With the Transforming Episode Accountability Model (TEAM) launching in January, the level of readiness varies greatly among skilled nursing providers, as well as hospitals mandated to take part in the initiative.

Some nursing home providers are in the position of educating hospitals about the program, giving these SNF operators a chance to stand out as likely prized collaborators for the initiative.

But other organizations have been slow to mobilize due to other SNF industry pressures and because TEAM’s impact felt initially distant, according to Brian Fuller, managing director in ATI Advisory’s provider strategy and care transformation practice. While some post-acute providers are actively analyzing data to prove their worth to hospital systems, others are only beginning to interpret their metrics or haven’t started at all.

And a recent poll from Aidin – a company offering a technology solution to facilitate more coordinated care – also showed variation in the level of readiness among providers taking part in a recent webinar. Representatives with health systems, post-acute centers and home health organizations were among the poll respondents.

At any rate, leaders with an eye on TEAM expect the program to take off, with more diagnoses likely to be added after its first year.

One of these leaders is Dr. Janice Thorpe, senior vice president of value-based care and clinical education at Genesis HealthCare. Kennett Square, Pennsylvania-based Genesis is one of the largest skilled nursing provider organizations in the country, operating nearly 200 centers across 17 states.

Genesis has been in TEAM meetings with hospital systems for some time now. Some acute care systems are still getting up to speed with the initiative, especially the fact that it’s a mandatory program, according to Thorpe.

“They might know that they’re a participating hospital but some of them say, ‘We’re not going to do that thing.’ This is not an initiative you get to voluntarily elect to do. For the first time, selected hospitals require mandatory participation … you need to be ready,” said Thorpe.

TEAM is considered the most significant mandatory bundled payment model to date, which aims to cover all costs associated with a 30-day episode of care, including a skilled nursing stay, but hospitals are in charge.

Thorpe found she has had to educate hospital systems about TEAM – it’s a value-add proposition for Genesis to be the operator in the room with a plan, and with details on the new initiative.

SNF operators need to prove themselves around performance metrics expected of TEAM. If an operator is used to participating in an ACO or with managed care organizations via value-based care contracts, the TEAM model is an “organic, inherent way” to continue taking on risk and deepening relationships with nearby hospital systems.

These organizations are used to managing length of stay and containing costs and finding strategies to help reduce readmissions within the first 30 days, Thorpe said. And so, a history of taking on risk and managing is preparation for TEAM all on its own, as well as a way to get in the door with hospital systems that must participate in the model.

“We had collateral for hospitals to show them that Genesis was very comfortable in the value-based care space,” said Thorpe. “We had created center level care pathways for all five DRGs that described an expedited length of stay with tactics to reduce readmissions and innovative ways to track the patient 30 days post discharge, so that we could be a good collaborator.”

Thorpe refers to diagnosis related groups (DRGs), the five major surgical conditions the model focuses on: lower extremity joint replacement, coronary artery bypass graft, major bowel procedure, surgical hip or femur fracture treatment, and spinal fusion.

In terms of risk in the TEAM model, most hospital systems are participating in the Tier One track. This means they’re eligible for financial upside related to the financial and quality outcomes of the 30-day episodes of care but do not face financial risks for underperformance. But their risk, and the scope of the model overall, , might change as the program rolls out in subsequent years.

“This is just the beginning. This is an initiative that’s going to spread like a rapid fire as we see the success of improved outcomes, as well as managing dollars spent per case,” said Thorpe. “It’s only a matter of time before we go from five DRGs … to 50. I really believe this is the tip of the iceberg.”

Slow reaction by some, more diagnoses to come

Besides surgical diagnoses, TEAM might see comorbid conditions added before long, like congestive heart failure; it would be a way for CMS to hold care settings responsible for chronic disease management outcomes, said Thorpe.

Fuller warns against a passive “wait and see” approach from operators during the first year without downside risk; implementing technology, care pathways and hospital partnerships takes many months.

He echoed Thorpe’s thoughts on TEAM expansion, expecting more than the five surgical conditions as early as 2027. Fuller went one step further to say CMS may introduce nested episode bundles within ACO models, which could make episode-based performance management unavoidable for most post-acute care providers.

Fuller has seen the market slower to react to the TEAM model compared to other value-based care arrangements, likely due to the initiative being far out in the minds of the industry. In other words, it was something that wasn’t due to affect operators right away.

Medicaid cuts were much more top of mind earlier this year, along with looming changes from the One Big Beautiful Bill Act (OBBBA) which took “all the air out of the atmosphere,” Fuller said.

Overall, it’s been a slow process for the market to ready itself, but there are some clients that have worked with ATI doing a deep dive into their data, Fuller said. They understand and have evaluated their market opportunity for the TEAM model and are actively having conversations with their hospital partners. Some even have partnership concepts on the table.

“Other clients are still in that process of understanding their data and kind of digesting what the data is telling them and how they should look at it and contextualize it,” noted Fuller.

A lot of ATI’s clients are in multiple markets too, meaning it’s going to be a different playbook depending on location.

Still others haven’t started the process at all to understand TEAM, and it remains low on the priority list. The same breakdown is seen in hospital systems too, Fuller said.

“We do work with hospitals, and this is not unlike what we also see with our hospital clients, this wide range of readiness,” said Fuller.

SNF confidence and a need for analytics

Regarding the Aidin poll, about 65% of respondents were confident to some degree that their staff would be ready to meet TEAM’s requirements by Jan. 1, 2026. About 9% said they weren’t confident quite yet, and 8% said they were just getting started with readiness, and 5% said they weren’t focused on the model yet. This is out of 66 total respondents. The remaining 14% said they were not on the initial TEAM list.

“That tracks with what I’m feeling in the marketplace currently,” added Fuller. “Markets were randomly selected, only about a quarter of the hospitals across the country were selected. So not every market is going to be directly impacted by this model, and especially not as it starts on Jan. 1.”

About 64% told Aidin that data and analytics will be most critical for improving tracking and comparing post-acute partner performance; this includes metrics like readmissions, length of stay and referral response times.

Genesis has its own CareData Hub and branded analytics team that pulls information from CMS as well as real-time data for the same metrics.

“I didn’t have tools like CareData Hub five years ago,” Thorpe said. “There’s a lot more satisfaction from managing real-time data versus claims-based data. That data tells us not only our volume from certain hospital systems, but TEAM specific volume into each center, and performance metrics.”

On the survey, providing transparent, actionable insights to clinicians and case managers at the point of decision was a close second in terms of using data and analytics for TEAM prep, at 28% of respondents. This was followed by monitoring episode costs and financial risk exposure in real time, which 5.5% of respondents chose as an area in which data and analytics will help them.

Only 3% of respondents said data and analytics will help with standardizing care pathways and reducing unwarranted variation with TEAM prep, but Fuller said this came up quite a bit with his clients, suggesting it may be a prep point that has flown under the radar.

Care pathways, specifically integrating SNF and home health services, offers a seamless post-acute continuum, along with opportunities tied to specific episode types. Post-operative orthopedic patients make up the highest volume of episodes under TEAM, and so a focus on care pathways for this episode could give operators an edge, Fuller said.