Opportunities for Change with TEAM

By Matt Phillion

As the implementation of the Transforming Episode Accountability Model (TEAM) grows closer, hospitals must continue to move from awareness into execution. Some hospital leaders struggle with the approaching deadline, while early adopters are figuring out how data infrastructure will make or break their performance during TEAM’s five-year window.

“I think TEAM has been under-covered partially because there is so much volatility in the general regulatory space in healthcare. Causing uncertainty about which regulatory updates are going to remain in place,” says Ahmed “Eddie” Qureshi, founder and CEO of Rainfall Health.

Deadlines are coming up fast, with the track selection deadline coming up in November and a go-live date of January 2026. Reporting will begin in February. Add that to recent slashes to Medicaid and additional issues that require hospitals to figure out where they need to prioritize their efforts.

“Nobody is ready for it because they’ve never had to be,” Qureshi says. “But this is a win for American patients as a whole. If you’ve ever been to a physician, you know how complex our system is. What this model does is it makes coordination of care the responsibility of a single party for these five procedures.”

The procedures in question are:

• Lower extremity joint replacement
• Surgical hip femur fracture treatment
• Spinal fusion
• Coronary artery bypass graft
• Major bowel procedures

“CMS has announced that this is the blueprint for the next generation of outcomes-based care,” says Qureshi. “The hospital needs to act as a single point for the patient to get all of their clinical care for 30 days post-discharge, not just the procedure itself but care coordination and care enablement.”

Nearly every major system will be touched by it, and because it’s mandated, they can’t opt out. In the face of pending cuts to funding, Qureshi says there are two ways to look at it:

“When you see a cut to one aspect of care, you can look at it as a liability, or you can look at it as a strategic initiative for ways to make sustainable healthcare possible,” he says. “Everyone is focused on these cuts to Medicaid and they will be impactful, absolutely, but there’s this onus that hospitals can take up with regards to TEAM, in that not only can we do a better job with care, we can make more money from some of our highest-margin procedures to start.”

There’s little time to spare to get ready for January, however.

“No hospital has all the components of post-acute care in house: if you look at the thousand hospitals involved, nobody has all of the skilled nursing facilities, primary care, and so on,” says Qureshi. “When hospitals don’t have those things in-house, you can’t rely solely on internal tools and have to take a wider view of the healthcare landscape.”

Early adopters set the scene

The struggle for compliance will vary widely between organizations, Qureshi notes. On the one side of the coin you have the Stanfords of the world, and on the other, small hospitals serving towns of 9,000 residents.

“Everybody is going to have slightly different challenges to overcome and going to have to start adapting their workflows—but everyone has to do it, and that’s what matters,” says Qureshi.

It also requires a change of attitude, or of tradition, in healthcare.

“There’s a lack of readiness because there’s this post-mortem view that we tend to have in healthcare when it comes to regulation,” Qureshi says. “We mess up, and we say okay how did we mess up and then we fix it.”

For example, Qureshi points to the EHR rollout process, in which we saw so many organizations build their own separate EHR systems spending billions of dollars only to migrate later to a more standardized system. It’s happened with many mandates, in the past, he notes, though it is possible to get ahead of curve with the right leadership and initiative.

“That’s not every health system, but we’ve seen it in the past: when bundled payment models came out for example,” says Qureshi. “But then you also have these innovative teams that raise their hands and volunteer to try these out first, and those systems consistently outperform others. You get to help set the standards and requirements when you come in early. In some ways, the tail doesn’t end up wagging the dog.”

Looking at it from a financial perspective

While patient care is always the first and foremost consideration, the financial impact cannot be overlooked.

“For those 30 days post-acute care, where are you sending those folks, and how are you getting them there? You have to go out and negotiate those terms in a compliant manner before the model goes live,” says Qureshi.

There’s a good reason to not wait, he says.

“Literally 18 months after, you’ll find out how you did and be either slapped with a huge penalty or you’ll have an upside. Our job at Rainfall is to make sure people understand where they’re going to land,” says Qureshi.

What organizations have done in the past for mandates such as this, he explains, is keep cash in reserve to pay a penalty if necessary.

“It’s such an inefficient use of capital,” Qureshi says. “Everyone is tightening their belts. We’re seeing massive layoffs. Everybody is reconciling with these issues, and we’re trying to dig people out of the doom and gloom. But if we do this properly, we can aim for a greater return.”

Some organizations are using that first year of the five-year process as a trial year, “rolling the dice to see what happens,” Qureshi says.

“With this model you’re seeing that CMS actually got smarter, it’s leagues ahead of previous models. They’re saying, ‘We’ll dock you if you use it as a trial year, and now your first year acts as part of your quality score for the next three years,’” he says. “If you don’t do anything you’ll be paying for it in years two through four of a five-year model.”

Rolling the dice or holding money in reserve are not strategies that will work in this case, he says.

“What is a good strategy is to say we have the ability to get a higher reimbursement for simply providing better outcomes by creating a less disparate healthcare system,” says Qureshi.

He also points out that it’s only five procedures, not every aspect of care. There are tools available to better understand your own data and figure out these areas for improvement.

“This is where I think we are living in a different age of healthcare. Healthcare data doubled from 1950 to 2000, and now it doubles every 70 days,” he says. “You need actual clinical data, and organizations can’t keep up on their own, but they also don’t have to build it themselves.”

A tectonic shift

Qureshi sees the potential for major change in the industry with the introduction of TEAM.

“I think one of those tectonic shifts is happening that will move the industry forward rapidly,” he says. “Whatever trajectory we pick is going to be decided in the next year and a half.”

This could mean a push to remove the barriers and silos that currently separate different aspects of care.

“How do we take down these silos? Let’s not boil the ocean, let’s start with these five procedures. Then we’ll move to seven in 2027 and 10 in 2030, and then that becomes the blueprint for outcome-based care,” he says.

This also means better outcomes by having less of the onus for improving patient care to be on the patient themselves.

“From the healthcare system perspective, once you start implementing better workflows, you start seeing realizable value in actual dollars and cents,” says Qureshi. “And then that allows you to see those hard dollars invested in better care within the health system. Who doesn’t want a pot of funds that can be invested in better case management, in strategic initiatives like mental health or adherence?”

Rainfall has done an analysis of 100 facilities for the TEAM model and on average found they could save between $3.1 and $11 million dollars per year on the five-year model.

“Those are not small numbers. Those are major components they could reinvest toward patient care,” says Qureshi.

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