Understanding the nuances between CMS's TEAM and BPCI Advanced value-based payment models is crucial for healthcare providers aiming to improve patient care and navigate financial risks effectively.
The Centers for Medicare & Medicaid Services (CMS) recently introduced the TEAM (Targeted Episodes and Measures) bundles, which will be mandatory starting January 1st for hospitals in selected areas. This new model aims to improve healthcare delivery and financial responsibility through a more focused and structured approach.
Unlike previous models, TEAM is designed to hold hospitals accountable for patient outcomes during specific surgical episodes. This post explores the differences and similarities between TEAM and CMS's existing bundles model, BPCI Advanced.
One of the key distinctions between TEAM and BPCI Advanced (Bundled Payments for Care Improvement Advanced) is the nature of participation. While TEAM mandates involvement for hospitals in certain areas, BPCI Advanced remains a voluntary program. This difference in participation requirements reflects CMS’s strategic approach to broadening the impact of their new value-based payment models.
Mandatory participation under TEAM is intended to create a consistent framework for assessing the effectiveness of bundled payments, whereas the voluntary nature of BPCI Advanced allows hospitals to choose their level of engagement based on their readiness and capacity.
TEAM is specifically designed to target surgical procedures, such as hip replacements, making hospitals financially responsible for all aspects of patient care during these episodes. This narrow focus allows for more precise adjustments and improvements in surgical care pathways.
In contrast, BPCI Advanced covers a broader range of medical treatments, including both surgical and non-surgical episodes. Hospitals participating in BPCI Advanced have the flexibility to select the types of episodes they want to manage, which can include chronic conditions and acute medical treatments.
A notable feature of the TEAM bundles is their emphasis on health equity. TEAM adjusts payments to better support hospitals that treat underserved populations, ensuring that financial incentives do not inadvertently widen disparities in healthcare access and outcomes.
Additionally, TEAM introduces a new environmental component aimed at addressing the impact of climate change on health. This initiative marks a progressive step by CMS to incorporate sustainability into healthcare delivery, recognizing the broader implications of environmental factors on patient health.
Both TEAM and BPCI Advanced involve financial risk-sharing, but they approach it differently. TEAM offers a gradual approach to financial risk with different tracks based on the hospital's readiness, allowing for a smoother transition and adaptation period.
BPCI Advanced also includes risk-sharing but provides participants with more flexibility and choice in selecting their episodes and risk levels. This flexibility enables hospitals to tailor their participation to their specific capabilities and strategic goals, balancing potential rewards with manageable risks.
Here at Radial we are always interested to see new approaches from CMS that aim to optimize health outcomes while ensuring financial sustainability of the nation's healthcare system. TEAM looks set to be an interesting step in the right direction, building on lessons learned from CMS's prior bundle models.
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