The largest mandatory episode model in Medicare's history began January 2026. If your hospital is in a selected market, participation was not a choice.
TEAM began January 1, 2026 and runs through December 31, 2030, with 716 participants. It is mandatory, which makes it both operationally consequential for the hospitals in it and methodologically important for everyone else.
The design in brief
In TEAM, “selected acute care hospitals coordinate care from surgery through 30 days post-hospitalization for people with Original Medicare undergoing one of five surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures.”
It “is a mandatory model and will run for five performance years from January 1, 2026, to December 31, 2030, in selected Core-Based Statistical Areas nationwide,” under Section 1115A authority.
The five categories span three service lines that rarely coordinate with each other: orthopedics, cardiac surgery, and general surgery. A hospital cannot solve TEAM in one department.
The problem CMS says it is solving
CMS states the rationale directly: “People who undergo surgery may experience fragmented care, which can lead to complications, prolonged recovery, or potentially avoidable acute care.” The intended solution is “improving the patient experience from surgery through recovery by supporting the coordination and transition of care between providers.”
Successful outcomes are defined as “reducing both avoidable hospital readmissions and emergency department use.”
The primary care referral requirement
One provision distinguishes TEAM from every episode model before it. “Participants must refer patients to primary care services to enable continuity of care and positive long-term health outcomes.”
This is a small sentence with a large intent. Episode models have always been criticized for treating a surgical event as if it were the whole of a patient’s care, ending accountability at day 30 or 90 and handing the patient back to nobody in particular. Requiring a primary care referral is CMS attempting to stitch the episode back into a longitudinal relationship.
Worth remembering: the referral requirement is the clearest signal available about how CMS now views the relationship between episodes and population health. Bundles are not being positioned as an alternative to primary-care-centered accountable care, they are being wired into it. For a hospital, that means TEAM cannot be run purely as a cost-reduction project inside the surgical service line. For an ACO in the same market, it means the surgical episodes affecting its attributed patients now come with a mandated hand-back to primary care. The primary care course argued that primary care is the center of population health; TEAM is the first episode model that agrees in writing.
Why mandatory matters
Voluntary models attract organizations that expect to succeed under them, which makes their results hard to interpret. The evaluation course covered this as selection into the intervention. A geographically mandatory model does not have that problem: hospitals in selected CBSAs participate regardless of their readiness or expectations.
That makes TEAM’s eventual evaluation considerably more informative than a voluntary model’s, and it makes the experience of unprepared hospitals part of the finding rather than a footnote.
Key takeaways
- TEAM runs January 1, 2026 through December 31, 2030 with 716 participants, mandatory in selected CBSAs.
- It covers five surgical categories spanning orthopedics, cardiac surgery, and general surgery.
- Accountability runs from surgery through 30 days post-hospitalization.
- Participants must refer patients to primary care, tying the episode into longitudinal care.
Sources
Check your understanding
How do hospitals come to participate in TEAM?
TEAM is a mandatory model running in selected CBSAs nationwide. Selection is geographic rather than by application, which is what makes its evaluation more credible than a voluntary model's.