Bundled Payments: 7 Ways to Position Home Care Competitively
CMS finalized the episode-based payment model Transforming Episode Accountability Model (TEAM). TEAM will be a five-year, mandatory episode-based payment model that will start in January 2026.
What Does Team Mean to Home Care Providers?
The TEAM model’s five surgical procedures include:
- lower extremity joint replacement,
- surgical hip femur fracture treatment,
- spinal fusion,
- coronary artery bypass graft, and
- major bowel procedure.
These five procedures are a bundle. In other words, participation includes all surgical procedures.
Bundled Payment Extends 30-Days After Discharge
TEAM‘s bundled payment extends 30 days after the Medicare beneficiary leaves the hospital. CMS will provide participants with a target price that will represent most Medicare spending during an episode of care, which will include the surgery (including the hospital inpatient stay or outpatient procedure) and items and services following hospital discharge, such as skilled nursing facility stays or provider follow-up visits. Holding participants accountable for all the costs of care for an episode may incentivize care coordination, improve patient care transitions, and decrease the risk of avoidable readmission.
3 Participation Tracks
TEAM has three participation tracks: Track 1 will have no downside risk and lower levels of reward for the first year, or up to three years for safety net hospitals; Track 2 will be associated with lower levels of risk and reward for certain TEAM participants, such as safety net hospitals or rural hospitals, for years 2 through 5; and Track 3 will be associated with higher levels of risk and reward for years 1 through 5.
7 Ways to Position Home Care Competitively
Patient Experience
TEAM aims to improve the patient experience from surgery through recovery by supporting the coordination and transition of care between providers and promoting a successful recovery that can reduce avoidable hospital readmissions and emergency department use.
Quality of Care Indicator: Patient Satisfaction
Patient satisfaction is a direct reflection of the quality of care provided. In the TEAM bundle model, patient feedback is often used as a key performance metric. High patient satisfaction scores indicate that the care provided met or exceeded patient expectations, which is crucial for maintaining the integrity of the bundled payment model.
Coordination of Care
Effective coordination with hospitals, physicians, and other home care providers is essential. Home care providers play a critical role in managing the patient’s transition from hospital to home, reducing the risk of readmissions, and ensuring continuity of care. Strong communication and collaboration with other care team members are crucial.
Quality of Care and Outcomes
Under TEAM bundles, home care providers are often evaluated based on patient outcomes, such as readmission rates and patient satisfaction. High-quality care that leads to positive outcomes is not only beneficial for patients but also ensures that home care providers can remain competitive and financially viable under the bundled payment model.
Cost Management
Home care providers need to manage their costs efficiently to remain profitable under the fixed payments provided by TEAM bundles. This includes optimizing resource utilization, reducing unnecessary visits, and avoiding costly complications that could erode profit margins.
Data Reporting & Analytics
Participating in TEAM bundles requires home care providers to collect and report data on various performance metrics. Providers must invest in data analytics capabilities to track patient outcomes, identify areas for improvement, and demonstrate their value in the care continuum.
Compliance with Regulations
Home care providers must stay updated on regulations and guidelines associated with TEAM bundles. This includes understanding the criteria for patient eligibility, covered services, and reporting requirements to ensure compliance and avoid penalties.
By focusing on these key areas, home care providers can successfully navigate the challenges and opportunities presented by TEAM mandatory bundles and contribute to better patient outcomes and more efficient healthcare delivery.
