Executive Summary
The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAMS), beginning in 2026, forces hospitals to assume significant risk for the 30-day post-discharge continuum of care. Success under this mandatory bundled payment initiative hinges on two levers: rigorous cost containment and superior quality outcomes. This paper asserts that traditional episodic cost management is insufficient. The most potent, yet often overlooked, strategy is the precision-driven, pre-surgical optimization of patient blood health. By deploying tools like MyBloodHealth, hospitals can systematically mitigate the largest single drivers of episodic cost—complications and readmissions—while simultaneously boosting the patient engagement metrics that drive quality adjustments.
I. The New Mandate: Navigating Risk in the CMS TEAMS Era
The CMS TEAMS model represents a definitive shift in reimbursement philosophy, bundling payments for common surgical procedures (such as Lower Extremity Joint Replacement) to include all related costs up to 30 days post-discharge.
Hospitals are no longer paid for volume; they are financially accountable for managing total episode spending against a regional target price. For every episode, a hospital must proactively manage high-cost variables, including:
Readmissions
Each prevented readmission saves an average of $10,000–$14,000
Post-Acute Care
Controlling discharge destination—prioritizing HHA over high-cost SNF stays
Complications
Eliminating unnecessary utilization, such as blood transfusions
The ultimate financial outcome—whether a hospital receives a bonus or incurs a repayment penalty—is determined by the cost difference, which is then adjusted by a Quality Score based on metrics like patient-reported outcomes (PROMs) and HCAHPS scores.
II. Anemia: The Hidden Variable Driving Episode Overspend
When analyzing episode costs, one clinical factor stands out as disproportionately driving high utilization and negative outcomes: pre-existing anemia.
Data clearly demonstrates the financial burden of this clinical condition:
| Patient Cohort | Average Total Payments ($) Per Patient |
|---|---|
| Unadjusted Costs for Anemic Patients | $14,535 |
| Unadjusted Costs for Non-anemic Patients | $9,451 |
Key Finding:
50%+ Higher average annualized cost for anemic patients compared to non-anemic patients for surgical episodes.
This cost is driven by complications, longer inpatient stays, and reliance on expensive resources like transfusions and Skilled Nursing Facility (SNF) stays.
The traditional bundled payment approach focuses on managing costs after the surgery has occurred (optimizing PAC). The strategic advantage under TEAMS is to manage the risk before the episode even begins. By implementing evidence-based protocols for anemia and other blood health risks in the surgical readiness phase, hospitals can:
- Reduce Complications: Correcting anemia pre-surgery significantly reduces the likelihood of complications and the need for costly blood transfusions during the procedure.
- Ensure a Successful Discharge: Healthier patients are more likely to qualify for and succeed with safe discharge to home health, avoiding the $6,500–$10,000 average cost of an unnecessary Skilled Nursing Facility (SNF) stay.
III. MyBloodHealth as the Engine for TEAMS Success
MyBloodHealth (MBH) directly translates proactive blood health optimization into tangible TEAMS performance benefits, functioning as a precision engine across the clinical and financial spectrum.
1. Driving Financial Savings Through Data Tracking
The platform facilitates the tracking of key blood health metrics over time. For hospitals, this data is invaluable for:
- Risk Stratification: Identifying high-risk patients (e.g., those with undiagnosed or uncontrolled anemia) who require intensive prehabilitation.
- Personalized Interventions: Enabling healthcare providers to develop personalized care plans that target blood health deficiencies, thereby reducing risk exposure within the 30-day episode window.
- Eliminating Avoidable Costs: By ensuring patients enter the episode optimized, MBH supports the goal of eliminating unnecessary, high-cost resources—like readmissions or extended PAC stays—that push episode spending above the regional target.
2. Enhancing Quality Performance via Patient Engagement
The TEAM model integrates quality metrics, and low scores can completely negate cost savings.
Key Finding:
A Quality Adjustment of just -2% can turn a $100,000 cost savings bonus into a $28,000 repayment obligation.
MyBloodHealth directly addresses the patient-facing metrics (HCAHPS, PROMs) by:
- Empowerment and Education: Giving patients access to their blood health data and providing educational resources. Engaged, informed patients are more adherent to treatment plans and better prepared for recovery, which naturally leads to higher patient satisfaction scores.
- Improved Care Coordination: The platform facilitates continuous communication between the patient and the care team during the critical 30-day post-discharge period, ensuring necessary follow-up care and preventing unnecessary Emergency Department (ED) visits.
Conclusion: From Reactive Cost Control to Proactive Risk Management
CMS TEAMS is not just a payment challenge; it is a clinical strategy challenge. Hospitals that continue to focus solely on downstream cost control will perpetually lag.
The path to receiving the maximum reconciliation bonus under TEAMS lies in adopting an upstream, precision-based approach. MyBloodHealth transforms a clinical data point into a financial lever, ensuring patients are optimized, complications are minimized, and engagement is maximized.
In the mandatory bundled payment world, an effective blood health optimization platform is no longer a clinical nice-to-have; it is a strategic and financial necessity.
Jason Carney is SVP, Clinical Strategy at hc1. He is responsible for product development, innovation, and go-to-market strategy for hc1’s Clinical solution portfolio. Jason is the co-developer, co-author, and patent holder for the MyBloodHealth® platform.
Contact: jcarney@hc1.com
