What is the TEAM Model?
The Transforming Episode Accountability Model (TEAM) is a five-year, mandatory Centers for Medicare & Medicaid Services (CMS) program designed to improve patient outcomes while controlling costs. Hospitals are held accountable for the quality and efficiency of care for selected surgical procedures, from admission through 30 days post-discharge.
TEAM builds on earlier bundled payments models – such as BPCI and CJR – but eliminates the challenges of voluntary participation and long 90-day care windows. By requiring participation in designated regions and shortening the episode periods to 30 days, TEAM enables more focused care coordination and broader transformation.
Key facts:
- Start date: January 1, 2026
- Downside risk begins: January 1, 2027
- Duration: 5 years (2026–2030)
- Mandatory participation: Acute care hospitals in selected Core-Based Statistical Areas (CBSAs)
- Procedures covered:
- Lower extremity joint replacement (LEJR)
- Hip and femur fracture surgery (SHFFT)
- Spinal fusion (FUSION)
- Coronary artery bypass graft (CABG)
- Major bowel procedures (BOWEL)
Keep reading to see how TEAM payments work and why early preparation is essential.
How TEAM payments work
Hospitals continue to bill Medicare as usual, but each episode is compared to a target price set by CMS using three years of historical data, adjusted for region and complexity.
Performance evaluation includes:
1. Spending vs. target price
Achieve quality benchmarks and spend less than target to earn additional payments.
2. Quality measures
Readmissions, complications, patient satisfaction, and adherence to clinical best practices.
3. Collaboration
Hospitals can share payments with physicians and other providers to encourage coordinated care.
Exceeding target prices requires repayment to Medicare – making cost control and quality performance equally critical.
Next: Understand why your preparation timeline matters.
Why preparation matters now
TEAM will affect financial management, care delivery, and operational workflows for more than 700 hospitals nationwide.
The shorter 30-day care window demands faster, more efficient coordination between hospitals, post-acute care providers, and primary care teams.
Risks of waiting until 2027:
- Missed early savings opportunities
- Increased penalty risk
- Rushed adaptation to new quality measures
Benefits of early preparation:
- Identify high-cost drivers before risk begins
- Strengthen post-acute partnerships
- Align protocols with CMS methodology
- Build analytics to monitor performance in near real-time
Milliman MedInsight Bundles can help you take these steps now – before downside risk begins.
How Milliman MedInsight Bundles helps
MedInsight Bundles is purpose-built for success in bundled payment programs – including TEAM – by translating complex episode data into actionable strategies.
Our solution provides:
- Episode-level costs and quality analysis
- Identification of savings opportunities and care variation
- Near real-time tracking of TEAM quality measures
- Audit and verification of CMS reconciliation reports
- Peer benchmarking using CMS-based logic
Why Milliman MedInsight:
- Built directly on CMS payment methodology
- Over a decade of bundled payment reporting expertise
- Led by experts with direct CMS program development experience
With MedInsight Bundles, you can navigate TEAM with confidence, improve patient outcomes, and protect margins.
Request a performance review to see how your organization measures up under TEAM methodology.
Strategic importance of the TEAM Model
TEAM is part of CMS’s broader 2030 vision to place all Medicare beneficiaries in accountable care arrangements.
Success now positions your organization to adapt quickly to future mandatory models and thrive in the evolving payment landscape.
Don’t wait – use TEAM preparation to build lasting value-based care capabilities.
