Reworking Episode Accountability Mannequin (TEAM), probably the most complete obligatory various cost mannequin (APM) to emerge from the Facilities for Medicare and Medicaid Providers (CMS), formally launched on January 1, 2026. It represents a major shift towards bundled funds and offers substantial alternatives to enhance care and cut back prices. However the potential advantages include a caveat: Evaluation exhibits {that a} majority of hospitals mandated to take part will probably lose cash when draw back threat turns into a part of this system in 2027 if they don’t make any modifications to the way in which they presently function within the 5 designated TEAM episodes of care.

There’s additionally excellent news. Organizations can take steps now, within the early months of this system, to place themselves for fulfillment by evaluating previous efficiency, figuring out alternatives for enchancment, and implementing episode-driven medical and operational workflows. Optimizing early offers a aggressive benefit and a larger likelihood of reaping the optimistic rewards and avoiding the unfavourable penalties in TEAM.

Why do many TEAM individuals stay unprepared? Listed below are three frequent themes I’ve seen emerge in conversations with business consultants, hospitals and doctor leaders.

Cause #1: Over-reliance on expertise and efficiency from earlier bundles

Many hospitals depend on previous expertise with bundled funds, assuming it can routinely translate into TEAM success. Actually, having some expertise with bundled funds helps, however hospitals want to know that there are crucial variations between earlier fashions, equivalent to Bundled Fee for Care Enchancment (BPCI) and TEAM.

Two main modifications embody:

• Benchmarking: Earlier bundled cost packages established benchmarks primarily based on particular person previous efficiency. This created a troublesome scenario for prime performers, who discovered it more and more troublesome to beat their very own price and high quality targets yr after yr. TEAM units targets primarily based on regional benchmark costs in 9 census divisions. Whereas this eliminates competitors towards you, it introduces the problem of competing with different doubtlessly high-performing areas and surgeons in your space.
• Timelines: TEAM shortens the post-acute interval from 90 days (typical of earlier bundled cost packages) to simply 30 days. This forces hospitals and surgeons to give attention to surgical high quality, preliminary hospitalizations and care transitions to cut back prices.

Each modifications require a brand new strategy. Value benchmarks will now be a transferring goal as different individuals within the area enhance their efficiency, and price discount methods for a 90-day post-acute interval in packages might not transfer the needle in TEAM.

Cause #2: Planning 2026 as a ‘observe yr’

TEAM hospitals know they will not be punished for lacking price and high quality targets throughout the 2026 efficiency yr, and a few should still be tempted to attend and see how their early efficiency evolves earlier than making modifications in 2027. The pitfall of this strategy is underestimating the period of time it takes for modifications to have a cloth influence on future program efficiency.

Figuring out the accessible levers to enhance prices and high quality, designing and implementing efficient workflows, and monitoring the outcomes to find out whether or not they’re having the anticipated influence (and if not, implementing extra changes and enhancements) can take a number of months to a yr. Hospitals and healthcare suppliers that wait till early 2027 to begin implementing modifications additionally threat lacking the mark in 2027 and dealing with downward penalties of as much as 20%.

Cause #3: Competing priorities and lacking broader strategic alignment

As a result of TEAM contains solely 5 preliminary procedures, some hospitals might not view the potential draw back threat – in whole {dollars} or as a share of their backside line – as materials sufficient to commit important sources to getting ready for this system’s launch. Hospitals are already dealing with a spread of economic pressures, from emergency division boarding and move points to staffing shortages and post-acute placement delays.

However this ignores two crucial factors. First, CMS has indicated that it plans to develop the record of procedures in TEAM, which can place extra monetary strain on hospitals that haven’t spent the suitable time and sources growing efficient workflows and processes for episodes of care from the beginning. Specialists predict the growth may occur as quickly as 2027, so hospitals that wait out the primary yr may fall even additional behind initially of the second yr of efficiency.

Second, efforts now to optimize TEAM and bundle efficiency may translate into success in addressing different medical and monetary priorities. Bundles have confirmed efficient in addressing rising prices and bettering affected person experiences at many Facilities of Excellence throughout the nation. Proficiency in bundled TEAM funds may additionally translate into extra capabilities past CMS – together with within the business market – to launch future bundles for a number of costly, high-volume procedures.

Particularly, bundled funds can enhance prices and high quality by:

• Bettering surgical high quality and effectivity by avoiding pointless consultations, optimizing working room effectivity and decreasing avoidable issues and surgical errors
• Bettering care transitions by means of seamless discharge planning and affected person care follow-up workflows, sturdy partnerships with post-acute care services, and minimizing avoidable readmissions
• Encouraging larger collaboration between healthcare suppliers and services concerned in an episode of care – from pre-procedural consultations to surgical procedures and post-discharge care
• Shifting applicable procedures to less expensive areas, equivalent to hospital outpatient clinics
• Minimizing price variations from web site to web site or supplier to supplier, and over-reliance on pointless companies, equivalent to inpatient rehabilitation

Among the longest-running potential bundled cost packages within the nation have proven that bundles are a viable choice for delivering distinctive care at a decrease price. TEAM individuals can study crucial classes from established fashions in three key areas: folks, processes and expertise.

Before everything, doctor champions are important to creating any main transition work, particularly for packages like TEAM, which can essentially shift a long time of fee-for-service habits towards a value-based care mannequin. These champions can create a cultural change towards shared accountability, have interaction each member of the healthcare crew, and collaborate with finance, IT, and different departments that can contribute to the success of bundled funds.

Second, organizations should make investments effort and time in growing the processes that can result in higher coordination throughout episodes of care. This contains figuring out the episodes, establishing applicable and environment friendly care pathways, planning care transitions, stopping readmission, and soliciting suggestions from suppliers and care groups to enhance processes over time.

Lastly, TEAM hospitals (and any group planning to take part in CMS-driven or business bundled cost fashions) want a robust expertise and companies associate to design, implement, monitor and optimize this system. Expertise platforms ought to embody deep analytics insights with modeling and drill-down capabilities so everybody can determine the levers they need to contribute to decrease prices and higher high quality of care, seamless workflow administration by means of built-in care and analytics purposes, and claims administration expertise that may simply bundle and unbundle claims associated to an episode.

The transition from ‘fee-for-service’ to ‘value-based’ care takes time. It will not occur in days or even weeks, however it can take months to efficiently implement and optimize it. Early movers who refine and strengthen their TEAM technique might be well-positioned for the subsequent wave of bundled APMs, whether or not by means of the growth of TEAM episodes, new obligatory CMS fashions, or business payers designing their very own packages.

TEAM is now the lively pressure within the shift to bundled funds and APMs on the whole, however it will not be the tip. With preparation, deep doctor involvement, sturdy collaborative partnerships, and cutting-edge expertise that helps APMs, organizations can keep away from the draw back threat of TEAM now and place themselves as aggressive leaders for regardless of the future holds.

Correction: An earlier model incorrectly displayed the character of the APM.

Photograph: Andriy Onufriyenko, Getty Photos

Tobin Lassen is Government Vice President and Chief Bundle Options Officer at Cedar Gate Applied sciences, an IQVIA firm and main value-based healthcare efficiency administration firm. He brings in-depth data and expertise in healthcare monetary administration. With greater than 30 years of expertise in value-based healthcare reimbursement, Mr. Lassen oversees the design, technique, growth and administration of risk-based bundled cost packages, and the administration and processing of bundled healthcare funds, claims, pricing, companies and options. A pioneer in bundled funds and related administrative expertise, he facilitated the growth of one of many largest cardiovascular bundled cost networks and facilities of excellence and continues to develop and handle different comparable bundled cost networks in obstetrics and gynecology, orthopedics and backbone, neurosurgery and different specialties nationwide.

This message seems by way of the MedCity Influencers program. Anybody can publish their views on enterprise and innovation in healthcare on MedCity Information by way of MedCity Influencers. Click on right here to see how.