TEAM will have three tracks:

• Track 1, which will have no downside risk and lower levels of reward for the first year
• Track 2, which will be associated with lower levels of risk and reward for certain hospitals, including safety net hospitals, for years two through five
• Track 3, which will be associated with higher levels of risk and reward for the entire five-year length of the model

How hospitals are preparing for TEAM

According to ATI Advisory, between 20% and 60% of spending associated with TEAM-related procedures occurs after patients leave the hospital, which means that health systems have a major incentive to work closely with post-acute care providers like nursing homes and other organizations.

"There's a subset of post-acute providers — there's an urgency where they want to be first in the door," said Brian Fuller, a managing director in ATI Advisory's value-based care design and delivery practice.

CMS has also encouraged hospitals to enter gainsharing agreements with a variety of partners, including skilled nursing facilities and other post-acute providers.

Elisabeth Wynn, EVP of health economics and finance at the Greater New York Hospital Association, said hospitals participating in TEAM are already preparing for potential partnerships by analyzing post-acute discharge patterns and metrics such as readmissions, length of stay, and patient satisfaction.

"The top priorities for [Greater New York Hospital Association] members in assessing post-acute partners are quality of care and willingness to collaborate on developing care pathways," Wynn said.

Esther Pandey, system VP of care transitions at Mount Sinai Health System, said post-acute collaborators should have a proven track record of managing care without additional financial incentives from hospitals, as well as flexibility when it comes to staffing amid workforce shortages.

Clear communication between direct care workers at both hospitals and post-acute facilities will also be key to prevent patients' conditions from worsening, Pandey said.

As TEAM implementation gets closer, Fuller recommended hospitals and post-acute providers think carefully about how to structure gainsharing agreements. Some factors to take into consideration include the amount and types of financial risks hospitals and post-acute providers take on and how to divide savings and losses.

In general, Steve Carr, chief sales officer for Centers Health Care, said that an ideal partnership between hospitals and post-acute providers would account for what share of spending occurs after patients are discharged from a hospital.

"If I, as a [skilled nursing facility] partner, put forth case management, I reduce my utilization, I improve readmissions, I increase my clinical capabilities. These are all costs," Carr said. "I'm losing revenue on the utilization side of things. If I don't make that up in additional business or by being rewarded as a strong partner, it's a race to the bottom."

Although some skilled nursing facilities are actively seeking hospital partners, there are still some reservations in the post-acute care space about TEAM and how it will impact post-acute providers.

"TEAM weighs heavily on decisions made by upstream physician and hospital providers, and while they are another essential care setting, the model discounts the collaborative role and importance of skilled nursing providers in determining an appropriate care plan for patients," said Martin Allen, SVP of reimbursement policy at the American Health Care Association.

How will TEAM impact post-acute care facilities? 

By  Jenn Skaggs, Manager, Optum Advisory

This year presents a valuable opportunity for post-acute care facilities to collaborate more closely with hospitals as they prepare for the rollout of TEAM in 2026. These collaborations  will allow post-acute facilities to showcase their ability to provide high-quality care while still managing costs and length-of-stay. Achieving these goals can lead to improved patient outcomes, increased patient satisfaction, and stronger relationships with acute care partners as TEAM approaches.

Effective communication between certified nursing assistants, nurses, therapists, and providers at nursing homes, as well as timely and accurate information sharing with their acute care counterparts, will be crucial for TEAM to succeed. In addition, aligning expectations, setting clear goals and outcomes, and reassessing as needed will also be important. If skilled nursing facilities invest in this way, they could also see a strong return on investment in best practices and best outcomes.

This collaborative approach could significantly enhance the role of nursing homes, which have been evolving and redefining themselves in the post-pandemic era. This shot in the arm and seat at the table is an excellent opportunity for them to showcase their value within the continuum of care.