Preparing for CMS TEAM - Challenges & Tools for Success

Bundled payments are reshaping the financial landscape of hospital care—and fast. For many hospitals, especially those facing the upcoming mandatory CMS TEAM model, this shift introduces both a significant opportunity and a real financial risk.

While bundled payments aim to improve quality and control costs, they also place new administrative and operational pressures on hospitals that may not yet be equipped to manage them.

In this article, we will look at some of the challenges for the upcoming TEAM model, what hospitals need to prepare, and how the newest Avant-garde Health product is positioning hospitals for success come January!

The Challenges of Bundled Payment Models

For many hospitals, the transition to bundled payments like CMS TEAM is uncharted territory. It offers a big opportunity but also a big risk as many hospitals are not necessarily set up for the demands of the mandatory program.

For example, some common pain points we see amongst hospitals include:

• Data Fragmentation: Information is often scattered across EHRs, billing systems, and post-acute providers.
• Limited Predictive Tools: Traditional systems lack forecasting capabilities for episode costs and outcomes.
• Physician Alignment: Understanding and improving individual physician performance can be complex.

Without the right tools, hospitals risk missing out on savings—and even incurring penalties.

What Hospitals Need to Prepare for the Mandatory CMS TEAM Model

To begin, the CMS TEAM model introduces target pricing with an embedded discount factor, meaning CMS will deliberately set spending targets below historical averages. In other words, hospitals must act immediately to reduce costs just so they are able to break even and avoid penalties.

Let’s take a look at some of the best places for hospitals to start tackling the challenges listed above.

1. Integrate Data Across the Entire Care Continuum

Fragmented data is one of the biggest roadblocks to success in bundled payments. Too often, hospitals are working with disconnected systems—separate EMRs, billing platforms, and siloed post-acute care data—that prevent a clear picture of performance.

To succeed under CMS TEAM, hospitals need a single source of truth that brings together electronic medical records (EMR), claims data, and national Medicare benchmarks. When these data sets are unified, hospitals can track costs, outcomes, and care patterns across the full episode—from pre-op assessments to post-acute discharge—enabling smarter decisions and faster interventions.

2. Gain Granular Patient-Level and Physician-Level Insights

High-level metrics aren’t enough in a model that holds hospitals financially accountable for every step of a patient’s journey. To manage performance effectively, hospitals must be able to answer questions like:

• What was the total cost of care for each episode?
• Who delivered the care, and how did their outcomes compare?
• Which discharge settings were used, and were they appropriate?
• Where are care variations occurring—and why?

This level of granular insight allows hospitals to identify specific cost drivers, improve consistency in care delivery, and implement targeted strategies at both the patient and physician levels. Without this clarity, opportunities for improvement go unseen—and savings are left on the table.

3. Act Before It’s Too Late

Many hospitals are accustomed to retrospective reporting, relying on claims data that may not arrive until months after care is delivered. But under CMS TEAM, reactive reporting simply isn’t enough.

Hospitals need real-time tools that allow them to monitor performance as it happens, anticipate financial exposure, and take corrective action before it's too late. Predictive modeling plays a key role here, allowing hospitals to forecast outcomes based on historical trends and EMR-derived data even before claims are finalized.

In a system where missed benchmarks can mean financial penalties, the ability to move quickly and make data-informed decisions is not just a bonus—it’s a necessity.

4. Collaborate and Learn from Peers

No single hospital has all the answers, especially when navigating a mandatory new model like CMS TEAM. That’s why access to expert guidance and a collaborative learning environment is so valuable.

By connecting with other hospitals across the country, care teams can benchmark performance, share best practices, troubleshoot challenges, and learn from each other’s successes—and mistakes. Collaborative networks offer an accelerated path to competency, helping hospitals stay current with evolving regulations and implementation strategies.

When your team is supported by a larger community, you’re better equipped to respond quickly, adapt strategies, and lead change rather than chase it.

The Avant-garde Solution: A New AI-Powered Product for CMS TEAM and Bundled Payment Success

Avant-garde isn’t just another analytics tool. It’s a proprietary, AI-powered platform purpose-built for bundled payment models, including CMS TEAM. Let’s take a look at some of the key features and what sets it apart.

AI-Driven Analytics and Guidance

Hospitals need data that’s timely, integrated, and actionable. Avant-garde’s platform pulls together EMR data, claims data, and national Medicare FFS datasets into one web-based system. This comprehensive view enables hospitals to analyze bundled payment performance with unmatched accuracy—something traditional systems simply can’t do.

Whether you’re tracking cost trends, episode utilization, or DRG-level variations, the platform’s robust evaluation engine helps you make smarter decisions that drive savings and protect your margins.

Granular Patient-Level Insights

CMS TEAM is all about accountability at the episode level. Avant-garde provides detailed analytics for every single encounter—including discharge dates, DRG/CPT codes, physician data, discharge locations, and a breakdown of costs by spend area.

You also get comprehensive physician performance reports, so you can identify care variations, track adherence to protocols, and create targeted strategies for improvement. This level of transparency is essential for success under TEAM, where small details can make a big difference in outcomes and reimbursement.

Predictive Custom Modeling

One of the biggest challenges in TEAM is uncertainty—waiting for claims data can delay insights, and claims data lags behind real-time care by months. Avant-garde solves this with predictive modeling that combines historical performance trends with EMR-derived discharge data to forecast outcomes before claims even hit your system. This allows the hospital to make changes based on predictive modeling instead of waiting on claims data to arrive. Time is of the essence!

Even better? You can benchmark your hospital’s performance against national, regional, or peer-specific data to understand where you stand and how to improve. It’s a powerful tool for making proactive decisions in a fast-moving healthcare landscape.

Access to the CMS TEAM Collaborative

No hospital should have to navigate CMS TEAM alone. Avant-garde clients get free access to our CMS TEAM Collaborative, an exclusive network of top-performing hospitals nationwide.

This community gives your team a unique advantage:

• Get expert training and guidance tailored to CMS TEAM.
• Learn best practices from hospitals like yours.
• Troubleshoot challenges together.
• Accelerate your learning curve so you can hit the ground running.

Success under CMS TEAM isn’t just about technology—it’s about having the right network and support.

Ready to Future-Proof Your Hospital for CMS TEAM?

The CMS TEAM model is almost here, and the time to prepare is now. Let’s make sure your hospital is ready to thrive under CMS TEAM.

Learn more about Avant-garde Health’s new CMS TEAM product and collaborative and receive a complimentary case costing and analytics review.