What is the TEAM Program?
Medicare’s Transforming Episode Accountability Model is a mandatory five-year payment model that will apply to 25% of hospitals beginning January 1, 2026.
TEAM holds acute care hospitals accountable for the quality and total cost of care for specific surgical procedures, from hospitalization to 30 days post-discharge.
Key Diagnoses Included:
Lower Extremity Joint Replacements
Coronary Artery Bypass Grafts (CABG)
Major Bowel Procedures
Hip Fractures
Spinal Fusions
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 Hospitals can earn reconciliation payments if costs are below target but face no penalties for exceeding costs.
Financial gains are capped at 10% stop-gain limit.
Bonus potential is tied to Composite Quality Score (CQS) adjustments, up to 10%.
Track 1
Upside-Only Risk
The 3 Tracks of Medicare’s Mandatory TEAM Model
Available from Performance Year 2 for safety net hospitals, rural hospitals, Medicare-dependent hospitals, sole community hospitals, and essential access hospitals.
Includes both upside and downside risks, meaning hospitals can earn bonuses as well as face penalties based on performance.
Stop-gain and stop-loss limits are capped at 10%, with CQS adjustments up to 10% for bonuses and up to 15% for penalties.
Track 2
Lower Two-Sided Risk
Available in all years and required for hospitals not eligible for Track 2 after Performance Year 1.
Features higher financial stakes with 20% stop-gain and stop-loss limits.
Bonus and penalty potential tied to CQS adjustments up to 10%.
Track 3
Higher Two-Sided Risk
Yes, hospitals participating in the TEAM model can select their track, but their options are structured based on the model year and their hospital classification. In Performance Year 1, all hospitals can choose Track 1 (upside-only risk) or Track 3 (two-sided risk).
Starting in Performance Year 2, safety net hospitals, rural hospitals, Medicare-dependent hospitals, sole community hospitals, and essential access hospitals may select Track 2 (lower two-sided risk) or Track 3.
Most other hospitals default to Track 3 from Performance Year 2 onward.
Can We Choose Our Track?
CMS provides a target price based on the national average, adjusted for regional and hospital-specific factors. Suppose CMS sets the benchmark for a total hip replacement at $25,000.
Setting the Target Price
If the hospital manages to reduce the total cost of the hip replacement episode (surgery plus 30 days post-discharge care) to $20,000 by optimizing care coordination, reducing readmissions, and managing post-operative care efficiently, then it achieves $5,000 in savings below the target.
Hospital Performance
This $5,000 difference would be the basis for a reconciliation bonus, which is calculated after adjustments for quality metrics using the Composite Quality Score (CQS). Higher CQS scores improve the bonus amount.
Reconciliation Payment
Instead of receiving bonuses per individual claim, TEAM participants receive annual reconciliation payments. CMS reconciles total costs against target prices at the end of each performance year, allowing for adjustments such as risk, quality scores, and any outlier costs. This consolidated reconciliation process lets CMS calculate the final bonus or penalty for the hospital at year-end.
Payment Timing
What is Composite Quality Score?
The CQS is calculated using a combination of metrics that reflect the quality of care provided, so that hospitals focus on improving quality as well as cutting costs.
⚬Evaluates how often patients are readmitted to the hospital within a specific timeframe (e.g., 30 days) post-discharge.
⚬Lower readmission rates indicate better care coordination and improved outcomes.
⚬Measures hospital performance in avoiding complications and adverse events, such as infections or surgical errors.
⚬Focuses on patient satisfaction and recovery outcomes, especially for joint replacements and other covered procedures.
⚬Examples include pain reduction, mobility improvement, and overall satisfaction with care.
Resilient’s Care Anywhere Program
Built for Medicare’s Mandatory TEAM Model
Resilient’s Care Anywhere Program is designed to help hospitals succeed under Medicare’s Transforming Episode Accountability Model (TEAM), launching January 1, 2026.
Our end-to-end solution supports hospitals in reducing episode costs, improving outcomes, and tracking value-based performance through:
Outpatient at Home
Establish physical therapy and rehab services in the home at the lowest cost of care to Medicare—driving higher compliance and fewer unnecessary SNF referrals.
Remote Therapeutic Monitoring (RTM) + Virtual PT
Lowers readmissions, improves patient outcomes, and extends care touchpoints post-discharge.
Value-Based Intelligence Tools
Enables hospitals to conduct pre-op risk stratification, track patient placements, and proactively manage high-cost post-acute care decisions.
Cost + Performance Reporting
Provides real-time dashboards to estimate episode costs across placement types and monitor performance against TEAM target pricing benchmarks.
Align with Medicare TEAM Program
The TEAM program adjusts hospital payments based on the total cost of care within 30 days post-op—rewarding efficiency and penalizing excess.
Resilient helps you stay ahead, control costs, and capture the upside.
Program Implementation
We stand up at home and virtual programs for the hospital, supporting all regulatory, operational, and compliance requirements.
Hospital Team Training
Comprehensive training for hospital staff, covering clinical workflows, technology usage, and program operations.
Support for the hospital's business development team to drive program success.
How We Deliver
Professional Services
We provide access to our pool of experienced clinicians and staffing partners to staff programs efficiently.
Management Services
We oversee the day-to-day operations of the program, ensuring efficiency, compliance, and continuous improvement inclusive of our 24/7 clinical command center for patient support.