Read below to determine if your facility is TEAM ready.

The Transforming Episode Accountability Model (TEAM) is a significant new initiative designed to enhance the quality of care while controlling costs within the Medicare system. Scheduled for implementation on January 1, 2026, this model is mandated by the Center for Medicare and Medicaid Innovation (CMMI) and will be administered by the Centers for Medicare and Medicaid Services (CMS). 

The TEAM model marks a significant step in Medicare’s shift toward value-based care, with hospitals being held more accountable for the cost and quality of care they provide throughout the entire surgical episode. It will drive changes in how hospitals approach patient care, focusing on long-term recovery and preventive measures to ensure the best possible outcomes for patients.

There are 741 selected TEAM participants, which include a diverse set of hospitals with distinct features. These hospitals must meet the following criteria to participate in the model:

Location:

• Core Based Statistical Area (CBSA): TEAM participants must be located within a selected CBSA. A CBSA may include urban or rural areas, which means hospitals from a broad range of geographic settings can participate in TEAM.
  
  
• Acute Care Hospitals: Only acute care hospitals located within a selected CBSA and paid under the Inpatient Prospective Payment System (IPPS) are eligible. 

Types of Hospitals:
TEAM participants may belong to a variety of hospital categories:

• Safety Net Hospitals: Hospitals that provide a large amount of care to low-income, uninsured, and underserved populations. These hospitals are often critical in maintaining access to care for vulnerable communities.
  
  
• Rural Hospitals: Hospitals located in rural areas, which may face unique challenges such as fewer resources, limited access to specialists, and geographic barriers for patients.
  
  
• Medicare Dependent Hospitals (MDH): Hospitals that are highly dependent on Medicare revenue. These hospitals tend to serve a higher proportion of elderly or low-income patients.
  
  
• Sole Community Hospitals (SCHs): Hospitals that are the only healthcare providers within a geographic area, meaning they are often the only hospital serving a large number of patients. These hospitals typically serve isolated or rural populations and are financially vulnerable.
  
  
• Essential Access Community Hospitals: These are hospitals that are important to the health infrastructure of a community, especially in areas where access to healthcare is limited.
  ‍
• Hospitals that Participated in BPCI Advanced or CJR Models: Hospitals that have been involved in other value-based care models, such as the Bundled Payments for Care Improvement (BPCI) Advanced model or the Comprehensive Care for Joint Replacement (CJR) model, which were designed to encourage care coordination and cost control for specific episodes of care. These hospitals, if not located in a select CBSA, had a one-time opportunity to voluntarily opt into the TEAM model.

You can view the full list of participating hospitals here: CMS TEAM Participant List (XLSX)

TEAM is specific to Medicare Part A & B beneficiaries where Medicare is their primary insurance.  It does not apply to beneficiaries enrolled in a managed care plan, with end stage renal disease, or covered under United Mine Workers of American health plan.

TEAM will initially focus on 5 high-cost, high-volume surgical episodes with specific MS-DRG and HCPCS codes:

• Coronary artery bypass graft surgery (CABG)
  
  • Includes: Coronary revascularization by CABG 
• Lower extremity joint replacement (LEJR)
  
  • Includes: Hip, knee, and ankle replacements 
  • Excludes: Arthroplasty of the small joints in the foot  
• Major bowel procedure
  
  • Includes: Major small or large bowel surgery 
• Surgical hip/femur fracture treatment (SHFFT)
  
  • Includes: Hip fixation procedure in the presence of a hip fracture (both open and closed surgical hip fixation) with or without fracture reduction 
  • Excludes: Joint replacement 
• Spinal fusion
  
  • Includes: Spinal fusion procedures for cervical, thoracic, or lumbar

A distinctive feature of TEAM is the 30-day post-discharge episode. Hospitals will be held responsible for patient outcomes during this window, creating a financial incentive for them to prioritize follow-up care and recovery management after the patient leaves the hospital.

The model continues CMS’s push toward value-based care, moving away from fee-for-service reimbursement. Under TEAM, hospitals are financially responsible for the entire episode of care starting with a surgical procedure and extending for 30 days post-discharge. This means that hospitals are incentivized to ensure high-quality, coordinated care throughout the patient's recovery, not just during the procedure itself.

Hospitals will now be accountable for the costs and outcomes associated with the entire episode, including any complications or readmissions within the 30-day window. This places financial responsibility on hospitals to manage care efficiently and reduce unnecessary costs without compromising patient outcomes.

Schedule time with one of our experts to understand your facility’s financial implications.

The primary objective of the model is to reduce costs associated with surgical episodes while simultaneously improving patient outcomes. To achieve this, hospitals will need to focus on preventive care, coordination across healthcare providers, and patient-centered care practices that enhance recovery and prevent complications or readmissions.

Hospitals participating in TEAM must meet specific quality performance measures, which influence financial reconciliation. 

Composite Quality Score (CQS), is a new measurement specific to TEAM and applies to TEAM beneficiaries.  Helping to inform the CQS are specific Quality Measures.  Quality Measures are evaluated at the hospital level and are:

• Hybrid Hospital-Wide Readmission
• (THA/TKA) PRO-PM (LEJR specific)
• HH-Falls with Injury - NEW PY 2
• HH-Post Respiratory Failure - NEW PY 2
• Failure to Rescue - NEW PY 2

• HAC Reduction Program for this quality measure PSI 90

TEAM is designed to align cost savings with improvements in patient experience and clinical outcomes, making quality a non-negotiable part of success. 

Hospitals will be rewarded for providing high-quality care within the episode at a lower cost, but penalties may be levied for poor outcomes or high costs that are not justified by the complexity of care.

TEAM offers three distinct participation tracks, allowing hospitals to choose the level of risk and reward they are willing to take on, depending on their circumstances and readiness. 

Track 1: No Downside Risk with Medium Reward

This track is designed to help hospitals ease into the new model, offering them time to adjust to the value-based care approach without bearing the financial burden of risk in the first year (or up to three years for safety net hospitals). Hospitals in Track 1 will not face penalties for higher-than-expected costs or poor patient outcomes.  Although there's no downside risk, hospitals can still earn financial rewards for meeting certain cost and quality performance goals.

Track 2: Lower Risk and Reward (Years 2-5)

Track 2 is available for specific hospital types starting in years 2 through 5 of the TEAM model. In Track 2, hospitals assume some risk for the cost and quality of care but at a lower level than Track 3. Likewise, the potential financial rewards are also reduced.

Track 3: Highest Risk and Reward (Years 1-5)

Track 3 is designed for hospitals that are fully committed to taking on the highest level of financial risk and reward in the TEAM model. This track is available throughout the full 5-year period of participation in the model (Years 1 through 5).

Hospitals in Track 3, if they manage costs well while maintaining or improving care quality, they can earn substantial rewards. However, if costs exceed expectations or quality falls short, they will face significant penalties.

Schedule time with one of our team’s experts to understand your facility’s financial implications with your Track choice

If your hospital is a mandated facility, here's a three-step readiness plan:

1. Assess Your Episode Risk

• Identify if your hospital performs TEAM-targeted procedures
• Review historical episode costs and quality scores
• Determine gaps in care coordination or documentation

2. Strengthen Partnerships Across the Continuum

• Formalize referral pathways with high-performing post-acute providers
• Align clinical teams on discharge protocols and patient handoffs
• Begin collaboration with primary care and ACO partners

3. Deploy Technology to Track Performance

• Implement tools to monitor episode costs, quality, and patient movement in real time
• Ensure interoperability with external providers
• Automate compliance reporting workflows

Hospitals participating in TEAM will require robust systems to manage both clinical quality and financial performance across extended care episodes.

Hospitals participating in TEAM will require robust systems to manage both clinical quality and financial performance across extended care episodes. Rainfall Health’s RainCompliant™ platform delivers exactly that—powered by artificial intelligence to simplify compliance, reduce administrative overhead, and improve patient outcomes.

RainCompliant™ by Rainfall Health provides:

• Real-time episode tracking from surgery to post-acute recovery
• Cross-provider data sharing and EHR integration
• Automated compliance documentation
• Analytics dashboards to monitor risk-adjusted cost and quality

“Our AI technology is designed to empower health systems with the tools they need to meet TEAM model requirements effortlessly,” said Ahmed Qureshi, CEO & Founder of Rainfall Health. “By streamlining compliance, we not only help organizations avoid penalties but also improve patient care and financial performance.”

Whether you're a large academic medical center or a rural hospital, Rainfall Health adapts to your workflows—helping you:

• Monitor episodes in real time with predictive analytics
• Automate quality reporting and documentation workflows
• Identify and close compliance gaps before they affect reimbursement
• Reduce readmissions by optimizing care transitions and discharge planning

Early adopters of RainCompliant™ have already reported reduced errors, improved care coordination, and increased Medicare reimbursement—highlighting the real-world impact of AI-driven compliance. Hospitals that proactively invest in these capabilities will be better positioned to succeed under TEAM—and in future CMS models that follow.

To ensure RainCompliant™ platform is grounded in real-world hospital needs, Rainfall Health is advised by a committee of nationally recognized healthcare leaders:

• Robert Bart, MD – CMIO, UPMC
• Scott Cooper, MD – Regional Physician Executive, Mercy
• Cora Han – Chief Health Data Officer, UC Health
• Manu Nair – Head of Corporate Development, Mayo Clinic
• Tametha Stroh, MSN, RN – Risk Management Lead, Kaiser Permanente
• Junaid Syed, MD – CMIO, Avera Health

This council guides product strategy, helping Rainfall Health stay ahead of regulatory shifts and support providers on the front lines.

As CMS continues to expand mandatory payment models like TEAM, equipping your organization with scalable, intelligent tools will be critical. To learn more or request a demo, visit www.rainfallhealth.com/raincompliant or email info@rainfallhealth.com.

The Transforming Episode Accountability Model (TEAM) marks a significant expansion in CMS’s value-based care strategy. With both cost control and quality improvement as dual goals, hospitals must think beyond traditional episode boundaries.

Whether you’re on the CMS participant list or preparing for what's next, the time to act is now.

Learn how hospitals are preparing for TEAM—and how Rainfall Health’s RainCompliant™ platform can support episode tracking, compliance, and care coordination.