Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives.
The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge.
CMS said that the model would build on the already existing Bundled Payments for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement models.
The proposed model would launch on Jan. 1, 2026, and run for five years, ending at the end of 2030.
“TEAM would be a mandatory episode-based alternative payment model in which selected acute care hospitals would coordinate care for people with Traditional Medicare who undergo one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital,” CMS wrote. “As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes.”
Given those all-important 30 days post discharge involved in the TEAM model, home health providers will naturally play a role in helping hospitals achieve high-quality outcomes.
The National Association for Home Care & Hospice (NAHC) is still awaiting further details, but sees home health agencies as squarely involved in the Innovation Center’s proposal.
“Much of the specifics are still to be decided,” NAHC President William A. Dombi told Home Health Care News. “Home health agencies can be expected to be significantly involved with the participating hospitals given the nature of the surgical patients that will be targeted, such as hip fractures and joint replacement patients.”
As part of its strategic direction, CMS wants all Medicare fee-for-service beneficiaries to be in a care relationship with accountability for quality and total cost of care by 2030.
TEAM would be yet another model furthering that goal, if enacted.
Dombi also noted that there could be both upsides and downsides to the incentives tied to the model.
“In many ways the integration of home health agencies will be essential to achieving the price targets that the hospitals will be operating under during an episode of care,” Dombi continued. “The upside is the likelihood that agencies will see increased patient referrals away from what might otherwise be a SNF referral. The downsides include the potential that the hospital will push patients towards the hospital’s outpatient services.”
Home health involvement
The BPCI-A model, which CMS referenced in its TEAM announcement, is a good comparison from the home health perspective.
“They can be involved in formal alignment agreements with participants that could take a variety of forms, and those could be financial, those could be participatory, those could be any number of things,” Michael Wolford, principal at the public accounting firm Forvis, previously told Home Health Care News regarding BPCI-A. “Home health tends to be a lower cost post-discharge setting for Medicare patients. Providers with financial incentives that exist in the BPCI-A model often look for a combination of clinical efficacy, successful patient outcomes and cost-effectiveness of care. Home health tends to rise to the top in those situations.”
Nick Seabrook, the managing principal at the home health consulting and executive search firm SimiTree, sees home health providers playing a similar role in the TEAM model.
“There’s a new CMMI initiative that just came out yesterday, the TEAM model,” Seabrook said at Home Health Care News’ Capital + Strategy event last week. “And basically, what it’s aimed at is better care coordination post-surgery. So, working with home care providers and other post-acute providers to make sure that [beneficiaries] are getting those adequate services that they need after those surgeries.”
CMS mentioned that care for post-surgery beneficiaries can often be fragmented, resulting in poor outcomes.
Health equity would also be a key measure under the TEAM model.
“People with Traditional Medicare undergoing a surgical procedure either in the hospital or as an outpatient may experience fragmented care that can lead to complications in recovery, avoidable hospitalization, and other high costs,” CMS wrote. “This is because in a fee-for-service (FFS) payment system, providers and suppliers are paid separately for each service and procedure, potentially resulting in fragmented care, duplicative use of resources, and avoidable utilization.”
Companies featured in this article:
CMMI, CMS, FORVIS, National Association for Home Care & Hospice, SimiTree
