Phase 1: Foundation

Establish the governance, ownership and advisory relationships that inform everything that follows.

Governance
  • Brief your board on the CMS TEAM model. Ensure board members understand Transforming Episode Accountability Model requirements, financial exposure and their fiduciary role in organizational readiness.
  • Assign executive ownership. Designate a senior leader responsible for TEAM model readiness with direct board reporting authority.
  • Establish a cross-functional TEAM working group. Include representation from clinical, compliance, finance, HR, risk and legal.

Finance
  • Identify your TEAM episode portfolio. Confirm which clinical episodes your organization is accountable for under the CMS TEAM model and determine the baseline for your current volume and cost performance.
  • Assess your Metropolitan Statistical Area (MSA) designation. Confirm whether your organization operates in a designated MSA and is subject to mandatory participation in this bundled payment model.
  • Engage your risk and benefits advisors. Bring outside expertise into the conversation early to build your value-based care readiness strategy from a position of strength.

Phase 2: Assessment

Build the analytical foundation needed to understand your organization’s true exposure.

Finance
  • Model financial exposure under multiple scenarios. Develop best-case, base-case and downside financial models based on current episode cost and quality performance relative to Centers for Medicare & Medicaid Services (CMS) benchmarks under the Transforming Episode Accountability Model.
  • Assess stop-loss and reinsurance coverage. Identify opportunities to strengthen existing risk transfer mechanisms, including stop-loss and reinsurance coverage, relative to potential episode cost exposure under this bundled payment model.
  • Integrate TEAM into your capital planning process. Account for potential reconciliation repayments and performance-based revenue adjustments in financial forecasting.

Compliance
  • Map TEAM documentation requirements. Identify gaps in clinical documentation practices that could affect cost calculations or quality scores.
  • Assess coding accuracy across TEAM episodes. Ensure coding practices are aligned with CMS TEAM model episode definitions and CMS reporting requirements.
  • Review your reconciliation and dispute resolution processes. Understand CMS’s reconciliation methodology and establish internal protocols for identifying and challenging discrepancies.

Clinical
  • Evaluate care coordination across the episode continuum. Assess your organization’s ability to manage cost and quality through post-acute recovery, including relationships with preferred post-acute partners – a foundational element of value-based care readiness.
  • Benchmark quality metric performance. Identify where your organization stands relative to CMS quality thresholds across Transforming Episode Accountability Model-defined clinical episodes.
  • Identify high-cost episode outliers. Analyze historical episode data to identify cost drivers that can be addressed through care redesign or care coordination improvements.

Phase 3: Infrastructure

Close the most significant readiness gaps and build the systems needed to sustain performance.

Human Resources
  • Assess workforce stability across TEAM-relevant service lines. High turnover and staffing gaps directly affect care coordination and episode performance under the CMS TEAM model.
  • Review employee benefits strategy through a TEAM lens. Evaluate whether your current benefits program supports the retention and engagement needed to sustain TEAM model readiness.
  • Develop a workforce readiness plan. Address identified staffing gaps, burnout risk and care coordination capacity in alignment with TEAM performance goals.

Risk Management
  • Conduct a comprehensive value-based care (VBC) contract portfolio review. Assess existing shared savings, bundled payment model and capitation contracts in the context of TEAM to understand aggregate financial exposure.
  • Evaluate management liability coverage. Ensure your organization has appropriate coverage for governance and leadership liability in the context of CMS TEAM model
  • Build an ongoing TEAM risk monitoring program. Establish data, governance and escalation protocols that allow your organization to track performance and respond to emerging risks in real time.
  • Apply an enterprise risk management (ERM) lens to your TEAM preparation. Use ERM to map the interdependencies across finance, compliance, clinical, HR and governance — and develop a unified view of your organization’s aggregate TEAM exposure. ERM creates the connective tissue that helps you avoid each function managing value-based care-readiness as a separate departmental initiative.

Compliance
  • Conduct a TEAM compliance gap assessment. Evaluate the strength of your compliance infrastructure against Transforming Episode Accountability Model requirements and prioritize remediation efforts.
  • Develop a board reporting framework for TEAM. Establish regular board-level reporting on TEAM readiness status, financial exposure and compliance performance.

Phase 4: Pre-2027 Confirmation

Final readiness validation before the compliance window opens.

All Functions
  • Complete a full enterprise readiness review. Conduct a cross-functional assessment of CMS TEAM model preparedness across governance, finance, compliance, clinical, HR and risk.
  • Validate financial models against updated CMS benchmarks. Refresh financial exposure modeling as CMS releases updated episode cost targets ahead of the Transforming Episode Accountability Model compliance window.
  • Confirm board sign-off on TEAM readiness. Document board review and approval of the organization’s TEAM model readiness posture and risk mitigation strategy.
  • Test reconciliation and reporting processes. Conduct a dry run of reconciliation and reporting workflows to identify and resolve operational gaps before bundled payment model performance measurement begins.
  • Brief your legal and management liability advisors. Ensure your legal team and management liability partners are fully informed of your TEAM model readiness status and any remaining exposure areas.

How HUB can help

HUB’s healthcare risk experts can help your organization work through this checklist, identify your most significant gaps and develop a readiness strategy tailored to your specific situation.

Contact your HUB advisor or visit hubinternational.com to schedule a consultation.