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On Jan. 1, 2026, the Centers for Medicare & Medicaid Services (CMS) kicked off one of the largest mandatory payment reforms in its history: a five-year experimental initiative called Transforming Episode Accountability Model, or TEAM. Under TEAM, 716 acute care hospitals will be responsible for coordinating care from surgery through 30 days of post-hospitalization recovery, as well as the associated costs.
In other words, for these 716 medical centers, the surgical case no longer ends at the handoff — and neither do the financial penalties if complications arise.
TEAM: What you need to know
According to CMS, TEAM is designed to improve beneficiary care by holding hospitals financially accountable for the full episode of care. The initiative is limited to Original Medicare patients undergoing one of five surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. TEAM will run until December 31, 2030, in selected Core-Based Statistical Areas (CBSAs) throughout the United States.
Most of us probably don’t jump for joy at the words “mandatory payment reform,” but TEAM provides a much-needed opportunity to zoom out and see the bigger picture. During the surgical process, it’s not unusual for each clinician to focus solely on their role and then hand off the patient to the next clinician. As a result, patients who undergo surgery often experience fragmented care after leaving the operating room. That sometimes leads to avoidable complications, prolonged recovery, and re-hospitalization, all of which are costly.
From cutting surgical site infections and shortening length of stay, two major academic medical centers we work with have saved more than $550,000 a year per tracked quality metric.
$550,000
How much two major academic medical centers saved per year, per tracked quality metric by partnering with C8 Health to reduce surgical site infections and length of stays
Under TEAM, participating hospitals are at risk for all costs of care within a 30-day “episode,” and keeping costs under the CMS target requires teamwork (no pun intended). According to CMS, “Episodes will begin with a person’s hospital inpatient stay or hospital outpatient procedure… Each episode will end 30 days after the individual leaves the hospital.” In other words, the job doesn’t end with the surgery; participants are now responsible for referring patients to primary care services and facilitating continuity of care.
For clinicians at the participating acute care hospitals, cross-functional collaboration isn't optional anymore. It's the only way to hit the CMS target.
Closing the care gaps
As a physician trained in anesthesia and internal medicine, C8 Health CMO and Co-founder Dr. Ido Zamberg, MD, MEHP has seen how fragmented healthcare leads to worse patient outcomes and avoidable hospital-acquired conditions (HACs).
Even though every team in the hospital is working toward a shared goal, clinicians tend to become siloed in their own departments.
“When I was a resident, I noticed that many of my colleagues had their own processes for patient care. Handoff gaps between departments were especially common because each team was working off of its own set of protocols.” - Dr. Ido Zamberg, MD, MEHP
These gaps often have serious consequences. A 2017 report found evidence that “systems-based factors influence surgical outcomes of intraoperative and postoperative morbidity,” with personnel handoffs listed among the main exposure variables. A separate report found that “most steps were vulnerable to multiple failures” when evaluating the OR-to-ICU handoff protocol. The Agency for Healthcare Research and Quality (AHRQ) has stated that “nearly one-third of medical errors and adverse events in healthcare can be tied to miscommunication and care coordination gaps during handoffs and care transitions.”
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With that data (and countless other examples) in mind, it becomes clearer why healthcare needs TEAM to shine a light on those siloed processes. And as Dr. Ketan Chopra, an anesthesiologist at Henry Ford, said in the webinar “Making TEAM Work”, “Visibility drives conversation.”
Here’s what happens when clinicians have greater visibility into surgical results: They talk about it. They brainstorm ways to improve. They change processes that weren’t working. That's exactly what happened at Henry Ford.
Dr. Chopra's team began tracking MPOG and ASPIRE data in C8 Health as part of a perioperative glucose management Quality Improvement project. That created what Dr. Chopra called “conversation and transparency.” Previously, finding that same data required logging in and navigating a series of unintuitive websites, so naturally, clinicians simply weren’t checking.
Once every member of the care team had access to this data, they were able to identify patterns and shortcomings inside and outside of the OR. They discovered that patients coming from the ICU were given different protocols, creating care gaps. Dr. Chopra worked with the nursing director on a re-education campaign to flag high glucose readings to physicians in PACU. That effort, along with similar work on temperature control, coincided with a drop in surgical site infections at Henry Ford this past year.
That’s just one of many similar stories we’ve heard from C8 platform users. All it takes to expose care gaps is a little visibility into the bigger picture.
The 30-day mindset shift
Like Dr. Chopra’s glucose management project, TEAM exposes weak spots in handoffs. Those breakdowns are rarely catastrophic mistakes. It’s the tiny missed steps — unclear ownership, variations in policy, misaligned protocols — that lead to care gaps. And those care gaps lead to complications, extended hospital stays, and re-hospitalization, all of which translate to higher costs for hospitals.
Meeting the challenge set forth by TEAM isn’t going to be easy. In some cases, participating hospitals may be at economic disadvantages depending on the cost target set by CMS. If their spending exceeds the target, they’ll be on the hook for repayment costs. Additionally, the TEAM Composite Quality Score (CQS) is public information, which could impact hospital ratings and public trust.
Viewing TEAM as an opportunity instead of a threat requires a pretty significant mindset shift. Suddenly, you’re not thinking about surgeries in terms of pre-op, intra-op, and post-op. When you view surgeries in terms of weeks and not hours, those invisible gaps become clear. And because all members of the care team share the responsibility, TEAM encourages collaborative decision-making across roles and departments.
For anesthesiologists, that means their role no longer starts in the OR and ends at PACU. Everyone needs to do their part to ensure that patients are optimized properly pre-operatively. Intra-op variability matters more, as does discharge timing. Pain management must be handled more consistently.
None of this happens without a shared playbook.
Next steps in making TEAM work
While CMS hasn’t confirmed that the TEAM model will spread beyond the 716 initial medical centers, we think it’s safe to assume that we should all be prepared for that possibility. Dr. Jennifer Perloff of the Institute for Accountable Care outlined the next steps for TEAM members in our webinar:
- Determine your status: Your first step should be learning your own hospital’s TEAM status and target price before the risk period sets in. CMS will reconcile all TEAM episodes annually, and those that spend less than the target price may earn reconciliation payments. That cycle starts six months after the end of each performance year.
- Audit data accessibility: It’s no secret that healthcare has a knowledge management problem. In addition to different departments having different protocols, guidelines are often stored in a variety of locations that can be difficult for clinicians to find, and clinicians may not have access to day-to-day metrics. As Dr. Chopra’s glucose-monitoring example shows, surfacing these stats opens up the conversation. From there, you can brainstorm solutions.
- Start in a single department: Organizational change doesn’t happen overnight. When you look at your data, you should be able to identify one department or surgical service with elevated same-day cancellations or suboptimal outcomes. That’s where you should open up the conversation and begin the 30-day mindshift. From one department, expand and iterate.
The consistent thread across all of these steps is the need for data. In many cases, clinicians either don’t have access to operational, performance, and financial data or simply don’t know where to find it. This is why C8 Health is such an important tool for hospitals, particularly those participating in the TEAM challenge: it helps create a data-driven culture that inspires excellence.
For example, the C8 app puts workflow-embedded guidance at clinicians’ fingertips when they need it most. No more searching databases or rifling through file cabinets — or, as often happens in critical moments, resorting to memory. With a unified source of all hospital-approved knowledge, pre-op, intra-op, and post-op teams all work from the same shared playbook. Handoffs are handled according to your own internal best practices, eliminating the gaps that cause costly complications.
Meanwhile, you can use C8’s performance data to track the metrics that determine whether these efforts are working as intended. Instead of leaving care consistency to chance and hoping for the best outcome, performance data binds outcomes and accountability. That gives leadership a chance to address any inconsistencies quickly and directly.
Don’t wait for the TEAM model to come to your hospital; take a proactive approach now to close those gaps and increase cross-functional teamwork. Your patients — and your bottom line — will thank you.
