Bass, Berry & Sims attorneys Justin Brown and Travis Lloyd authored an article for the American Health Law Association (AHLA) outlining how the Transforming Episode Accountability Model (TEAM) announced by the Centers for Medicare & Medicaid Services (CMS) in August 2024 could lead more hospitals and health systems to make use of the value-based enterprise (VBE) framework under the healthcare fraud and abuse laws.
As described by the authors, “TEAM is a five-year, mandatory alternative payment model that will test whether an episode-based pricing methodology for select surgical procedures can reduce costs while maintaining or improving quality. The model will put hospitals at upside and downside financial risk for the cost and quality of care provided through the episode by comparing performance year spend to a target price and quality measure performance to benchmarks.”
Justin and Travis provide insight on what hospitals and health systems will need to do to be successful under the TEAM model, such as collaborating with post-acute care providers, primary care providers and others. The need to develop collaborative relationships with other providers may hasten use of the VBE framework: “Although hospitals can continue to rely on the familiar [healthcare fraud and abuse] framework, they may, in face of the need to design novel, extensive financial arrangements with other providers, avail themselves of the VBE framework.”
The full article, “The Value-Based Dream TEAM? How CMS’s New Payment Model Could Spur Widespread Adoption of Value-Based Arrangements,” was published in the January/February 2025 edition of AHLA’s Health Law Connections magazine and is available online (subscription required).