Are You Ready for Value-Based Care Implementation for CMS Transforming Episode Accountability Model (TEAM)? A Strategic Approach to Support Participant Success

Shari Garceau, MSN, RN, CMAC, CCM, ACM-RN, TCM, CLSSGB
Member, ACPA

With the final rule expected in August 2025, preparation will lead to success. The strategy encompasses the critical aspects of change management to facilitate a seamless transition, including stakeholder engagement, risk mitigation, and the establishment of clear communication channels. By leveraging data analytics and evidence-based practices, we aim to continuously refine our approach, ensuring alignment with regulatory requirements and industry standards. A commitment to distinction is reflected in dedication to achieving measurable improvement in patient care and operational efficiency. 

1) Stakeholder Engagement

Making changes, whether voluntary or mandated, to align practice with the CMS TEAM (Transforming Episode Accountability Model) requires engaging key stakeholders as the first step. CMS TEAM is a coordinated effort that engages multiple departments.

It is important to involve key stakeholders in the assessment process to gain a comprehensive understanding of the needs and perspectives across the organization. This includes engaging with management, employees, partners, and clients through various channels, such as meetings, feedback sessions, whiteboarding sessions, and collaborative workshops.

Below are the key stakeholders to include throughout the process of implementing TEAM within an organization:

  • Executive Leadership – Guides strategy, sets goals, oversees project success.
  • Primary Care Providers (PCPs) & Office Managers – Ensure communication and appropriate referrals to specialists.
  • Surgeons & Office Managers – Coordinate care across specialists, payors, and facilities.
  • Patient Access/Registrars – Verify insurance coverage and ensure TEAM eligibility.
  • Scheduling Teams – Ensure timely, complete scheduling with appropriate codes.
  • Coding & CDI Teams – Validate CPT/HCPCS codes and ensure data capture for reporting.
  • Supply Chain & Pharmacy – Manage necessary resources and avoid waste.
  • Utilization Management (UM) – Apply screening criteria and involve physician advisors to ensure appropriate level of care.
  • Case Management (CM) – Coordinate care transitions, discharge planning, and DME.
  • Physician Advisors – Guide clinical documentation, DRG validation, and throughput.
  • Health Information Management (HIM) – Ensure CMS-compliant documentation and record integrity.
  • Billing & Business Office – Submit accurate and timely claims.
  • Information Technology (IT) – Support system integration and EHR capabilities for TEAM.
  • Training & Development – Educate staff on TEAM protocols and CMS compliance.
  • Quality Assurance – Monitor outcomes, conduct audits, and ensure continuous improvement.
  • Post-Acute Providers – Coordinate timely patient transitions and return to prior level of function.

2} Assessment of Organizational Readiness

The initial step in implementing a value-based practice aligned with CMS TEAM is to conduct a thorough assessment of the organization’s current state and gap identification. This involves:

  • Skill Gap Analysis: Use surveys, interviews, and observations to identify deficits in staff knowledge, process performance, or technology.
  • Objective Setting: Define measurable goals (e.g., improved throughput, reduced denials, better care coordination).
  • Data Collection & Analysis: Gather data to identify workflow breakdowns, cost drivers, and improvement opportunities.
  • Process Mapping: Visualize current workflows to identify inefficiencies and redesign patient-centered, TEAM-aligned pathways.
  • Technology Assessment: Evaluate current tools, interfaces, and EHR functionality to identify what must be optimized or upgraded.
  • Resource Allocation: Ensure appropriate personnel, finances, and materials are available to support the change.
  • Risk Analysis: Identify implementation barriers (e.g., staffing, training gaps, system limitations) and prepare mitigation strategies.

3) Strategic Recommendation Design

Based on the assessment results, the next step is to formulate strategic recommendations for implementing a high-quality value-based approach to the CMS TEAM episodes of care. Key elements to consider include:

  • Change Management: Use proven strategies to support staff through change and address resistance.
  • Defined Roles & Responsibilities: Clarify expectations for all departments involved; update job descriptions as needed.
  • Process Improvement: Build efficient, documented workflows that prioritize safe, coordinated care.
  • Technology Enhancement: Leverage existing systems or implement new tools to support TEAM documentation and tracking.
  • Staff Feedback & Iteration: Involve frontline teams in refining the approach and training content.
  • Comprehensive Education Plan: Offer training on CMS guidelines, billing rules, and TEAM workflows, with regular refreshers.

4) Implementation Strategy 

Effective implementation requires careful planning and execution. Consider the following strategies:

  • Pilot Projects: Start with one provider, department, or facility to build expertise and refine processes.
  • Full Rollout: If ready, launch systemwide with full staff readiness and aligned protocols.
  • Training Completion: Require all involved staff to complete education programs before go-live.
  • Technology Utilization: Use platforms for education delivery, workflow automation, real-time communication, and patient-centered documentation.

5) Monitoring and Continuous Improvement

Build a feedback loop to track performance and adjust as needed.

  • Progress Tracking: Use KPIs and analytics to monitor implementation, staff engagement, and patient outcomes.
  • Feedback Collection: Regularly solicit input via surveys, interviews, and team meetings.
  • Iterative Adjustments: Use real-world data to refine workflows, education, and technology use.

6) Reporting 

Regularly share insights and progress reports with key stakeholders to maintain transparency and keep all stakeholders and the community informed about the program’s impact and developments. Utilize comprehensive data visualization tools to present findings in a clear, accessible, and actionable manner.

CMS TEAM reporting will also be maintained in accordance with CMS guidelines and will be publicly available for patients to make informed healthcare decisions.

Conclusion 

Implementing a CMS TEAM program is a strategic investment in the future of both the organization and the patients. By systematically assessing needs, designing tailored implementations, implementing effective strategies, and continuously monitoring progress, organizations can foster a culture of continuous growth, success, and patient-centered quality care.