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TEAM Readiness: Positioning Your Value-based Care Success in Medicare's New Bundled Payment Model


Transforming Episode Accountability Model (TEAM)
Surgical Bundled Payment - new CMS Model: TEAMS

The healthcare landscape is evolving, and Medicare's new Transforming Episode Accountability Model (TEAM) represents a significant shift in how hospitals will be "on the hook" for certain surgical procedures. Set to launch in 2026, TEAM is a mandatory bundled payment model that will impact approximately 680 acute care hospitals across 188 markets nationwide.


At Benevolence Health, we're committed to helping hospitals navigate this change successfully. Here's what you need to know about TEAM and how we can support your organization's transition:


What is TEAM?


TEAM is a five-year model running from 2026 to 2030 that bundles payments for five types of surgical episodes:


1. Major joint replacement of the lower extremity

2. Surgical hip and femur fracture treatment

3. Spinal fusion

4. Coronary artery bypass graft

5. Major bowel procedures


Under TEAM, hospitals will be financially responsible for the entire 30-day episode of care, including the initial hospital stay and most services provided within 30 days of discharge.


Key Features of TEAM:


- Mandatory participation for selected hospitals

- Three risk tracks with varying levels of upside and downside risk

- Regional pricing adjusted for patient characteristics and hospital case mix

- Quality performance impacts financial results

- Opportunities for physician gainsharing


Why TEAM Matters


TEAM represents a significant portion of many hospitals' Medicare revenue - potentially up to 15% for some organizations. Success in this model requires a comprehensive approach that addresses clinical care redesign, financial management, data analytics, and provider alignment.

Bundles and Costs

Participating hospitals will receive regional target prices in late 2025 to cover all costs for a 30-day episode of care for the following bundles:

Bundle

Average National Cost


National Episodes


MS-DRGs and/or HCPCS codes*


Coronary Artery Bypass Graft Surgery (CABG)

$48,905

28,088

MS-DRG 231, 232, 233, 234, 235, 236

Lower Extremity Joint Replacement (LEJR)

$21,063

215,957

MS-DRG 469, 470, 521, 522

HCPCS 27447, 27130, 27702

Surgical Hip and Femur Fracture Treatment (SHFFT)

$35,501

75,254

MS-DRG 480, 481, 482

Spinal Fusion (non-Cervical)

$46,326

65,968

MS-DRG 402, 426-430, 447, 448, 450, 451, 471-473

HCPCS 22551, 22554, 22612, 22630, 22633

Major Bowel Procedure

$29,184

59,983

MS-DRG 329, 330, 331

* Note: Ambulatory Surgery Centers (ASCs) will not initiate an episode.  


How Benevolence Health Can Help


Our team of experts offers a full suite of services to position your hospital for success in TEAM:


1. Strategic Readiness Assessment: We'll evaluate your current state and provide a roadmap for TEAM preparation.


2. Financial Impact Analysis: Understand the potential financial implications of TEAM on your organization.


3. Clinical Pathway Optimization: Redesign care pathways to improve outcomes and reduce costs for TEAM episodes.


4. Post-Acute Care Network Optimization: Build high-performing post-acute partnerships crucial for 30-day episode management.


5. Physician Engagement and Alignment: Develop strategies to align physicians with TEAM objectives.


6. Quality Improvement Initiatives: Enhance performance on TEAM quality measures.


7. Patient Engagement Strategies: Implement programs to improve patient outcomes and satisfaction throughout the episode of care.


8. Data Analytics and Performance Monitoring: Leverage our partnerships for unparalleled insights.


The Time to Prepare is Now


While 2026 may seem distant, successful TEAM participation requires careful planning and implementation. Hospitals that start preparing now will be best positioned to thrive under this new model.


At Benevolence Health, we're committed to being your strategic partner in navigating TEAM and other value-based care initiatives. Our comprehensive approach ensures that you're not just compliant with TEAM requirements but leveraging the model to drive meaningful improvements in care quality, patient outcomes, and financial performance.


Contact us today to learn more about how we can support your organization's journey to TEAM success. Together, we can transform this challenge into an opportunity for excellence in patient care and financial stewardship.

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