CMS’s new TEAM model marks a pivotal moment for hospitals: mandatory participation, financial accountability, and heightened expectations around surgical episodes that have historically driven massive spend variability. At Clarify, we view this as more than a regulatory shift — it’s a defining opportunity for hospitals to build lasting competitive advantage through smarter, data-driven care.

But success in TEAM won’t come from managing costs retrospectively or chasing quality metrics after the fact. It requires a proactive, real-time command center for episode performance. One that empowers care teams with timely insights, supports operational decisions with predictive intelligence, and gives financial leaders the tools to model risk before it becomes reality. We’ve spent years developing AI-powered analytics solutions that deliver episode-level visibility, not just across inpatient care, but all the way through post-acute transitions and recovery. Whether it’s optimizing referrals, flagging costly variation, or simulating outcomes under CMS’s evolving rules, we help hospitals operationalize value-based care with speed and precision.

This blog lays out what’s coming, why it matters, and how your hospital can turn the TEAM mandate into a strategic inflection point. As with every transformation in healthcare, those best prepared with actionable data will lead. We’re here to make sure you’re one of them.

The Centers for Medicare & Medicaid Services (CMS) is ushering in the next era of value-based care with its new Transforming Episode Accountability Model (TEAM), slated to launch in January 2026. For hospitals in selected markets, participation will be mandatory, introducing both new financial risks and strategic opportunities.

TEAM focuses on five high-volume, high-cost surgical episodes: lower extremity joint replacement, surgical hip/femur fracture treatment, spinal fusion, coronary artery bypass grafting, and major bowel procedures. Under the model, hospitals will be held accountable for the total cost and quality of these episodes, from the initial procedure through 30 days post-discharge.

As with prior bundled payment models like BPCI-A and CJR, success in TEAM will demand careful episode management, robust care coordination, and a strong focus on quality outcomes. But TEAM goes further—with more sophisticated risk-adjusted pricing methodologies and expanded quality metrics.

For many hospitals, this raises an important question: Is your data infrastructure ready to support this level of accountability?

At its core, TEAM is about aligning clinical, operational, and financial strategy around clearly defined episodes of care. To thrive under the program, hospitals will need to:

1. Monitor Episode Costs in Real Time:
   Understanding performance against CMS target prices cannot be a retrospective exercise. Hospitals need timely, episode-level cost tracking to manage variation, identify trends, and make proactive adjustments.
2. Optimize Post-Acute Care and Transitions:
   Post-acute utilization is a key cost driver, and a major focus of CMS quality measurement. Success depends on having clear visibility into post-acute referral patterns and outcomes, with data to inform preferred partner selection.
3. Strengthen Quality Outcomes:
   TEAM introduces performance-based payment adjustments tied to measures such as readmissions, adverse events, and patient-reported outcomes. Tracking these quality indicators at the episode level is essential.
4. Model Financial Risk and ROI:
   Hospitals must be able to simulate how different clinical and operational strategies will impact both financial performance and patient outcomes under TEAM.

Meeting the demands of CMS TEAM requires a deeper level of insight and agility. AI-powered enterprise analytics platforms can provide hospitals with:

• Patient-centric episode definitions that reflect real-world care patterns
• Continuous episode monitoring across the full care continuum
• Predictive modeling to assess financial risk and opportunity
• Referral optimization tools to guide post-acute care decisions
• Quality tracking aligned with CMS’s evolving measures

By integrating these functions, advanced analytics solutions help hospitals shift from reactive compliance to proactive strategy, positioning them for long-term success within the TEAM model.

The TEAM program presents both a regulatory challenge and a strategic opportunity. Hospitals that invest now in the right data infrastructure and analytic capabilities will not only mitigate financial risk, but also enhance care coordination, improve outcomes, and strengthen community trust.

As the implementation date approaches, equipping leadership and care teams with actionable, episode-based insights will be critical. TEAM readiness isn’t just about meeting CMS requirements—it’s about setting the foundation for a more agile, intelligent healthcare delivery system.

Want to learn more about how analytics can help your hospital succeed under CMS TEAM? Explore Clarify Health’s episode-based analytics here.