CMS Team Model: A New Era in Healthcare Accountability

CMS is implementing the Transforming Episode Accountability Model (TEAM) to improve patient care. By making hospitals responsible for the cost and quality of patient care throughout certain treatment episodes, this model focuses on value and quality rather than volume (which is frequently the focus of traditional healthcare systems). Set to launch in 2026, the CMS Team Model is a systematic, patient-centered strategy to improve healthcare outcomes overall, not just another cost-cutting measure.

What is the CMS Team Model?

This model focuses on care episodes—defined treatment periods that begin with a procedure or hospital admission and extend 30 days post-discharge. Hospitals are in charge of both the initial treatment and providing high-quality follow-up care throughout this time. This may help to prevent problems or readmissions. 

This is how it functions:

Key Components	Details
Episode Length	30 days post-discharge, focusing on impactful follow-up
Cost Accountability	Target pricing adjusted by demographics, hospital size, and patient complexity
Quality Measures	Includes metrics like readmission rates and patient-reported outcomes
Health Equity Focus	Encourages addressing social needs like housing and food security for underserved populations

How Does The CMS Team Model Benefit Patient Care?

By shifting from a fee-for-service structure to a value-based care approach, the Team Model CMS improves patient care in several ways:

Enhanced Coordination Between Providers

Primary care physicians and specialists must collaborate closely under TEAM to prevent patients from getting lost in the shuffle. All patients who are discharged from hospitals must receive a recommendation from their primary care physician, maintaining the emphasis on seamless treatment across providers.

Reduction in Readmissions

TEAM helps prevent preventable readmissions by closely monitoring patient outcomes, particularly during the 30-day post-discharge window. Hospitals are encouraged to handle problems like appropriate medication administration, discharge planning, and prompt follow-up care, all of which reduce the chance that patients will return because of difficulties.

Quality-Centric Approach with Financial Incentives

Based on performance in quality metrics like patient-reported outcomes and all-cause readmission rates, CMS imposes financial incentives and penalties. It is pressuring hospitals to put patient care ahead of service volume by linking rewards to quality rather than quantity.

Focus on Health Equity

Hospitals are required to test patients for social needs such as housing, food, and transportation as part of TEAM's emphasis on health equity and social determinants of health. To address inequities that have historically impacted underprivileged areas, hospitals are urged to submit health equality plans.0

How Risk Adjustments Ensure Fairness?

Every patient case is unique, so CMS incorporates several risk adjusters to make sure hospitals aren’t unfairly penalized for treating high-risk patients. These include adjustments based on:

• Age
• Comorbidities (Hierarchical Condition Categories)
• Social Risk Factors
• Hospital Type (e.g., safety net status)

With this approach, hospitals treating more complex or higher-risk populations are on an even playing field, so their performance is measured more accurately against realistic benchmarks.

About Persivia

Healthcare transformation requires innovation. Persivia is prepared to collaborate with healthcare organizations as the CMS Team Model approaches, offering them data-driven insights and creative solutions to assist them manage this transition. 

Together, let's promote significant advancements in patient care!