns on participation.