Mandatory by 2026: 5 Ways to Prepare for Team Payment Models at CMS
The healthcare system has been extended due to rising costs, burnout in employees and acute post-care debris, and the Centers for Medicare and Medicaid Services (CMS) is ramping up the ante.
Starting from January 1, 2026, the Transformation Case Accountability Model (Team) will become a mandatory for 797 Core Statistical Areas (CBSA) hospitals in the United States
This is not another pilot or voluntary alternative payment model. This is the latest effort from a series of CMS to link reimbursement to value. This time the hospital and its nursing partners will be responsible for the overall cost and quality of care throughout the plot.
Despite its scope and meaning, the team flew a certain amount of flight under the radar. But just a few months away from 2026, it’s time to build education, programs and partnerships.
What is a team model?
The team is a five-year mandatory bundled payment model focusing on five surgical events:
- Lower limb joint replacement (LEJR)
- Surgery hip and femoral fracture treatment
- Spine Fusion
- Coronary artery bypass graft (CABG)
- Major intestinal surgery
Hospitals in selected CBSA will be responsible for all Medicare Part A and B costs associated with these procedures – from initial hospitalization to 30 days after admission. These include skilled nursing, rehabilitation, family health, physician visits and readmissions.
Depending on the participating track, hospitals may face downside risks of up to 20% based on their total onset spending exceeds the target price of CMS and how they perform on defined quality measures.
Why the team is important
Many hospitals have experience with bundles like BPCI Advanced and CJR, but the team adds complexity by tightening timelines and deepening accountability. It also introduces new expectations regarding primary care referrals, equity reporting and post-branch nursing coordination.
Hospitals that are not prepared for risks are not only financially but also operationally and clinically. Fortunately, health systems can now take clear actions to prepare for success.
1. Understand your plot risks
Hospitals should first analyze their historical performance in the five team plots. What procedures drive spending after acute? Where are the most readmissions or complications? What is your benchmark for patient-reported results?
Hospitals participating in BPCI-A or CJR may already have this data. Others need to rely on internal claims analysis or work with external partners to simulate potential profit and loss under team pricing models.
Understanding your performance is critical to predicting financial exposure compared to national benchmarks (and how to standardize quality scores).
2. Map your acute post-network
One of the team’s central goals is to reduce acute post-schizophrenia, especially during the transition from hospital to home. Hospitals must have a better understanding of what happens after discharge.
This means mapping your recommendation pattern, evaluating the acute post-provider results, and determining the biggest gap. Which SNFs, home health facilities or rehabilitation facilities have been providing quality results? What drivers can avoid exploitation or readmission?
Consider establishing a preferred provider relationship that includes data sharing and outcome expectations. In short, treating acute postpartums is not like vendors, but an extension of your care team.
3. Build (or buy) plot-level visibility
You can't manage what you can't see. Success under team leadership will depend on the hospital’s ability to monitor patient progress in real time through surgery, discharge and rehabilitation.
Hospitals should prioritize infrastructure tracking infrastructure that incorporates EHR data, claim activities and real-time patient interactions. This includes the ability to label risk factors, rapid nursing interventions, and differences or deviations from nursing pathways.
It is also important to note that teams are more than just cost limits. It's about quality.
Your system should capture and report core quality metrics of the team, including readmission rates, patient safety metrics, and patient-reported results for LEJR plots.
4. Align and train your nursing team
The team introduced new workflows and accountability standards that went beyond the walls of the hospital. Both clinical and administrative teams must understand:
- The scope and meaning of the team
- Their role in documenting and delivering high-quality care throughout the plot
- How primary care referrals and care coordination affect reimbursement
Hospitals should also prepare discharge planners, case managers and navigators to manage patients through the nursing transition to a more active role.
5. Don't wait to interact with your partners
Eventually, while the first performance year includes many hospital tracks, the mat will disappear quickly. Health systems that will not implement the risk of change until late 2025 or early 2026 lack opportunities for curriculum correction.
Whether you work with a care coordination provider and/or an integrated post-acute network, you can find solutions that enhance your internal functionality.
Your goal should be to create a connected, patient-centered approach that spans clinical, financial and operational needs.
The future of payment reform
CMS made it clear that payment reform will stay here. The team shows that bundled care is no longer a test bed.
For hospitals and health systems, the challenges are enormous, but so are opportunities. The team provides a framework to provide more coordinated, cost-effective and patient-centered care. Those who are ready now will thrive in a value-based future.
If you are not ready yet, now is the time. The team is here. Will you be ready?
Photo: Gustavofrazao, Getty Images
Kyle Cooksey is CEO of Deacon Health, focusing on value-based care platforms, focusing on professional care costs curbing and improving patient outcomes. With over two decades of medical experience, Kyle is an experienced executive known for driving innovation in high-cost, high-demand regions. He specializes in aligning operational strategies with customer needs to deliver measurable results. In the Deacon, he is expanding a human-centered validation navigation model to meet the ever-expanding demand for special value-based care solutions.
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