Medicare’s newest value-based care initiative, the Transforming Episode Accountability Model (TEAM), also known as CMS TEAM Model, marks a bold shift in healthcare payments. Starting January 2026, this mandatory program will operate in 188 carefully selected geographic areas through a randomized selection of Core-Based Statistical Areas (CBSAs). This five-year program, running through December 31, 2030, represents CMS’s most ambitious attempt yet to transform healthcare delivery.
Why CMS Team Model Matters Now
The healthcare sector is currently confronted with major concerns such as the fragmented delivery of healthcare and exponentially rising expenses. The Team Model addresses these issues through an innovative approach that moves beyond traditional fee-for-service models. What sets this initiative apart is its mandatory nature in selected regions and its comprehensive strategy for combining cost control with quality improvement.
Core Components That Set TEAM Apart
TEAM Model CMS introduces three distinct participation tracks, each designed to accommodate different hospital types and risk tolerance levels:
Track 1 (Glide Path)
- No downside risk in Year 1
- Gradual transition to full-risk
- Lower initial rewards
Track 2 (Years 2-5)
- Designed for rural and safety net hospitals
- Progressive risk increase
- Quality-adjusted payments
Track 3
- Full two-sided risk
- Available all performance years
- Maximum potential rewards
| Procedure Type | Duration | Key Features |
| CABG | 30 days post-discharge | Enhanced monitoring |
| LEJR | 30 days post-discharge | Site-neutral pricing |
| Major Bowel | 30 days post-discharge | 1.5% CMS discount |
| SHFFT | 30 days post-discharge | Specialized protocols |
| Spinal Fusion | 30 days post-discharge | Regional benchmarking |
Breaking Down The Quality Metrics
TEAM’s quality measurement system operates through the Hospital Quality Reporting Program (IQR), focusing on specific, measurable outcomes. The universal measures include:
- Universal Quality Metrics
- Hybrid hospital-wide all-cause readmission rates
- CMS patient safety and adverse events composite scores
- Hospital harm prevention metrics
For LEJR procedures, additional specialized measures track patient-reported outcomes, post-surgical complications, and functional improvement metrics. These comprehensive metrics ensure that cost savings don’t come at the expense of patient care quality.
The Health Equity Revolution
CMS TEAM Model introduces groundbreaking requirements for addressing healthcare disparities through mandatory health-related social needs screening. The model requires evaluation of:
- Mandatory Screening Areas
- Food security
- Housing stability
- Transportation accessibility
- Utility access
- Social support networks
This comprehensive approach extends beyond basic screening. Organizations can submit detailed health equity plans outlining strategies to address identified disparities. The Team Model CMS demographic data collection encompasses race, ethnicity, language, disability status, sexual orientation, and gender identity, creating a robust framework for understanding and addressing healthcare inequities.
Financial Impact: Real Numbers
The payment structure combines historical benchmarks with forward-looking incentives, creating an ideal system for rewarding quality care:
| Risk Level | Quality Requirements | Financial Impact | Track Eligibility |
| Track 1 | Basic metrics | Limited upside only | All hospitals Y1 |
| Track 2 | Enhanced reporting | Moderate two-sided | Rural/Safety Net |
| Track 3 | Comprehensive | Full two-sided | All qualified |
Strategic Preparation Steps
Successful implementation requires comprehensive preparation across key areas:
- Clinical Systems
- Standardized care protocols
- Evidence-based pathways
- Risk stratification tools
- Care transition programs
- Technology Infrastructure
- Episode cost tracking systems
- Quality metric dashboards
- Social needs documentation
- Performance Analytics
Innovation Opportunities
TEAM catalyzes innovation across healthcare delivery. Remote patient monitoring systems help track recovery progress, while predictive analytics identify potential complications before they occur. A digital health platform with care coordination facilitates seamless communication among providers, and patient engagement tools ensure active participation in recovery.
Future Drifts
The model builds upon valuable lessons learned from previous models like CJR and BPCI Advanced while introducing new elements for comprehensive care improvement. The model particularly emphasizes protecting safety net hospitals through adjusted regional target prices and specialized risk tracks. This thoughtful approach to equity ensures that vulnerable populations maintain access to high-quality care while driving systemic improvements.
Action Steps for Success
Healthcare organizations must prioritize specific actions across two key timeframes:
Immediate Priorities (2024-2025)
- Assess current episode costs
- Review quality performance
- Evaluate HRSN screening capabilities
- Begin staff training
Long-term Strategy (2026+)
- Implement comprehensive data analytics
- Develop community partnerships
- Establish quality improvement teams
- Create patient engagement programs
Looking Ahead
TEAM represents a pivotal shift in Medicare’s approach to value-based care. Its comprehensive design, incorporating health equity, quality metrics, and financial incentives, sets a new standard for healthcare delivery reform. The model’s emphasis on protecting vulnerable populations while driving innovation creates a framework for sustainable healthcare transformation. As the industry moves toward 2026, this model may well become the blueprint for future payment reforms across both public and private sectors. Organizations that embrace these changes early will be better positioned to succeed in this evolving landscape.
Final Words
Healthcare leaders like you need more than just another CMS TEAM Model. You need a partner who understands your challenges. Persivia brings clarity to value-based care complexity, turning your clinical and financial data into actionable insights that drive real results. When success means mastering both patient outcomes and program requirements, we’re the partner who helps you excel at both.
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