Episode-Based Success: A SolvEdge Roadmap for Managing Clinical Risk, Post-Acute Networks and Shared Savings Under TEAM
- SolvEdge
- 6 mins read
Healthcare in the U.S. is in the middle of one of its most important shifts in decades. The Centers for Medicare & Medicaid Services (CMS) has introduced the Transforming Episode Accountability Model (TEAM) — a mandatory, episode-based bundled payment program for select hospitals beginning in 2026. Unlike voluntary pilots of the past, TEAM will fundamentally reshape how hospitals, physicians, and Accountable Care Organizations (ACOs) manage surgical episodes and the 30 days of recovery that follow.
For healthcare leaders, the challenge is clear: how do we align clinical quality, financial incentives, and post-acute care to succeed under TEAM? At SolvEdge, we believe the answer lies in building a proactive roadmap that addresses three critical dimensions: clinical risk management, post-acute networks, and shared savings alignment.
1. Managing Clinical Risk: Turning Variation into Value
The biggest driver of cost in surgical episodes is variation in clinical practice. TEAM requires hospitals to take responsibility not only for the index hospitalization but also for post-discharge costs. That means every unnecessary test, extended length of stay, or preventable complication eats directly into reconciliation payments.
Roadmap actions for providers:
- Standardize surgical pathways across orthopedics, cardiac, and general surgery using evidence-based protocols.
- Embed checklists and order sets into the EHR to minimize variability.
- Leverage predictive analytics to identify high-risk patients before surgery (frailty, comorbidities, social risk factors).
- Implement real-time dashboards to track length of stay, complications, and readmissions by surgeon and procedure.
When risk is measured and managed in real time, hospitals and physicians can consistently deliver care that is both high-quality and cost-effective.
2. Building Post-Acute Networks: The 30-Day Success Factor
CMS designed TEAM to ensure hospitals manage care beyond discharge. That means post-acute care (PAC) is now a core determinant of success. Historically, discharge decisions have been inconsistent — some patients go to high-cost skilled nursing facilities, while others thrive at home with home health. TEAM makes those choices financial as well as clinical decisions.
Roadmap actions for post-acute strategy:
- Develop a preferred post-acute network based on outcomes and cost efficiency.
- Use contractual performance agreements with SNFs and home health providers tied to readmission rates, therapy effectiveness, and functional outcomes.
- Launch patient navigation programs to ensure every patient has scheduled follow-up within 7 days of discharge.
- Deploy remote monitoring tools to reduce emergency visits and catch complications early.
Hospitals that treat PAC providers as strategic partners rather than transactional vendors will create smoother care transitions and protect TEAM reconciliation margins.
3. Aligning Shared Savings: Hospitals, Physicians & ACOs on
the Same Page
Episode-based models succeed only when incentives are aligned across all stakeholders. Surgeons need to feel they are rewarded for high-quality outcomes, hospitals need protection against downside risk, and ACOs need integration between population-based and episode-based contracts.
Roadmap actions for shared alignment:
- Establish physician gainsharing models that are legally compliant and tied to quality-adjusted savings.
- Integrate ACO care management into episode workflows, especially pre-op optimization and primary care follow-up.
- Set up joint governance councils that include hospital leaders, surgeons, and ACO representatives to make episode-level decisions.
- Simulate CMS reconciliation using historical claims to create transparent, trust-based discussions about risk-sharing.
When governance, financial modeling, and contracts are aligned, the TEAM model becomes an opportunity for collective success rather than a zero-sum game.
Why SolvEdge? Turning TEAM into a Competitive Advantage
At SolvEdge, we partner with health systems, ACOs, and physician groups to prepare for CMS’s next generation of payment reform. Our TEAM Readiness Framework helps organizations:
- Simulate episode-level reconciliation outcomes.
- Design compliant gainsharing agreements.
- Build post-acute networks that balance cost and quality.
- Deploy episode analytics platforms for real-time insight.
The result? A healthcare organization that doesn’t just “survive” TEAM but uses it as a competitive differentiator — attracting patients, aligning providers, and capturing sustainable margin.
The TEAM model signals the end of optional experimentation in episode-based care. Hospitals, physicians, and ACOs must now move from siloed operations to tightly aligned ecosystems where clinical risk is managed proactively, post-acute networks are strategically designed, and shared savings create true partnership.
Episode-based success will belong to organizations that start preparing today. SolvEdge is ready to help you get there.
