Series
Healthcare Regulatory Roundup
Twice each month, PYA experts discuss the latest industry developments as part of our popular Healthcare Regulatory Roundup (HCRR) webinar series. In addition to straightforward explanations of those developments and actionable guidance, attendees will be offered the chance to earn continuing professional education units in selected sessions.
The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) is a mandatory five-year bundled payment model that makes hospitals financially accountable for the total cost and quality of care across an episode, from the initial procedure through post-discharge recovery. Under TEAM, unwarranted care variation, avoidable complications, and care gaps can create material financial risk.
During this webinar, Angie Caldwell, Lee Ann Odom, and Jason Hardin will explain how hospitals can use baseline and Performance Year 1 (PY1) claims data to quantify TEAM exposure, identify where cost variation exists, and prioritize high-impact improvement opportunities. The presenters will also demonstrate how an executive-ready dashboard can translate claims data into decision-ready intelligence across care settings, physician performance, and post-acute outcomes. In addition, they will outline a Phase II “insight-to-action” approach that helps organizations move from analytics to sustained operational improvement through governance, targeted interventions, and structured implementation support.
Jason, Angie, and Lee Ann will address the following learning objectives:
- Understand TEAM’s episode-based accountability and the practical implications for managing total episode cost and quality across the continuum.
- Explain how the shift from Track 1 (PY1 upside-only) to Track 3 beginning in Performance Year 2 (2027) increases downside exposure and elevates the need for proactive episode management.
- Use baseline episodic claims (January 2022 through June 2024) and PY1 data to assess risk relative to CMS target prices and identify variation patterns, utilization trends, and cost drivers.
- Identify common barriers to generating actionable claims insights, including data fragmentation, time lags, limited analytics capacity, insight complexity, and stakeholder engagement challenges, and describe practical tactics to overcome them.
- Interpret dashboard insights by care setting and physician performance to prioritize interventions that reduce unnecessary variation and improve outcomes.
- Identify an approach to ongoing monitoring, including lead indicators and operational measures of success.
- Apply an “insight to action” framework to prioritize performance improvement tactical plans.
