CMS TEAM model preparation: Opportunity analysis

Why hospitals and providers should leverage episodes of care data before TEAM begins 

As CMS continues to advance value-based care initiatives, including the Transforming Episodes Accountability Model (TEAM), hospitals and health systems face increasing pressure to adapt to episodic payment models. To help overcome this pressure, opportunity analysis, which includes simulated TEAM episodes of care, provides a low-risk, data-driven way to prepare for these changes in payment policy and care delivery before TEAM’s formal implementation. 

In this blog, we’ll explain why integrating simulated episodes of care into your strategic planning can set your organization up for success under the CMS TEAM model. We’ll also cover the basics of episodes of care and how DataGen helps providers nationwide to access bundled payment opportunity analyses to better understand the expected impact of TEAM, reduce risk and drive improvement. 

What are simulated TEAM episodes of care?   

Simulated TEAM episodes of care are built using claims data from the Medicare fee-for-service (FFS) beneficiary population, according to the FY 2025 Medicare IPPS final rule.   

These episodes are “simulated” since they mimic the rules and structure outlined by CMS in the final rule, thus allowing any hospital to evaluate its hypothetical performance outside of participation in the future live model.   

How do simulated TEAM episodes of care benefit hospitals?   

TEAM success depends on seamless provider collaboration across different specialties and across the continuum of care. By using episodes of care data to simulate TEAM rules and requirements, providers can better understand how to align care delivery goals, reduce care fragmentation and ensure a more unified approach to patient outcomes. 

1. Test the financial impact of TEAM 

Simulated TEAM episodes of care allow hospitals to assess how well they are positioned for the upcoming mandatory TEAM model. These episodes can be used to model financial performance under each of the risk tracks in TEAM prior to participation, helping leadership understand their risks and opportunities.  

By evaluating historic data in an episodic framework, hospitals can gather critical insights on Medicare episode expenditures, resource utilization and opportunities to improve coordination across the continuum of care. 

2. Gain a competitive advantage 

Early data-driven preparation can offer hospitals a competitive edge before the TEAM model begins. Look to benchmarks created from simulated TEAM episodes of care to analyze how individual hospital care patterns compare to the market. Case mix-adjusted benchmarks will allow hospitals to understand what improvement may be feasible prior to initiating adjustments in care strategies.   

Every element of the episode has an influence on Medicare episode spend — choice of first post-acute care setting, length of stay, number of home health visits, readmissions, etc. Hospitals must evaluate how they plan to impact post-discharge care and subsequently conduct predictive “what-if” analyses to determine if they can meet TEAM’s financial goals.   

3. Refine care coordination and quality initiatives 

CMS’ TEAM model preparation requires optimized care pathways that span the entire patient episode. Opportunity analyses with simulated TEAM episodes of care allow hospitals to analyze patterns in the post-discharge period, identify gaps in care coordination and develop processes that align with TEAM’s emphasis on quality outcomes across an episode.  

Get more information on TEAM episodes of care analysis 

Learn more about DataGen and our TEAM bundled payment opportunity analysis. Explore how our solution can help you prepare for the mandatory CMS Transforming Episode Accountability Model (TEAM) and future models.  

Plus, download our Transforming Episode Accountability Model info sheet to learn how to boost your analytics to achieve clinical, quality and financial goals.