The Center for Medicare and Medicaid Innovation (CMMI) has recently released a list of hospitals for TEAM. These hospitals are required to participate in the Transforming Episode Accountability Model (TEAM). This announcement marks a significant step in healthcare reform, focusing on bundled payments for high-volume procedures.
Key Points:
- Mandatory Participation: Selected hospitals must identify a point of contact for TEAM-related communications from CMMI.
- Timeline: TEAM will run from January 1, 2026, through December 31, 2030.
- Scope: The model covers five high-volume procedures:
o Lower extremity joint replacement (LEJR)
o Surgical hip femur fracture treatment (SHFFT)
o Coronary artery bypass graft (CABG)
o Spinal fusion
o Major bowel procedure - Financial Impact: These procedures account for approximately 15% of Medicare inpatient covered charges.
- Bundled Payment Structure:
o 30-day retrospective bundled payment
o Includes almost all covered Part A and B services
o Target price based on regional spending data with risk adjustments
Preparation Period
Selected list of hospitals for TEAM have about 16 months to prepare for TEAM implementation. While this may seem generous, the complexity of re-engineering care processes across multiple surgical specialties demands immediate action.
Persivia’s Expertise
With over 15 years of healthcare expertise, Persivia offers an end-to-end solution for the TEAM (Transforming Emergency and Ambulatory care in Medicare) Model, leveraging our extensive experience with episodic care models. Our comprehensive approach includes:
- Data-Driven Insights
Unlock the power of your data with Persivia’s cutting-edge analytics. Our CareSpace® platform conducts in-depth assessments of your TEAM episode performance, giving you a crystal-clear view of your current state. But we don’t stop there – our advanced analytics engine dives deep into your operations, pinpointing exactly where you’re making profits and where you’re facing losses. Stay ahead of the curve with our real-time cost and utilization trend tracking, helping you to make informed decisions that drive success in the TEAM Model landscape.
2. Enhanced Care Coordination
Our innovative CareTrak® Point of Care Tool bridges the gap between primary care physicians and specialists, ensuring that every member of your care team is always on the same page. Experience the power of unified care delivery, where communication flows effortlessly, and patient outcomes soar.
3. Health Equity Focus
Our advanced data aggregation capabilities seamlessly integrate social determinants of health (SDoH) into your patient profiles, providing a holistic view of each individual’s health journey. Our robust health risk assessments go beyond traditional metrics, incorporating crucial health equity factors to build truly comprehensive Longitudinal Patient Records (LPR).
Next Steps for Selected Hospitals
- Review the CMMI list to confirm your hospital’s selection
- Designate a point of contact for TEAM communications
- Begin a current state assessment of your hospital’s performance in relevant procedures
- Consider partnering with experienced consultants like Persivia to navigate the transition
Our episodic models successfully reduced readmissions and increased savings, demonstrating improved patient outcomes and cost-effectiveness, read more. Watch our Podcast on CMS Team Model – A Guide for Hospitals and ACOs
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