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  • The CMS TEAM Model Could Transform How Hospitals Manage Post-Acute Care 

    The CMS TEAM Model Could Transform How Hospitals Manage Post-Acute Care 

    The Centers for Medicare and Medicaid Services (CMS) has finalized the Transforming Episode Accountability Model (TEAM) a mandatory five-year bundled payment model that has the potential to transform how hospitals manage acute care. 

    Overview of the CMS Team Model 

    Under the CMS TEAM model, select hospitals would be responsible for coordinating a Medicare beneficiary’s care when they undergo certain surgical procedures, from the point when surgery is completed until 30 days after the patient is released from the hospital. The hospital will be responsible for all services and items provided during this episode of care.  

    Hospitals will bill Medicare as usual under the TEAM model, but they will be given target prices for specific episodes of care based on 3 years of baseline data adjusted for various factors, including episode complexity and region data. Hospitals will then be assessed based on (1) How their actual spending compares to the target price and (2) Their quality of care based on certain quality measures. The hospitals with spending that is lower than the target price, while still meeting quality standards, will receive a TEAM payment—those that spend more will owe a Medicare repayment.  

    There are four steps that CMS will follow when calculating the TEAM Model Reimbursement Amount: 

    1. Convert the quality measure performance into a usable score by comparing your hospital’s performance to the performance of other hospitals and applying volume weighting (based on the volume of episodes per hospital).  

    2. Calculate the hospital reconciliation amount, or the difference in dollar amount between the target price and actual spending. 

    3. Adjust the cost amount using the quality score. 

    4. Finalize the Net Payment Reconciliation Amount by applying stop-loss or stop-gain limits based on your hospital’s track (1, 2, or 3). 

    The TEAM model is being implemented in an effort to address the scattered and expensive care that Medicare beneficiaries often end up with from bouncing between different doctors and clinics, receiving unnecessary or repeat tests and fragmented care. By aligning financial incentives, CMS believes that an improvement in care coordination—and ultimately better health outcomes—will follow.  

    What the CMS TEAM Model Means for Healthcare Providers 

    The TEAM model is a 5-year program that goes into effect on January 1st, 2026, and ends on December 31st, 2030.  

    As of now, the TEAM model includes only five procedures: 

    1. Coronary Artery Bypass Graft  

    2. Major Bowel Procedure 

    3. Lower Extremity Joint Replacement 

    4. Spinal Fusion 

    5. Surgical Hip and Femur Fracture Treatment 

    These TEAM episodes have been chosen as the inaugural five because they represent high-expenditure and high-volume care.  

    As a part of TEAM, there are steps that hospitals must take in regard to reporting health equity. Starting in performance year 1 (2026), hospitals must screen for at least four of the five health-related social needs (HRSNs), reporting the aggregated screening data and screened-positive data of each HRSN domain for every beneficiary.  

    Hospitals must also submit a health equity plan to CMS. While this is a voluntary submission in the first year of TEAM, it is a requirement for each year after. Information that must be included in the plan consists of: 

    • How the hospital plans to identify health disparities 
    • How the hospital plans to identify its health equity goals and how these goals will be used to monitor and evaluate progress toward reducing the identified health disparities 
    • The hospital’s health equity plan intervention strategy. 
    • How health equity performance measures will be identified, what data sources will construct these measures, and what will be used to monitor and evaluate the measures. 

    Along with the health equity plan, hospitals must also submit demographic data—race, gender identity, ethnicity, language, sexual orientation, disability, and sex characteristics—for their patients. Similar to the health equity plan, this is a voluntary submission the first year, then mandatory following that.  

    Prepare for TEAM with Inbound Health 

    With the implementation of the TEAM model in 2026 defining a shift toward improving quality of care, healthcare institutions must focus on finding ways to improve their quality of care while keeping down healthcare costs. Inbound Health can help.  

    Inbound Health enables healthcare providers to launch, scale, and operate acute and post-acute care-at-home programs, which improves patient outcomes, lowers costs, and increases hospital capacity by opening up beds for the sickest patients. The result is a greater capacity to care for patients in a timely manner, intervening in their healthcare before their health can regress, lowering the number of costly procedures, and limiting hospital readmissions.  

    When it comes to improving patient care and reducing costs, acute and post-acute care models are critical for addressing a key aspect of the care episode: the 30-day post-procedure period. Learn how Inbound Health can help you prepare for the TEAM model. 

    Ryan Carmel

    November 14, 2024
    Blogs
    Acute Hospital Care at Home, CMS TEAM Model, quality of care, recovery care at home
  • SSM Health partners with Inbound Health to offer in-home, hospital quality care to patients

    SSM Health partners with Inbound Health to offer in-home, hospital quality care to patients

    MADISON, WI, NOVEMBER 11, 2024 – SSM Health and Inbound Health, a leading provider of in-home, advanced care programs for health systems, announce another innovative new partnership to bring personalized, in-home, hospital quality health care services to patients. 

    This week patients at SSM Health St. Mary’s Hospital – Madison who meet specific criteria will have the option to be transferred home to receive services traditionally offered in the hospital with the launch of a new SSM Health at Home program – Hospital Care at Home.

    “We’re excited to offer our patients more choices for their care,” said Dr. James Lehman, SSM Health Wisconsin Regional Clinical Program Medical Director. “We recognize that many patients prefer to receive care in their own homes and research shows that they can recover faster there which leads to lower rates of hospital readmissions.”

    Patients eligible for the new program will benefit from personalized, daily in-home, and virtual visits by a dedicated team of specially trained physicians, nurses, therapists and other clinicians to ensure that they receive the highest standards of care. Each patient will receive a digital tablet to be used during the program to provide enhanced remote monitoring and round-the-clock assistance from the care team at the touch of a button.

    A specialized care coordinator will ensure seamless communication among the patient’s primary care provider, specialty caregivers and support network. Patients in the program will receive the same level of services and equipment typically offered in a hospital setting but within the comfort of their own home.

    “Our continued collaboration with SSM Health marks another significant advancement in our collective mission to transform the delivery of high-quality health care services,” said Dave Kerwar, CEO for Inbound Health.

    The Hospital Care at Home program builds on the success earlier this year of the two organization’s collaboration to offer in-home, skilled nursing care through SSM Health at Home’s Recovery Care at Home program.

    “We are proud to bring another innovative new program to our patients to provide them with exceptional care in their own homes,” said Kyle Nondorf, VP for Acute Care for SSM Health in Wisconsin. “In addition to being cared for in their own homes where they can be surrounded by family and friends, the program helps to free up beds for patients who need to receive care in a traditional hospital setting.”

    About Inbound Health:

    Inbound Health provides a full stack of capabilities that enable health systems and health plans to offer hospital and skilled nursing facility-level care in the home. With a commitment to quality and compassionate care, Inbound Health has supported the treatment of more than 9,000 patients across 350+ DRGs and counting and will further customize the care model to the needs and strategies of its partners. For more information, visit inboundhealth.com or find us on LinkedIn.

    About SSM Health:

    Nationally recognized for quality and innovation, SSM Health is a Catholic, not-for-profit, fully integrated health system working to advance health equity and empower all people to achieve their full potential. 

    With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSM Health provides convenient access to high-quality community-based services as well as world-class academic medicine, clinical trials, and research studies. The organization’s footprint includes hospitals, physician offices, outpatient and virtual care services, senior care, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company, and an accountable care organization.

    As one of the largest employers in every community it serves, the organization’s 40,000 team members and 13,900+ providers are dedicated to fulfilling SSM Health’s Mission: “Through our exceptional health care services, we reveal the healing presence of God.” Like our founding sisters, we care deeply for our communities — SSM Health reported $470 million in community benefit in 2023, including the provision of more than $346 million in uncompensated care. For more information, visit ssmhealth.com or find us on Facebook and LinkedIn.

    Media Contacts: 

    Ryan Carmel

    Inbound Health

    [email protected]

    612-444-3744

    Kathryn Scott 

    SSM Health

    [email protected]

    608-381-8124 

    Ryan Carmel

    November 11, 2024
    Press Releases
    acute care at home, hospital care at home, post-acute care at home, recovery care at home, SSM Health

2925 Chicago Ave.
7th Floor
Minneapolis, MN 55407

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