Is Your Organization Prepared for TEAM?

By Matt Phillion

The Transforming Episode Accountability Model (TEAM) is set to launch on January 1, 2026, and healthcare providers face a looming deadline to prepare.

This mandatory model is intended to advance the Centers for Medicare and Medicaid Services (CMS) Innovation Center’s prior work on episode-based alternative payment models and will run for five years, ending in December 2030. It is intended to help with the fragmented care some surgery patients face that can lead to complications, prolong recovery or require potentially avoidable care. Specifically, TEAM episodes will test lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures.

But how ready is the industry for TEAM?

“It’s interesting. I think a lot of hospitals are generally both aware of TEAM and hopeful, but as the administration changed, a lot of investors, strategic advisors, and former hospital operators I’ve spoken with expected it to get punted,” says Kyle Cooksey, CEO of Deacon Health. “It’s not that they wanted it to get punted, but they expected CMS to reshuffle its entire agenda, and hospitals are going to have to do a lot of work to success with this new payment model.”

In April 2025, however, new rulings came out indicating otherwise.

“I think it caught a lot of hospital operators by surprise. They’re now saying this is not going anywhere and we’ve got to get prepared,” says Cooksey. “We’ve run the analytics across all 786 participating hospitals, both those that are mandated and those opting in, and there’s a portion of those hospitals who are performing decently, not losing money but who won’t find a ton of lift on shared savings.”

One hospital they spoke with estimated it might lose as much as $37 million annually in revenue starting in January.

“That would bankrupt many hospitals if they don’t put a plan together,” says Cooksey. “I think hospitals generally are unprepared. It’s not easy to manage a model like this, and hospitals still aren’t great at post-discharge care, and that’s the point of the whole program.”

The need to work together

A lot of people in the industry see TEAM as exclusively focusing on pre-planning and post-discharge planning but has significant overlaps in the territory of patient safety as well—something Cooksey has had very personal experience with.

“Back in 1997, my mom passed away as a result of completely fragmented care in the specialty space,” he says. “Specialty care has such a massive opportunity in this nation and in this healthcare system to improve on avoidable readmissions, fragmented care, increased costs. It’s all connected.”

TEAM’s mission fixes a lot of core problems in these areas, Cooksey says.

“With sicker patients who have multiple comorbidities, pulling things together in a thoroughly connected, managed way can create wonderful results for patients,” he says.

These are high-cost patients who need connected care, Cooksey says.

“What keeps me up at night is that some hospital systems believe they can do it all on their own,” he says. “It’s misguided to think they can handle the connected care while controlling costs. A lot of systems I’ve talked to have very clearly said that they need a partner who can do preplanning and handle discharge plannings and work with all the connectedness.”

He also worries that hospitals will come to that conclusion too late.

“I worry that hospitals are going to come to the end of the first reconciliation period and say, ‘I should have talked to you in 2025 to be ready for this,’” he says. “I think a lot of hospitals think they can do this on their own.”

Hospital systems depend on each other far less than they should, he says.

Post-discharge planning is an evergreen issue.

“It’s scary when someone isn’t minding the gap,” says Cooksey.

He describes a situation his team encountered recently involving a patient with multiple comorbidities, whose care plan allowed for a 14-day hospital stay. At the end of the 14 days, the nurse navigator reached out to extend the request to 60 days, which was going to add $80,000 to the cost of the bundle.

“The patient had no caregiver, no help at home. They were scared to leave,” says Cooksey. “Our nurse reached out to get them help from a social worker. I tell my employees we have to think like we’re taking care of our own grandparents. If we approach all of our patients like they were our grandparents, who might have no clue what’s happening, you have to step up and step in, and lead them through the system.”

Challenges with planning and compliance

Among the gaps in discharge planning is the frequency with which prescriptions are simply never filled.

“I literally want to scream when I go to my local pharmacy because it’s so complicated. I can’t tell you how often I see people in the lobby confused and waiting,” says Cooksey. “And they’re not being discharged, they’re just getting their prescriptions filled.”

Studies have found that upwards of 50% of post-discharge medications go unfilled.

“Think about how critical that is. That’s a gap that has to be closed,” says Cooksey. “It’s for the safety of the patient, helps avoid readmissions, all of these things. They end up back in the hospital and if only someone had said, ‘Have you had your prescription filled yet?’”

Polychronic patients add their own set of challenges and gaps in care.

“As patients get older, they start relying more and more on specialists, and I can’t tell you how many times I’ve seen a lack of awareness in what’s been diagnosed. Everyone lives on their own little island,” says Cooksey.

The goal of TEAM is to close gaps, but specialists can be hyper focused on the surgical episode. There needs to be a wider view that loops in the PCP and all specialists to ensure they are aware of all comorbidities.

“When we do our assessment, we talk to the PCP, to the specialist, to the patient, to the EMR, pulling it all together into a comprehensive care plan with a 360-degree view,” says Cooksey. “Once the surgeon discharges the patient, they’re often not thinking about that patient anymore. It’s very siloed. What we need is a simple connection, a care management platform that can solve for that.”

Technology’s role will be to enhance, not replace, the human connection needed to do this right, Cooksey says.

“The greatest technology in the world can do good things, but it takes the clinical connection of a nurse navigator, especially post-discharge, to connect those dots,” he says. “Tools like AI are wonderful, we use it in our technology, but for the foreseeable future no one, no system, would ever trust a digital technology to provide care. We require connected, compassionate, thoughtful resources to really manage the care of these patients.”

Hospitals can opt for an arrangement with no risk for the first year of the model, which may delay the urgency to address some of these challenges. Cooksey suspects it will take until the end of the first TEAM reconciliation period for things to really begin to heat up.

“I think what we’ll see in 2026 is hospitals who think they can do it on their own will start looking for vendors who can help,” says Cooksey. “And I think technology will start being developed to holistically cover these gaps.”

Addressing those holes between specialties is the wave of the future, Cooksey says.

“I see a focus around polychronic specialty care. The specialty space is still so deeply fragmented, but I want to see a future where we’re all better, and this burgeoning patient population will be served better. Connecting all those specialty care areas so that the right outcomes are found,” says Cooksey.

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.