A variety of factors can contribute to patients with Medicare not being adequately prepared for surgical procedures or postoperative care. This lack of preparation can lead to complications, extended recovery periods, and possibly, an increased likelihood of rehospitalization – all of which result in adverse outcomes and escalated costs. As the Centers for Medicare & Medicaid Services (CMS) continues to advocate for improvements in cost efficiency and healthcare quality, they plan to introduce a new value-based care model, the Transforming Episode Accountability Model (TEAM), on January 1, 2026.
The TEAM is a compulsory bundled payment model designed to streamline care coordination, reduce fragmented care, boost service quality, and decrease Medicare spending. Scheduled to run for five years, this model will affect approximately 25% of all Medicare beneficiaries, influencing practices in 741 hospitals across 188 metropolitan areas.
A notable feature of the TEAM model is its emphasis on cost and quality of care for five specific surgical episodes that span the initial hospital stay and a 30-day post-discharge period. Although this model presages potential benefits, healthcare providers may face significant challenges, particularly where their episode costs exceed CMS benchmarks, thus losing the difference in reimbursements. On the other hand, providers maintaining or reducing costs within the CMS threshold may enjoy shared cost savings and quality bonuses.
The CMS provides detailed guidelines to assist hospitals in preparing for the rollout of the TEAM model. A crucial aspect of this model involves creating strategies to cater to underserved populations, emphasizing the importance of health equity.
Digital engagement is especially suited for supporting outcomes related to the TEAM model. To optimize TEAM performance, healthcare providers should consider digital solutions that offer longitudinal guided care plans covering all five surgical categories outlined by TEAM. Such a solution should also incorporate engagement with patients well in advance of scheduled surgeries and continue through the mandated 30-day recovery period.
Presurgical support plays an essential role in preparing patients for their procedures, promoting optimal health, and providing thorough patient education. A well-designed digital engagement strategy should provide complete, easily understandable, and accessible education relative to the care and condition of patients. Along with offering live support to answer non-clinical issues, this approach should also accommodate social determinants of health (SDOH) patient requirements.
In conclusion, a robust digital engagement solution covering the entire continuum of patient care can support healthcare providers in achieving their TEAM-related objectives. Although TEAM focuses on post-procedure, the process of ensuring positive outcomes and reducing care costs starts before surgery. The all-inclusive patient engagement solutions offered by Get Well are precision-tailored for such needs and can offer the necessary support as you work through implementing TEAM at your organization.