Today’s Medicare program faces familiar cost and quality challenges. Medicare Part A is projected to be insolvent in 2033 and will start drawing down funds from the Part A Trust Fund in 2028. While moderating slightly during the COVID pandemic, spending growth has increased and remains high – 8.1 percent in 2023. Medical complexity also remains a challenge, with…
Download Slides As of January 1, 2026, CMS’s Transforming Episode Accountability Model (TEAM) is live – and for selected hospitals, participation is mandatory. TEAM is more than a reimbursement change. It is a readiness test for value-based care, demanding tighter financial, clinical, and operational coordination. Unlike voluntary programs such as BPCI Advanced, TEAM requires…
Download Slides Last year we saw a shift in the CMS Value-Based Care Program, with the announcement of two specialty care risk payment models, and the retirement of several models like Primary Care First, Making Care Primary, and alterations in Kidney Care Choices. CMS also restated its strategies for Value-Based Care, requiring the inclusion…
As healthcare organizations deepen their investments in value-based care, one obstacle continues to stymie progress: incomplete visibility into the patient’s health status. The problem isn’t limited to a single source, such as claims data, though claims are often blamed. Rather, it’s the fragmented nature of healthcare data itself. Patient information is dispersed across a patchwork of…
Accountable care organizations (ACOs) aim to improve patient care by managing their conditions and maintaining access to affordable care. To do so, ACOs amass data about patient health and spending, and there’s a potentially positive side effect: ACOs can serve as watchdogs to guard against wasteful and fraudulent spending in health care. That has happened over…
With TEAM’s focus on improving surgical recoveries and costs in major hospital-based surgeries, it’s easy to miss the importance of primary care physicians. But their role is essential for meeting TEAM’s objective to improve patient recovery and lower costs in the five major types of surgery covered by TEAM. And perhaps not in the way…
When the Centers for Medicare & Medicaid Services (CMS) launched the Transforming Episode Accountability Model (TEAM) and the AIM for Health Equity and Accountable Care Growth (AHEAD) model, it wasn’t tinkering with policy at the margins — it was redefining what hospitals are accountable for. The new rules make one truth unavoidable: the hospital’s responsibility doesn’t…
Modern medicine is more advanced than ever, yet clinical care still leans heavily on what is, in practice, informed guesswork. Doctors make the most probable diagnosis, select the therapy most likely to help, and adjust only when outcomes fall short. To further complicate matters, one-half of patients with chronic diseases do not take their medications as…
You cannot control CMS raising cut points. But you can control how you respond. Changes are happening to how Medicare Advantage plans are measured for medication adherence. Starting in measurement year 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three Part D adherence measures: diabetes medications, RAS antagonists, and statins. What’s Actually…
The new Transforming Episode Accountability Model (TEAM) targets the highest cost or volume surgeries in the Medicare program. While hospitals bear the financial risk, CMS has created a vehicle to align interests with other providers through Collaboration Agreements that can include financial incentives. How those are structured will be key to the successful alignment—or fracture—of the hospital’s…