Success in CMS’ mandatory, 5-year Transforming Episode Accountability Model (TEAM) requires a comprehensive, value-driven approach to managing care across the continuum. The model focuses on enhancing the patient experience, reducing avoidable readmissions, and ensuring that patients receive high-quality, coordinated care during and after surgical procedures. A core requirement of the model is that participants refer to primary care services, which further advances the Centers for Medicare and Medicaid Innovation’s (CMMI) strategic direction for Medicare- fee-for-service beneficiaries to be established in care relationships with accountability for both quality and total cost of care.
CMS has identified acute care hospitals in Core-Based Statistical Areas (CBSAs) for mandatory participation. To encourage other hospitals to maintain momentum in episode-based care, hospitals participating in the Bundled Payments for Care Improvement (BPCI) Advanced or the Comprehensive Care for Joint Replacement (CJR) Models will be eligible to voluntarily opt into the TEAM model.
An episode of care begins with a hospital inpatient stay or outpatient procedure for surgeries such as lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. The episode concludes 30 days after the patient is discharged from the hospital.
TEAM ties performance to three quality measures:
1. Hospital-wide all-cause readmission rate
2. Patient safety and adverse events composite
3. Hospital-level THA/TKA (total hip and knee arthroplasty) patient-reported outcome-based performance
Performance on these measures will directly impact financial reconciliation, linking quality to payment outcomes.
ACOs will continue to submit Medicare Fee-for-service (FFS) claims and receive target prices for each episode before the performance year. These target prices, covering Medicare Part A and B services, will be risk-adjusted based on beneficiary- and hospital-level factors. Performance will be assessed by comparing actual Medicare FFS spending for the episode against the target price and adjusted by the quality measures. Participants may receive payments from CMS or owe repayments depending on performance.
Accountable Care Organizations selected to participate in the TEAM model must consider how to establish communication pathways across the care continuum. For many Accountable Care Organizations, government models can be challenging to navigate. However, for Health Select Services (HSS) ACOs, powered by Bon Secours Mercy Health, the decades of experience and proven success in Care Management capabilities make planning efforts easier.
Health Select Services (HSS) ensures its ACOs are fully prepared by completing readiness assessments and helping care management and hospital leadership assess the current processes against TEAM model requirements. This analysis identifies opportunities to improve patient outcomes, reduce readmissions, and enhance coordination of care with Primary Care Providers (PCPs).
Given the 30-day episode duration, organizations must develop data-driven strategies to manage care post-discharge. HSS ACOs utilize Admission, Discharge, and Transfer (ADT) feeds to track patients across the care continuum, ensuring care continuity from hospital discharge to primary care follow-up. Real-time data access allows leadership to monitor performance throughout the year, which is crucial since CMS reconciles financial performance only once annually.
HSS emphasizes forming cross-functional steering committees that include acute and non-acute leadership. Our clinically led team at our ACOs value engagement from our providers and interdisciplinary teams. We strategize to improve hospital-wide readmissions, patient safety and adverse events, and hospital-level patient-reported outcomes under model requirements. By having a diversified team of champions, you can foster adherence to model requirements.
Adapting to government-mandated models can be challenging. With over a decade of experience, Health Select Services specializes in care management program assessments and the operational implementation of transformative care delivery models. At Health Select Services, we understand how important it is for organizations to ensure patients receive the right care at the right time, in the lowest-level care setting as clinically appropriate.
Our customizable solutions help organizations conduct comprehensive readiness assessments and implement evidence-based practices for transitions of care, care pathways, and patient handoffs that ensure continuity and seamless care delivery to high-performing skilled nursing facility networks or home settings. We offer real-time data management strategies to help track patient admissions and ensure timely provider and care management interventions.
Our customizable solutions evaluate your organization’s current care management program and provide strategic planning to enhance key programmatic elements for value-based care success. HSS also offers practice transformation support to identify and implement process improvements that streamline your operations and optimize performance.
Health Select Services is an integrated clinical and technical platform that helps Accountable Care Organizations (ACOs) to strengthen healthcare delivery. With over a decade of proven success, HSS supports health care leaders in developing innovative strategies to tackle challenges while enhancing access, quality, and cost efficiency across the care continuum.
