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Across late August 2024, the Centers for Medicare & Medicaid Services (CMS) recently finalized the Transforming Episode Accountability Model (TEAM) in the Hospital Inpatient Prospective Payment System Final Rule. This is CMS’ latest attempt to transition all traditional Medicare beneficiaries into an accountable care relationship by 2030. Specialty care strategies are an important piece of accomplishing that goal and TEAM builds on the past successes of Bundled Payments for Care Improvement Advanced (BPCI-A) and Comprehensive Joint Replacement (CJR) models.
TEAM is a mandatory model beginning January 1, 2026 and running for five years, requiring the participation of hospitals in 188 Core Based Statistical Areas (CBSAs). At a high level, participating hospitals are paid a set amount, or target price, for five episodes of care. While the model centers on specialty care episodes, hospitals are required to refer patients to primary care providers, promoting overall value-based care efforts. This target price for each episode is expected to cover the patient’s total cost of care for thirty days after a trigger event.
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