The Episode Accountability Model (TEAM) represents a significant shift from traditional fee-for-service models towards a more integrated, value-based care system. By focusing on specific episodes of care, TEAM encourages healthcare providers to think beyond individual services and consider the patient’s entire journey through the healthcare system. This holistic approach not only promises to improve patient outcomes but also to optimize healthcare spending and resource allocation.
Understanding TEAM’s Core Principles
TEAM is designed to address some of the most pressing challenges in modern healthcare delivery. The model aims to:
- Enhance care coordination across different healthcare settings
- Improve the quality of care while reducing unnecessary costs
- Promote accountability among healthcare providers
- Support better long-term health outcomes for patients
CMS TEAM model achieves these goals by holding healthcare providers accountable for both the cost and quality of care during specific episodes. This accountability extends beyond the immediate procedure or hospital stay, encompassing follow-up care and potential complications.
Connecting Patients to Primary Care
One of TEAM’s most innovative aspects is its emphasis on establishing long-term, accountable care relationships. Participants in the model are tasked with connecting patients to primary care services, recognizing that ongoing, preventive care is crucial for optimal health outcomes. This focus on primary care integration helps to create a more continuous and comprehensive healthcare experience for patients, potentially reducing the likelihood of future complications or hospitalizations.
Scope of the CMS TEAM Model
TEAM initially focuses on five key surgical procedures:
- Lower extremity joint replacement
- Surgical hip femur fracture treatment
- Spinal fusion
- Coronary artery bypass graft
- Major bowel procedure
For each of these procedures, CMS will provide participants with a target price that encompasses most Medicare spending during the episode of care. This price includes not only the surgery itself but also related services following hospital discharge, such as skilled nursing facility stays and follow-up visits.
By holding participants accountable for the total cost of care during an episode, TEAM incentivizes better care coordination, smoother patient transitions, and a reduction in avoidable readmissions. This comprehensive approach encourages healthcare providers to think beyond their immediate role and consider the patient’s entire care journey.
Financial Structure and Incentives
The Episode Accountability Model (TEAM) introduces a nuanced financial structure designed to balance risk and reward. Participants can choose from three tracks, each offering different levels of financial risk and potential rewards:
- Tracks 1 and 2: These tracks offer lower financial risks and rewards, making them suitable for providers who may be new to value-based care models or those serving higher proportions of underserved populations.
- Track 3: This track involves higher potential financial risks and rewards, designed for providers with more experience in value-based care models.
This tiered approach allows a diverse range of healthcare providers to participate in TEAM, from smaller community hospitals to large academic medical centers.
Promoting Health Equity
A standout feature of the TEAM Model is its strong focus on health equity. Recognizing that certain populations face greater barriers to accessing quality healthcare, TEAM incorporates several mechanisms to address these disparities:
1. Financial Flexibility
The model offers certain flexibilities to help participants caring for a higher proportion of underserved individuals, such as safety net hospitals. This includes the option to participate in Tracks 1 and 2, which have lower financial risks.
2. Social Risk Adjustment
TEAM’s target pricing methodology includes a social risk adjustment. This ensures that target prices accurately reflect the additional financial investment needed to care for underserved individuals.
3. Voluntary Health Equity Plans
Participants can voluntarily submit health equity plans to CMS, demonstrating their commitment to addressing healthcare disparities.
4. Demographic Data Reporting
The model encourages the reporting of demographic data to CMS, enabling better tracking and addressing of health disparities.
5. Screening for Social Needs
TEAM participants may voluntarily screen and report individuals for health-related social needs, recognizing the impact of social determinants on health outcomes.
By incorporating these elements, TEAM goes beyond clinical care to address the broader factors that influence health outcomes, particularly for underserved populations.
Persivia’s Innovative Solutions to ensure TEAM Success
As healthcare providers navigate the complexities of the TEAM model, they need robust technological support and expertise. This is where Persivia, a leader in healthcare technology solutions, steps in to play a crucial role. By offering a comprehensive suite of tools and services, Persivia helps healthcare organizations to excel in the TEAM model and other episodic care initiatives:
- Orchestrating Success in Episodic Care
Persivia’s approach to supporting the TEAM model is multifaceted and comprehensive. At its core is a robust data infrastructure that forms the foundation for informed decision-making and continuous improvement. This infrastructure captures, analyzes, and interprets both clinical and financial data, providing a 360-degree view of patient care and organizational performance.
One of Persivia’s key strengths lies in its proactive episode identification capabilities. By leveraging population demographics and performance metrics, healthcare providers can identify eligible patients at the time of admission. This early recognition allows for timely interventions and improved care coordination, setting the stage for better outcomes from the outset.
- Advanced Analytics: The Cornerstone of Personalized Care
Persivia’s advanced analytics tools take patient care to the next level. Through multi-layered risk stratification, providers can identify high-risk patients and create personalized care plans. This not only enhances patient outcomes but also contributes to cost optimization. Real-time tracking of performance metrics ensures that hospitals can continuously adjust their strategies to meet bundled payment goals.
- Continuity of Care: From Admission to Recovery
With Persivia’s CareSpace® platform, providers get real-time care alerts. Patients are seamlessly tracked throughout their anchor and post-anchor stays. This continuous monitoring promotes uninterrupted care and minimizes treatment gaps. CareSpace® designs patient-centered, evidence-based care pathways that cover the entire episode of care, ensuring that every step of the patient journey is optimized for the best possible outcomes.
- Bridging Care Settings for Seamless Transitions
Recognizing the importance of smooth transitions in episodic care, Persivia maintains a strong network of high-quality providers across the care continuum. This network, encompassing hospitals, post-acute care facilities, and home health agencies, ensures that patients experience seamless transitions between different care settings.
- Engaging Patients in the Digital Age
In today’s increasingly digital healthcare landscape, CareSpace® offers remote monitoring, telehealth, and patient communication. These digital engagement tools not only enhance patient involvement but also improve overall care delivery, aligning perfectly with the TEAM model’s focus on comprehensive, patient-centered care.
- Benchmarking for Continuous Improvement
To help healthcare providers understand their performance in the context of the broader healthcare landscape, Persivia enables benchmarking against national and regional standards. This feature allows hospitals to identify areas for improvement and understand their competitive position, driving continuous enhancement of care quality and efficiency.
- Adaptability in a Dynamic Healthcare Environment
Perhaps one of Persivia’s most valuable attributes is its commitment to flexibility and responsive support. The platform is designed to be tailored to each organization’s unique needs, allowing for rapid adaptation to changing requirements. This adaptability is crucial for success in the evolving landscape of episodic care models like TEAM.
The Path Forward
The TEAM Model represents a significant step towards a more integrated, equitable, and efficient healthcare system. By bridging the gaps between different care settings, incentivizing quality over quantity, and explicitly addressing health equity, TEAM sets a new standard for value-based care models.
As healthcare providers begin to implement TEAM, we can expect to see a shift towards more coordinated care, improved patient outcomes, and potentially significant cost savings for the healthcare system as a whole. While challenges undoubtedly lie ahead in implementing such a comprehensive model, the potential benefits for patients, providers, and the broader healthcare system are substantial.
The journey from fragmentation to fusion in healthcare is a complex one, but with innovative models like TEAM leading the way, we are moving towards a future where high-quality, equitable, and efficient care is the norm rather than the exception. As this model unfolds, it will be crucial for healthcare providers, policymakers, and patients alike to engage with and learn from its implementation, continuously refining our approach to episode-based care and healthcare delivery as a whole.