CMS is implementing the Transforming Episode Accountability paradigm (TEAM), an episode-based, required care paradigm. This paradigm, which goes into effect on January 1, 2026, requires more than just following the rules. Hospitals and integrated care systems need to change their strategies. It is not theoretical, nor is it optional. You are in a Core-Based Statistical Area (CBSA) if you are in one of the designated ones.

Hospitals now have to get ready for accountability for the cost and quality of care during complete episodes of care. Transforming Episode Accountability Model redefines the criteria for measuring and enforcing value, beginning with the index hospital hospitalization and continuing for 30 days after release. The focus is focused on surgical procedures that traditionally exhibit substantial variance in cost and results.

What TEAM Does

The following five surgical procedures are part of the Transforming Episode Accountability Model:

• Lower Extremity Joint Replacement (LEJR)
• Surgical Hip and Femur Fracture Treatment (SHFFT)
• Spinal Fusion
• Coronary Artery Bypass Graft (CABG)
• Major Bowel Procedures

CMS will designate hospitals in particular CBSAs to take part at random. While some hospitals require volunteers, many do not. Increasing provider responsibility, streamlining care coordination, and eventually lowering Medicare expenditures while enhancing results are the objectives.

The Performance Determining Metrics

There will be no unbiased evaluation of TEAM hospitals. CMS has established particular financial and quality parameters that serve as the basis for this model:

Quality Measures:

• Hybrid All-Cause Readmission Measure for the Whole Hospital
• CMS Composite for Patient Safety and Adverse Events
• PRO-PM for Total Knee and Hip Replacement

Financial Metrics:

• Benchmarked episode price using a historical baseline spanning three years
• Adjusted using a set 3% discount, normalization, and trend variables.

Hospitals are either paid or repaid based on their Composite Quality Scores (CQS). This is a performance-backed framework, not an experimental program anymore.

What is Different About This?

TEAM presents some firsts:

• Required Involvement: TEAM is required in certain CBSAs, in contrast to earlier optional models.
• Integrating Equity: This is the first episode-based CMS model that incorporates health equity. Health equity strategies are required of hospitals.
• Whole-System Risk Adjustment: Age, the number of HCCs, dual eligibility, and the Area Deprivation Index are among the variables taken into account.
• Holistic Information Needs: CMS requires providers to gather and report sociodemographic information. Data maturity is rewarded by the model.

TEAM’s Timeline and Key Milestones

Milestone	Date/Period
Final Rule Release	Summer 2024
Performance Year 1 Begins	January 1, 2026
Payment Reconciliation Begins	2027 (for PY1 outcomes)
Equity Plans Due	Before the performance starts

Hospitals have a short window of time to be ready. There is no way to wait.

Things Healthcare Systems Need to Face

For health systems, there are some pressing, concrete issues:

• Infrastructure for data: Are your systems capable of handling the data reporting standards set out by CMS?
• Integration of care: For smooth patient transfers, are your post-acute partners on the same page?
• Variation in clinical practice: Do different departments and doctors use the same treatment pathways?
• Patient observation: After discharge, is it possible to monitor a patient’s progress in real time?

TEAM will disclose any systemic weaknesses financially.

Making Use of Data as an Asset, Not a Complication

Hospitals can no longer rely solely on passive data. Active, continuous engagement with cost and quality KPIs is necessary for TEAM. Reconciliation payments will benefit hospitals that are proficient with their data. There will be consequences for those who fall behind.

Important data activities consist of:

• Gathering of patient-reported outcomes before and after surgery
• Tracking problems and readmissions
• Alerts in real time for 30 days after discharge
• Equity data collection: deprivation by race, ethnicity, language, and zip code

Getting Ready for TEAM: What You Need to Do Right Now

• Get Your Equity Plan Started: CMS will want you to specify your approach to addressing inequities.
• Chart Out Your Surgical Sequences: Recognize the expenses, LOS, and challenges of the existing workflows.
• Identify High-Volume Surgeons: Synchronize and standardize their clinical judgment.
• Form External Alliances: Assure data sharing between home health agencies and SNFs.
• Assess Your Stack of Technology:  Tech preparedness is just as important to TEAM success as clinical execution.

Bottom Line

The clock is ticking & the pressure is real!

The cost-quality ratio in American healthcare is changing as a result of the Transforming Episode Accountability Model. It infuses hospitals’ day-to-day operations with ethical, financial, and technological standards. Only your results will be used to evaluate you, not the caliber of your intentions.

Now is the moment for healthcare executives to take action. TEAM and similar models are here to stay. They are in line with CMS’s long-term goals of fair access, accountability, and uniformity.

You can remain ahead of the curve with Persivia’s Digital Health Platforms. With evidence-based care models, AI-powered tools, and smooth integration throughout the continuum, Persivia is in a unique position to help you through your transition. It guarantees that you are not only compliant but also competitive, whether you are synchronizing care, coordinating, or streamlining surgical episode workflows.

Prepared hospitals will prosper. Those who put things off will have to pay the price.

The Role of Persivia

Persivia offers hospitals all-inclusive infrastructure to support their TEAM implementation and success:

• Combining internal data with CMS to get actionable insights
• Care pathway customization by procedure
• Integration of post-acute care partners with patient tracking tools
• Clinical teams’ real-time alerting systems
• Tools for risk-based categorization to maximize discharge preparation

Persivia, which has over ten years of experience in value-based care technology, makes sure hospitals do not simply respond to TEAM but hey lead it.