Healthcare Cost & Affordability
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CMS, under the Trump administration, has proposed the mandatory, nationwide Transforming Episode Accountability Model (TEAM, also referred to as CJR-X), which will require most hospitals to manage total Medicare spending for joint replacements, with a 2% financial discount on lower extremity joint replacement (LEJR), SHFFT, and spinal fusion episodes, and 1.5% for CABG and major bowel procedures. This marks a decisive return to mandatory bundled payment models and a structural shift in risk and accountability from payers to hospitals, intensifying cost-control pressures and redefining hospital strategies for surgical and post-acute care management starting October 2027. Alongside this, California and leading Medicaid stakeholders are advancing multipayer primary care payment reform, signaling a parallel trend toward broader alignment on value-based payment across public programs.
Key sources: CMS proposes mandatory hospital-bundled model for joint replacements, Medi-Cal Bold Idea — Multipayer Primary Care Payment Reform Model
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