The Transforming Episode Accountability Model (TEAM): A new era in surgical care coordination

Understanding TEAM: Purpose and vision

The Transforming Episode Accountability Model (TEAM) addresses a critical challenge in health care today: fragmented care for Medicare beneficiaries undergoing surgical procedures. This fragmentation often leads to complications in recovery, avoidable hospitalizations and increased health care spending. Launched by the Centers for Medicare & Medicaid Services (CMS), TEAM represents a significant advancement in episode-based payment models designed to improve coordinated care across the patient journey.

Starting in January 2026, TEAM is a five-year mandatory model that holds acute care hospitals accountable for ensuring Medicare patients receive coordinated, high-quality care during and after specific surgical procedures. The model extends beyond just the hospital stay to include the critical 30-day post-discharge period, promoting seamless transitions between providers and successful patient recovery.

Why TEAM matters: Goals and benefits

TEAM is guided by clear goals aimed at improving patient outcomes while controlling health care costs:

• Quicker recovery after surgery through coordinated care approaches
• Fewer avoidable hospital and emergency department visits during recovery
• Shorter hospital and post-acute care stays through efficient care delivery
• Smoother transitions to primary care following surgical procedures
• Lower overall health care costs while maintaining quality standards
• More equitable health outcomes across diverse patient populations

By holding participants accountable for both the quality and cost of surgical episodes and ensuring patients are referred to primary care services, TEAM supports CMS’s broader initiative to have all Medicare beneficiaries in care relationships with accountability for quality and total cost of care by 2030.

The five surgical procedures covered by TEAM

1. Lower extremity joint replacement: Including total hip and knee replacement surgeries
2. Surgical hip femur fracture treatment: Procedures to repair hip fractures, common in elderly patients
3. Spinal fusion: Surgical procedure joining vertebrae, typically used to treat spinal instability or degenerative conditions
4. Coronary artery bypass graft (CABG): Heart surgery that improves blood flow by bypassing blocked coronary arteries
5. Major bowel procedure: Including colectomies and other complex intestinal surgeries

Comprehensive episode components

What makes TEAM particularly powerful is its comprehensive approach to episode-based care. Each episode encompasses a wide range of services:

• Inpatient hospital services
• Physician services (both specialists and primary care)
• Outpatient therapy services
• Skilled nursing facility care
• Home health services
• Clinical laboratory services
• Durable medical equipment
• Medications (Part B drugs and biologicals)
• Hospice care

This inclusive approach ensures that all aspects of a patient’s care journey are coordinated under the model, avoiding gaps in service that can lead to complications or readmissions.

Enhabit’s role in delivering quality care under TEAM

As a leading provider of home health and post-acute care services, Enhabit is strategically positioned to help hospitals succeed under TEAM by:

Reducing costs while enhancing quality

• Comprehensive post-discharge planning: Our specialized teams work collaboratively with surgeons and hospitals to develop personalized care plans that begin before discharge and continue through the critical 30-day post-discharge period.
• Early intervention protocols: Our team of clinical program directors collaborates with surgeons to proactively identify potential complications, addressing them before emergency care or readmission.
• Optimized resource utilization: By providing the appropriate level of care within the home environment, we contribute to a reduction in unnecessary hospital admissions and skilled nursing facility usage.
• Seamless care coordination: Our care teams serve as a bridge between hospital-based and primary care providers, ensuring information flows smoothly across care settings. When patients experience our Care Transitions Program, they experience better communication between health care providers, greater education about their condition and overall better outcomes in their recovery.

Delivering high-quality patient outcomes

• Interdisciplinary care teams: Effective coordination of the care team ensures a comprehensive approach to addressing all patient needs and following protocol-specific interventions.
• Primary care connectivity: We assist in meeting TEAM’s requirement for patients to connect with primary care providers after hospital discharge, thereby supporting long-term health outcomes.
• Technology: Enhabit utilizes predictive analytics to promote the coordination of care, ensuring that each patient receives a care plan tailored to achieve optimal outcomes.
• Patient and caregiver education: Offering comprehensive education empowers patients and their families with the knowledge and skills essential for recovery.

Looking ahead: The future of surgical care

As TEAM begins implementation in 2026, Enhabit is preparing to be an essential partner for participating hospitals. By leveraging our expertise in home-based recovery and rehabilitation, we help ensure patients receive the right care, at the right time, in the right setting.

Vice President of Specialty Programs Pam Samaniego said, “After surgery, home health care offers a smooth and supportive path to recovery — wherever the patient calls home. Enhabit’s specialty programs offer specialized, coordinated care that promotes optimal recovery, minimizes complications, supports independence and helps mitigate unnecessary costs while achieving the best possible outcomes. As a trusted post-acute care partner, Enhabit is uniquely positioned to help hospitals participating in TEAM achieve better outcomes through seamless transitions and patient-centered care.”

The shift toward episode-based payment models, such as TEAM, represents a fundamental reimagining of surgical care delivery. It emphasizes coordination across the full continuum of care while holding providers accountable for both quality and cost outcomes. With Enhabit’s support, hospitals can confidently navigate this transition, delivering superior patient outcomes and experiences while achieving financial success under the new model.

For health care providers preparing for TEAM implementation, partnering with experienced post-acute care organizations like Enhabit will be crucial to success in this new era of value-based surgical care.