In a move that signals a seismic shift in the healthcare landscape, the Centers for Medicare & Medicaid Services (CMS) have finalized the Transforming Episode Accountability Model TEAM – a groundbreaking bundled payment initiative that places hospitals firmly in the driver’s seat.
Traditionally, bundled payment models have been voluntary, allowing providers to opt-in and experiment with alternative payment methodologies. However, the CMS TEAM model represents a significant departure from this approach, as it is poised to become the most substantial mandatory bundled payment model to date.
Under the TEAM model, acute-care hospitals will be responsible for managing the entirety of a 30-day episode of care, including any skilled nursing facility (SNF) stays. This level of accountability gives hospitals the opportunity to truly transform the way care is delivered, optimizing outcomes and driving down unnecessary costs.
One of the key reasons behind this shift is CMS’ overarching goal to have all Medicare Fee-for-Service (FFS) beneficiaries participating in value-based care by 2030. The TEAM model is a critical piece of this ambitious initiative, as it aims to align incentives across the continuum of care and foster greater collaboration between hospitals and post-acute providers.
Measuring Performance: The Pathway to Success
As hospitals take the wheel in the TEAM model, it’s essential to understand how their performance will be evaluated. CMS has designed a comprehensive framework that focuses on both quality and financial metrics to drive meaningful improvements in care delivery.
Quality Measures
The quality component of TEAM will play a crucial role in determining financial rewards for participants. CMS has selected a set of measures that highlight care coordination, patient safety, and patient-reported outcomes (PROs), including:
• Hybrid Hospital-Wide All-Cause Readmission Measure
• CMS Patient Safety and Adverse Events Composite
• Hospital-Level Total Hip and/or Total Knee Arthroplasty (THA/TKA) PRO-PM
These measures will be combined into a composite quality score (CQS), which can adjust the reconciliation payment up to 10% or repayment amount up to 15%, depending on the participation track. Higher quality performance will result in better financial outcomes for hospitals.
Financial Benchmarking
The foundation of the TEAM payment methodology is the benchmark data used for the creation of the target prices. CMS has opted for a three-year weighted baseline period that rolls forward annually, balancing the need for accurate, up-to-date data with the stability required for participants to thrive.
The target prices will be further adjusted through a prospective trend factor, a normalization factor, and a 3% discount. This approach aims to provide predictable, accurate, and easily interpretable targets for hospitals to work towards.
Risk Adjustment
The TEAM model’s preliminary target prices will serve as a basis for forecasting episode spending during the performance period, but they will need to be adjusted for risk to reflect the unique characteristics of each beneficiary.
This risk adjustment will use a methodology similar to that of the CJR three-year extension and will consider:
• Age Bracket: Determined by the beneficiary’s age on the first day of the episode.
• Hierarchical Condition Category (HCC) Count: Based on a 90-day look-back period, akin to BPCI Advanced.
• Social Risk Factors: This includes dual eligibility status, area deprivation index, and eligibility for Part D low-income subsidies.
The multipliers for risk adjustment, calculated during the baseline period, will be categorized by the MS-DRG/HCPCS episode level. These multipliers will be provided in advance and will remain unchanged at reconciliation, allowing participants to estimate finalized target prices proactively before reconciliation.
Navigate Complex Care Pathways Effortlessly—Trust Persivia’s Proven Solutions!
Persivia, with an extensive experience of 15 years in healthcare offers a comprehensive suite of solutions to support potential Healthcare’s New Frontier: The Impact of the Transforming Episode Accountability Model participants, including advanced analytics, care management integration, performance benchmarking, tools:
- Advanced Analytics Solutions
CareSpace® platform provides powerful analytics capabilities that transform raw CMS data into actionable insights. Their AI-driven workflows and pathways create personalized care programs, optimize risk adjustment, and prioritize members at the point of care.
2. Integration of Care Management
Persivia’s solutions facilitate seamless integration of care management across various providers. Their single platform follows patients from admission through post-acute stays and into the home, aligning incentives across multiple reimbursement models.
3. Performance Benchmarking
Persivia offers robust benchmarking tools that help organizations compare their performance against regional and national standards. This comparative analysis is crucial for identifying best practices and areas needing improvement.
4. Continuous Patient Tracking
Effortlessly monitor patients throughout their anchor and post-anchor stays with real-time care alerts. This capability promotes continuity of care and helps reduce gaps in treatment.
5. Evidence-Based Care Pathways
Persivia designs patient-centered, evidence-based care pathways that encompass the entire episode of care, ensuring that every step of the patient journey is optimized for the best possible outcomes.
6. Seamless Care Transitions
We facilitate smooth transitions of care through a robust network of high-quality providers across the continuum, including hospitals, post-acute care facilities, and home health agencies.
7. Digital Tools and Patient Involvement
Utilize digital tools for remote monitoring, telehealth, and patient communication to encourage active patient involvement and enhance overall care delivery.
8. Responsive Service and Flexible Platform
Experience responsive service and a flexible platform designed to accelerate results for all episodic models. Our approach is tailored to meet the specific needs of your organization and adapt to the evolving healthcare landscape.
9. Benchmark Comparison
Compare your performance to national and regional benchmarks to understand where you stand and identify areas for improvement.
Closing Thoughts
The Transforming Episode Accountability Model (TEAM) is set to have a far-reaching impact, with CMS planning to include acute-care hospitals (ACHs) in approximately 25% of Core-Based Statistical Areas (CBSAs) across the United States. This wide-ranging implementation means that both seasoned and novice providers in episode-based models will need to navigate the complexities of this new initiative.
TEAM places acute-care hospitals (ACHs) firmly at the center of episode-based care, empowering them to reshape the delivery of high-quality, cost-effective services.
However, the complexities of the TEAM model mean that both seasoned and novice providers will need to carefully navigate this new landscape. For many ACHs, fully capitalizing on the opportunities and synergies within TEAM may not be immediately evident. Simply having access to data is not enough – organizations must develop a deep understanding of the information, uncover potential areas for improvement, and commit to instituting meaningful change.
This is where Persivia’s expertise comes into play. Drawing on our proven track record in leveraging advanced analytics and data-driven insights, we can help ACHs identify their unique strengths and weaknesses within episode-based programs. Our cutting-edge platforms can equip hospitals with the tools they need to optimize care pathways, manage risk, and maximize financial performance – all while fostering greater collaboration across the continuum of care.
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