Comparing the CMS TEAM Model vs. Previous Bundled Payment Pilots (BPCI, CJR)

As CMS continues to reshape payment models for hospitals and providers, the Transforming Episode Accountability Model (TEAM) stands out as a bold shift from previous bundled payment pilots. It builds on the lessons learned from Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) but introduces a broader scope and stricter expectations.

In this article, we’ll walk through how the TEAM model compares with BPCI and CJR across key areas like participation requirements, episode structure, risk exposure, and care coordination. Whether you're a hospital executive, case manager, or clinician, understanding these changes is critical to preparing for what’s next.

What Was BPCI?

Launched in 2013, the Bundled Payments for Care Improvement (BPCI) initiative aimed to align incentives across acute and post-acute care providers. It allowed hospitals, physician groups, and post-acute facilities to voluntarily participate in bundled payment arrangements for specific episodes of care.

There were four different tracks under BPCI:

• Model 1: Focused on inpatient stays.

• Model 2: Included both hospital and post-acute care.

• Model 3: Covered post-acute care only.

• Model 4: Made a single payment for the inpatient stay and related services.

In 2018, CMS introduced BPCI Advanced, a more streamlined version with fewer episode options, quality metrics, and a focus on risk-adjusted pricing.

Key characteristics of BPCI:

• **Voluntary participation
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• **Episode-based payments
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• **Retrospective reconciliation
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• Limited enforcement of care coordination standards

What Was CJR?

The Comprehensive Care for Joint Replacement (CJR) model launched in 2016 as one of CMS’s first mandatory bundled payment programs. It applied to hip and knee replacements in selected geographic areas and targeted both cost containment and quality improvement.

Key features of CJR:

• Mandatory for hospitals in selected MSAs
• Focused on orthopedic procedures
• Included post-acute care services for 90 days after discharge
• Financial risk and reward based on spending vs. target price
• Quality metrics factored into reconciliation

CJR helped demonstrate that bundled payments could reduce costs without compromising patient outcomes, especially when applied to high-volume, standardized procedures.

What Is the TEAM Model?

Announced in 2024 and launching in 2026, TEAM (Transforming Episode Accountability Model) is CMS’s latest effort to accelerate the shift to value-based care. Unlike BPCI or even CJR, TEAM covers a broader range of clinical conditions and imposes mandatory participation for many hospitals.

Here are the core aspects of TEAM:

• Mandatory for selected hospitals across diverse service areas
• Episode length is 30 days post-discharge
• Financial accountability and shared savings/losses
• Incorporates quality metrics like readmissions and mortality
• TEAM incorporates equity through risk adjustment that includes a beneficiary economic risk adjuster and other clinical and demographic factors. CMS emphasizes referrals to primary care and improved care transitions for all beneficiaries, including those with higher social risk.
• Encourages collaboration across inpatient and outpatient settings

Key Difference 1: Voluntary vs. Mandatory

BPCI: Opt-In Flexibility

Hospitals could choose which episodes to participate in under BPCI and BPCI Advanced. This flexibility allowed organizations to choose areas where they felt confident about performance and potential savings. It also limited participation mostly to health systems with strong infrastructure.

CJR: Limited Mandate

CJR was mandatory but only for hospitals in designated metropolitan areas. Many facilities outside those regions were never affected, and CMS later scaled down the number of participating regions.

TEAM: Broad and Mandatory

TEAM moves away from optional participation. If a hospital is selected for inclusion, it must take part. The geographic spread is more extensive than CJR, and the list of included episodes is longer and more complex. This mandatory nature raises the stakes for organizations that may not have the systems in place to manage cost and quality effectively.

Key Difference 2: Episode Types

BPCI: Targeted, Elective Focus

Most BPCI participants selected episodes with relatively predictable costs, such as joint replacements, cardiac procedures, or sepsis. Participants could avoid high-variability episodes.

CJR: Narrow Scope

CJR focused only on lower extremity joint replacements. This narrow design simplified implementation but limited its impact across other service lines.

TEAM: Broader Focus

TEAM shifts to a mandatory, multi-specialty structure, covering a wider range of high-cost, high-volume inpatient procedures. The five included surgical episodes are:

• **Lower Extremity Joint Replacement (LEJR)
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• **Surgical Hip/Femur Fracture Treatment (SHFFT)
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• **Spinal Fusion
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• **Coronary Artery Bypass Graft (CABG)
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• Major Bowel Procedures

This expansion introduces greater clinical variation and risk. Each of these procedures often involves complex care pathways, post-acute coordination, and significant resource utilization.

Key Difference 3: Risk Structure

BPCI: Risk Could Be Limited

Participants could cap their downside exposure or avoid it altogether. Many chose episodes with predictable costs and higher margins to reduce risk.

**CJR: Gradual Performance-Based Risk

**Hospitals faced gains or losses based on how their episode spending compared to a set target price. Risk started at lower levels and increased gradually over the model’s life, giving organizations time to adjust.

**TEAM: Upside-Only in Year One, Two-Sided Risk Thereafter
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In Performance Year 1 (2026), all hospitals begin in Track 1, which is upside-only with a 10% stop-gain cap and no downside risk. This provides a transition period for hospitals to adapt to TEAM’s operational and reporting requirements before moving to higher-stakes participation.

Beginning in Performance Year 2 (2027), most hospitals are required to participate in a two-sided risk track, where both shared savings and repayment obligations apply, with stop-gain and stop-loss limits defined by CMS. Certain safety-net and rural hospitals may remain eligible for upside-only arrangements longer.

Reconciliation occurs annually at the close of each performance year, comparing actual episode spending to the CMS-set target price and adjusting payments based on the hospital’s Composite Quality Score (CQS).

Key Difference 4: Care Coordination Requirements

BPCI: Loose Expectations

While CMS encouraged care coordination under BPCI, there were few concrete requirements. Success depended on each organization’s initiative.

CJR: Structured Transitions

CJR added expectations around discharge planning and post-acute referrals but left room for interpretation. Many hospitals developed care pathways but not always consistently.

TEAM: Structured and Auditable

TEAM places more weight on care coordination throughout the episode. Hospitals are expected to:

• Work closely with post-acute care providers

• Reduce unnecessary readmissions

• Address social determinants of health

• Engage patients and families early in the discharge process

• Capture and document all transitions of care

The expectations for clinical integration and communication are clearer and enforceable.

Key Difference 5: Quality Metrics

BPCI: Limited Quality Influence

While some quality metrics were considered in BPCI Advanced, they did not heavily impact payments.

CJR: Adjusted for Performance

Quality scores influenced whether hospitals earned shared savings. However, the focus was limited to joint-related metrics.

TEAM: Tied to Payment Outcomes

Under the CMS TEAM model, hospital payment adjustments are directly linked to performance on a defined set of quality measures, scored through a Composite Quality Score (CQS). High-quality care is rewarded, while hospitals that reduce costs but perform poorly on quality may face penalties.

Quality measures tracked in TEAM include:

Performance Year 1 (2026):

• Hybrid Hospital-Wide All-Cause Readmission Measure – captures unplanned readmissions across all conditions.

• THA/TKA Patient-Reported Outcome Performance Measure (PRO-PM) – evaluates patient-reported functional outcomes following total hip or knee arthroplasty.

• CMS PSI-90 Composite – a patient safety composite covering multiple adverse events.

Starting Performance Year 2 (2027), additional measures are added:

• Hospital Harm – Falls with Injury

• Hospital Harm – Postoperative Respiratory Failure

• 30-Day Risk-Standardized Death Rate among Surgical Inpatients with Complications (“Failure-to-Rescue”)

Additional measures, such as Information Transfer PRO-PM, are scheduled to be incorporated later in the model’s five-year period.

Key Difference 6: Health Equity

One major difference between TEAM and previous models is its emphasis on reducing disparities in care. TEAM includes equity-focused requirements such as:

• Stratifying quality metrics by demographic groups

• Targeting interventions for underserved populations

• Reporting on social risk factors

These expectations were largely absent from BPCI and CJR. Now, hospitals must consider equity not just as a social good, but as a financial priority.

Technology and Data Requirements: Analytics Are Essential

Then: Optional Advantage

Hospitals participating in BPCI or CJR could get by with basic tools and retrospective analysis. Only the most advanced systems used predictive analytics and real-time dashboards.

Now: Operational Necessity

TEAM demands real-time insight into cost drivers, quality metrics, and care variation. Hospitals will need:

• Predictive Episode-level performance tracking

• Patient-level risk stratification

• Predictive models for readmission risk

• Dashboards for care team coordination

• Detailed coding and documentation processes

Without the right technology infrastructure, it will be difficult to succeed in TEAM.

Lessons for CMS TEAM from BPCI and CJR: What Still Matters

Despite the changes, there are important lessons from earlier models that remain relevant:

• Build trust with physicians: Engagement is critical. Providers must understand their role in the episode and how their decisions affect cost and outcomes.

• Strengthen post-acute partnerships: Skilled nursing facilities and home health providers are central to managing costs and avoiding readmissions.

• Invest in care pathways: Standardizing care can reduce variation and improve outcomes, especially for high-volume episodes.

• Use reconciliation reports to learn: Financial performance is a reflection of operational decisions. Use the data to refine strategy.

The Bottom Line: CMS TEAM Is a Different Ballgame

While BPCI and CJR laid the groundwork for bundled payments, the TEAM model brings a different level of urgency and complexity. It is broader, riskier, and more focused on comprehensive care redesign.

Hospitals that approach TEAM with the same mindset used in past pilots may find themselves unprepared. Those that treat TEAM as an opportunity to truly coordinate care, modernize analytics, and align stakeholders will be better positioned to thrive under this new mandate.

CMS has made it clear that value-based care is not optional. TEAM is the latest, but not the last, model to push hospitals in this direction. Preparation today could define your financial and clinical performance for years to come.

To learn more strategies for success in TEAM, join 160+ individuals and more than 40 of the top hospitals and health systems in the interactive CMS TEAM Collaborative.

Apply to join for FREE today!