Using precision digital engagement to educate, support patients prior to care, sets the stage for optimal TEAM performance
For a variety of reasons, people with Medicare undergoing surgery may not be well-prepared for their procedure or care for themselves properly post-surgery. When this happens, it can lead to complications, longer recovery times and other issues that ultimately lead to patients returning to the hospital or ED. This results in poorer outcomes and higher overall costs.
As CMS continues to push for improvements in quality and cost, it will roll out a new value-based care model, the Transforming Episode Accountability Model (TEAM) on January 1, 2026. TEAM is a mandatory, bundled payment model designed to improve care coordination, reduce fragmentation, enhance quality and lower Medicare spending. TEAM will run for five years and will affect 741 hospitals in 188 metropolitan areas—including approximately 25% of all Medicare beneficiaries.
The Five Surgical Categories
Specifically, selected hospitals will be accountable for the cost and quality of care (spanning the initial hospital stay and 30 days post-discharge) for five surgical episodes:
- Lower extremity joint replacement (LEJR)
- Coronary artery bypass graft (CABG)
- Spinal fusion
- Surgical hip/femur fracture treatment (SHFFT), and
- Major bowel procedures
Challenge and Opportunity for Hospitals
While offering the potential for upside, performance under TEAM also presents significant challenges for hospitals that see costs per episode higher than the CMS benchmark with few levers to control those costs.
However, the bottom line is that if hospitals exceed the target costs, they’ll lose the difference in reimbursements. If they come in at or below the CMS threshold, they may receive shared savings and quality bonuses.
Guidance and a Path Forward
CMS offers detailed guidance to help hospitals prepare for the launch of TEAM. Among them, CMS suggests:
- Offering relevant patient engagement services and technology
- Investing in presurgical optimization, particularly for high-risk patients such as those that require physical therapy or have chronic diseases
TEAM also places a strong emphasis on health equity and requires hospitals to develop strategies to address the needs of underserved populations.
Digital Engagement Well-Suited to Support TEAM-Related Outcomes
When considering the best solutions to help you maximize TEAM performance, look for digital options with longitudinal guided care plans that cover all five surgical episodes outlined in TEAM. Additionally, assess if it engages with the patient well before their scheduled surgery and stays with them throughout the TEAM-mandated 30-day recovery period. Additionally, ensure the solution you are considering addresses SDOH patient needs as well.
Keep in mind, too, that presurgical support is critical, because it prepares the patient so they become as healthy and well-educated as possible prior to their procedure. Examples of the types of timely queries patients receive include:
- How is your pain level right now?
- Do you have any new cuts or scraps?
- Are you following your pre-hab exercises?
Complete, easy-to-understand and easy-to-access education relevant to their care and condition should also be provided. For instance, a patient with an upcoming cardiac procedure should receive tailored heart-healthy nutrition guidance. Another Medicare enrollee, preparing for knee replacement, should receive appropriate exercises to strengthen the knee prior to surgery.
Patients with social needs should be identified and supported with relevant resources and when needed. Live support with should be available, that can provide frontline assistance with nonclinical issues such as scheduling follow-up visits, help in finding transportation to appointments or answering questions
The Bottom Line: While the focus on TEAM involves the 30-days post-procedure, achieving positive outcomes and lowering the total cost of care begins before the surgery. A digital engagement solution that supports the whole patient throughout the entire continuum of care and can help hospitals achieve their TEAM-related goals.
Schedule a Demo? Get Well offers precision patient engagement solutions that address these needs, and can support you as you address TEAM at your organization.
