This article is part of the HHCN+ membership
As 2026 approaches, so does the launch of the Centers for Medicare and Medicaid Services' (CMS) mandatory bundle, the Transformation Episode Accountability Model (TEAM). Our knowledgeable home health care providers are ready to help.
The TEAM model, which goes into effect on January 1, offers significant benefits to home health care providers. Potential benefits include an increase in the demographics of Medicare fee-for-service beneficiaries as thin-margin Medicare Advantage becomes more widespread. However, providers who are unprepared or fail to reduce readmissions risk financial consequences.
“The risk is not being well-positioned in the market,” Brian Fuller, managing director of value-based care design and delivery at ATI Advisory, told Home Healthcare News. “Either they're not being proactive about building hospital team partnerships, or they lack the creativity to do something different than what they're already doing.”
TEAM holds hospitals accountable for the quality and cost of patients with one of five selected conditions. Payments for these procedures are bundled with payments for 30 days after the outpatient procedure or 30 days after discharge from the hospital. The five conditions selected were lower extremity joint replacement (LEJR), surgical treatment of femur and fractures (SHFFT), spinal fusion, coronary artery bypass grafting (CABG), and colorectal surgery.
Fuller said home health providers can participate in the TEAM model through three pathways.
TEAM encourages patients to be sent to the lowest-cost setting, typically steering patients to receive home health care over skilled nursing facility (SNF) care, thereby increasing home health utilization. Patients placed in a SNF can receive home health care after discharge to smooth the transition and avoid readmissions during the 30-day period of the TEAM model. Additionally, two of the five TEAM conditions blend inpatient and outpatient services, meaning hospitals may move a higher proportion of surgeries to hospital outpatient departments to save costs, and home health providers should be available to ensure a smooth recovery.
In addition to the risk of not having a favorable market position, home health agencies also run the risk of not performing well even if they accept patients.
“That's where home health care has the highest risk,” Fuller said. “In the TEAM model, readmissions are double-counted, which means readmissions count toward the financial target price as claims for readmissions. Readmissions are also the biggest impediment to the overall quality score in this model. Composite quality scores also directly impact financial outcomes, so a single readmission will be double-counted on both the billing side and the quality metrics side. Incidentally, both have direct financial implications.” Implications for the success of this model. ”
level of preparation
Some providers are taking significant steps to prepare for TEAM.
In preparation for the launch of this model, Catholic health care system ArchCare, which provides home health care, began piloting a program similar to TEAM across its facilities. As part of these pilot efforts, the organization has focused on short-term hospitalizations, improved communication with hospital partners, and worked to promote continuity of care.
“Patients have the peace of mind that when they come in on the day of surgery, they will have the same care management team that will follow them from day one until they go home,” said Dr. Taimur Mirza, ArchCare's chief medical officer, in a recent webinar hosted by Home Health Care News and other WTWH Media publications. “We're really excited about TEAM. We think we're already taking the right steps and we can't wait to see how this pays off over the next few years.”
Based in New York City, ArchCare's services include home and community-based services and resident care programs. The company's home health services include nursing services, physical therapy, occupational therapy, speech therapy, personal care assistance, companionship services, and more.
ArchCare is not the only stakeholder in the TEAM model actively preparing for the start of the new year.
A majority of TEAM model stakeholders say they are ready for implementation in January, according to a poll conducted at a recent webinar by healthcare technology company Aidin. Among respondents, including home health administrators, care management leaders, and business development and program directors, 65% said they were “very confident” or “somewhat confident” in their organization's ability to meet TEAM requirements by January 1.
North said he was surprised by the number of respondents who said they were confident in their team's preparation.
“I thought this was a great sign that everyone was taking preparation seriously,” North told HHCN.
North said if home health agencies lack the necessary metrics and relationships with hospital systems, success within TEAM may be lower.
How to prepare your team
TEAM For home health agencies caring for patients, a positive relationship with a hospital is key to success, but there are steps you should take before even entering into a conversation with a hospital.
Agencies need to start with analytics to understand hospital spending and utilization patterns for each of the five conditions related to TEAM, Fuller said.
Home health providers will need to reflect their own metrics to determine referral response times, readmission rates, length of stay and other measures, North said.
“If we start really looking at those now and deciding where we need to start working on them, where we need to improve, where we really need to promote to hospitals, we already have the potential to do better on that (metric) front,” North said.
North said when agencies are ready to discuss with hospitals, they should request a joint planning meeting to determine the hospitals' expectations and ensure alignment.
To best prepare for conversations with hospitals, agencies also need to understand how they are performing compared to competing agencies in the market.
“Other bundled payment models were historical provider pricing models, which meant we had to overcome our past selves,” Fuller said. “This is a regional target price model, which means it has to be better than where you live.”
Fuller said these regions are large, ranging from three to eight states. Going into a conversation with a hospital with an understanding of where the institution stands relative to its peers makes the institution appear more educated, engaged, and more likely to support the hospital's success.
While analytics capabilities allow home health providers to start a dialogue with hospitals, Fuller said he has noticed that many post-acute care providers are educating hospitals themselves about the TEAM model, why it is important, and how home health providers fit into the equation.
Healthcare providers should also monitor the Inpatient Prospective Payment System (IPPS) regulations under which TEAM was established. The next rulemaking cycle is expected to produce a proposed rule in late spring and a final rule in late summer.
“If they're going to change the model, they're going to change it there,” Fuller said. “If they are going to expand the model and CMS is very clear that that is their intent, they will do it through rulemaking.”
