On-Demand Learning Lab - The CMS TEAM Model: Quality, Care Coordination, and Care Transitions-Feb 2025 Learning Lab Handout

Feb 2025 Learning Lab Handout - Slide Deck

Pdf Summary

The document summarizes the CMS Transforming Episode Accountability Model (TEAM) and outlines how quality, care coordination, and care transitions drive success under this mandatory episode-based alternative payment model. TEAM applies to traditional Medicare fee-for-service beneficiaries (Parts A and B) who undergo one of five surgical episode categories—Lower Extremity Joint Replacement, Surgical Hip/Femur Fracture Treatment, Spinal Fusion, Coronary Artery Bypass Graft, and Major Bowel Procedures. Episodes begin with an anchor hospitalization or anchor procedure and extend through 30 days post-discharge, including most Medicare Part A and B services (with defined exclusions). Hospitals are selected primarily through mandatory Core-Based Statistical Areas (CBSAs), with certain geographic and volume-based exclusions (notably Maryland). Beneficiary inclusion criteria exclude Medicare Advantage, ESRD eligibility, and certain other coverage types; if eligibility changes mid-episode, the episode is canceled.<br /><br />TEAM participants may engage “TEAM collaborators” (e.g., ACOs, SNFs, HHAs, IRFs, physicians and therapy providers) via sharing/distribution arrangements and allowed patient engagement incentives, while maintaining beneficiary protections—especially freedom of choice of providers. A key operational waiver is the SNF 3-day rule waiver, allowed only when specific CMS “qualified SNF” requirements are met.<br /><br />Financial performance is tied to quality through a Composite Quality Score and participation tracks with varying upside/downside risk and stop-gain/stop-loss limits across payment years 2026–2030 (preparation occurring during 2025). Quality measures include readmissions, patient-reported outcomes for LEJR, and safety/harm and mortality-related measures in later years; results will be publicly displayed.<br /><br />The presentation emphasizes building comprehensive, standardized care management and transitions-of-care programs starting as early as surgical scheduling, incorporating SDoH assessment, patient/caregiver engagement, early level-of-care determination, and structured post-discharge follow-up (including a first call within 24 hours). NAHQ resources (competency framework, micro-credentials, HQ Solutions, CPHQ support, and workforce training) are positioned to help organizations develop analytics, performance improvement, and population health capabilities needed for TEAM readiness.

Keywords

CMS Transforming Episode Accountability Model (TEAM)

mandatory episode-based alternative payment model

Medicare fee-for-service Parts A and B

30-day post-discharge episode window

surgical episode categories (LEJR, SHFFT, Spinal Fusion, CABG, Major Bowel)

Core-Based Statistical Areas (CBSA) hospital selection

Composite Quality Score and quality-linked payment

care coordination and transitions of care

SNF 3-day rule waiver and qualified SNF requirements

patient engagement incentives and TEAM collaborators (ACOs, SNFs, HHAs, IRFs)