Mathematica Selected to Evaluate CMS’s Transforming Episode Accountability Model

The Centers for Medicare & Medicaid Services (CMS) is testing new ways to improve the quality and value of care for people with Medicare, and it selected Mathematica to evaluate the agency’s Transforming Episode Accountability Model (TEAM) in service of this goal. This evaluation will help CMS determine whether episode-based payment improves care quality and reduces unnecessary spending across common surgical procedures. The evaluation will also generate evidence to inform future Medicare payment policy.

TEAM is an episode-based payment model designed to encourage hospitals and other providers to coordinate care across settings for five types of surgical episodes, from surgery through 30 days after discharge. By aligning payment with quality and efficiency, the model aims to reduce avoidable hospital and emergency department use, shorten hospital and post-acute care stays, support smoother transitions to primary care, promote faster recovery, and lower overall episode costs.

"CMS is investing in new approaches to improve care while ensuring Medicare dollars are spent effectively," said Mathematica Senior Fellow Greg Peterson. "This evaluation will provide timely evidence about how TEAM affects patients, providers, and costs, helping CMS understand what works, where implementation differs across hospitals, and what lessons can inform future payment models."

Mathematica will lead a mixed-methods evaluation examining TEAM's effects on Medicare spending, healthcare utilization, quality, patients’ outcomes and experiences, and hospital care delivery. The evaluation will combine Medicare claims and administrative data with patient and hospital surveys and interviews to assess whether the model is achieving its goals, how participating hospitals are adapting their care delivery, and how results vary across different hospitals and communities.

The evaluation is designed to generate evidence throughout implementation. Mathematica will provide CMS with annual evaluation reports and emerging findings to help the agency monitor TEAM's performance, identify implementation challenges, and inform future decisions about episode-based payment models.

Mathematica is partnering with Abt Global and clinicians to evaluate all five of the surgical episode types in TEAM, providing CMS with a comprehensive understanding of how the model performs across different patient populations and care environments.