Episode 5: TEAM & the Future of Value-Based Care Models

Join host Chad Mulvany as he shares the latest healthcare policy and legislative updates for the week of August 3, 2025. Later in the episode, Chad is joined by guests Michael Wolford and Stephen Kitterman, value-based care leaders in the Healthcare Consulting practice at Forvis Mazars, to discuss the fast-approaching Transforming Episode Accountability Model (TEAM) and other value-based care and payment priorities under the new CMS administration.

• Washington Watch (1:34)
• Wolford & Kitterman Interview (29:59)

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See keys to success in TEAM and further insights into CMS’ value-based care priorities.

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Healthcare Practice at Forvis Mazars

Chad Mulvany

Michael Wolford

Stephen Kitterman

Episode Transcript

(00:02):
On today's episode of Achieving Health,
I've got the latest policy and legislativeupdates from Washington, D.C.
for the week of August 4th, 2025.
Then I'll be joined by my ForvisMazars colleagues
Michael Wolford and Stephen Kitterman.
We'll discuss the upcoming TransformingEpisode Accountability Model from CMS
and the potential for more mandatoryrisk under the agency's new leadership.

(00:26):
Stay tuned.
This is AchievingHealth, a podcast from Forvis Mazars,
where we delve into the topicsthat matter most to healthcare
organizationsacross the continuum of care.
Our goal is to help younavigate the dynamic healthcare landscape
and achieve health at your organization.
Here's your host, Chad Mulvany.

(00:51):
Welcome to Achieving Health.
I'm Chad Mulvany, director inthe Healthcare Practice at Forvis Mazars.
Thank you for joining me today.
Before we get started with WashingtonWatch, I'd like to let you know
about our new webinar series,OBBBA Tuesdays, which will dive
into the healthcare implicationsof the One Big Beautiful Bill Act.

(01:12):
My colleaguesand I will explore how hospitals,
health systems, and other providerscan prepare for Medicaid cuts
and the expected increasein the uninsured.
The series starts August 26thand will continue every other Tuesday
through November 4th.
We'll have a link in the show noteswhere you can register
and hope you'll be able to join usfor this important conversation.

(01:33):
We'll begin today with our WashingtonWatch segment, where I share
updates on the most recent actionsof federal policymakers
and their anticipated impacton healthcare providers and payers.
Today's WashingtonWatch reflects information as of
8:00 Eastern, Monday, August 4th, 2025.
My comments arebased on what's being reported by the D.C.

(01:55):
trade press at this time, mixedwith a good bit of judgment
about where things may go,based on my experience in D.C.
So today's remarks reflect informationas of this moment and will likely change.
As far as our agenda is concerned,I really want to dig into the July 31st
HRSA announcementabout the 340B rebate model pilot.

(02:18):
While the proposal is limited,it certainly has significant ramifications
for covered entities and providessome indication
as to how they're going to needto prepare.
Also on July 21st,the Congressional Budget Office released
its final OBBBA score.
The bill results in a significant increasein the federal deficit over ten years

(02:38):
and likely triggers the S-PAYGO sequester,which could result
in additional Medicare cutsif Congress doesn't step in.
Also on July 31st, CMS
released its fiscal year 2026IPPS Final Rule.
In a bit of good news for hospitals,CMS estimates
the inpatient payments will increaseby $5 billion nationally,

(02:59):
that's about 4.3%, in Fed fiscal 2026as a result of all changes in the rule.
This is worth noting it's significant overthe 4 billion that was proposed
and is probably, like I said,
some of the best news that hospitalshave received in a couple of months.
On the opposite end of the spectrum,also want to cover the 2026 OPPS proposed
rule, which makes for an interestingand challenging read.

(03:23):
The payment update is again inadequate,although that will
fall in line with the IPPS.
But there are alsoa number of policy proposals
that honestly were telegraphed or retreadsfrom the prior Trump administration
that are going to be difficultfor hospitals to deal with.
CMS also, in mid-July, issued

(03:45):
the 2026 Physician Fee ScheduleProposed Rule.
While it was certainly lower keythan the OPPS
rule, there is a significant changeto work-in-practice RVUs
that will disproportionately impacthospital-based positions.
So starting with the 340B pilotrebate model.
On Thursday, HRSA released itslong-anticipated rebate model guidance.

(04:08):
The guidance implementsa relatively narrow, program focused on
the 10 drugs that are subject to Medicaredrug price negotiations for 2026.
Because this list is Part D,the initial impact
will occur for drugs dispensedthrough community and contract pharmacies.
Therefore, the impact on covered entities

(04:28):
may vary by stateand also participation with Apexus.
The proposed rule notesthat HRSA may allow for an expansion
of the rebate modelbased on an assessment of the program.
The rule also notesthat the model is intended to address 340B
and Inflation Reduction Actmaximum fair price deduplication.
However, it is worth noting and importantto note that the model requirements state

(04:51):
that rebates should not be deniedbased on compliance
concerns with diversionor Medicaid duplicate discounts.
Also, any denial of a rebate,
the manufacturers must providespecific documentation.
In terms of timelines, manufacturersinterested in participating
must submit an applicationto HRSA that addresses specific questions
in the Federal Register Noticeby September 15th.

(05:15):
The application also requires assurances
that all costs for data submissionthrough an IT platform
be borne by the manufacturer,with no additional administrative costs
for running the rebate modelpassed on to covered entities.
HRSA will approve applicationsfor a January 1st, 2026
start date by October 15th, and HRSAis requiring that manufacturers approved

(05:38):
for the rebate model pilot provideat least 60 calendar days
notice to covered entitiesbefore implementation of the model.
And this notice must also includeinstructions for registering
for anyIT platforms that will be required.
HRSA notes that manufacturers should allowcovered entities to submit data
for up to 45 calendar days,from the date the drug was dispensed.

(06:00):
Participatingmanufacturers are also required to pay
all rebates to covered entities, or,if they are denied, to provide
documentation and supportwithin 10 calendar days of submission.
While the model is far narrower in scopethan those manufacturers
attempted to implement last fall,I think there's still potential
for disruption to cash flow for hospitalsand covered entities.

(06:24):
First, covered entities will have limitedtime to set up a rebate cycle to capture
all of the data necessary and submitit timely.
In addition, when you think aboutwhat you're going to need to set
this rebate cycle up, in addition to 340Bexpertise,
you're also going to need experiencemanaging rebates and also setting
up systems of internal controlto manage the workflow

(06:45):
and ensure that data is collectedand submitted accurately and timely.
Second,and I think when I put my policy hat on,
while
the rule mentions denialsand it mentions them exactly twice,
it does not make any specific referenceto an appeals process.
I would hope that HRSA will allow for one,

(07:05):
but given that the parametersaren't addressed in the rule,
that's concerning, and that'scertainly something that covered entities
and their associations should raisein comments back to HRSA about the model.
Were I a covered entitysubject to the model, in addition
to investing the resources necessaryto quickly stand up a rebate cycle,

(07:25):
I would also want to put infrastructurein place to track certain data
elements, almost sort of like what you donow with your revenue cycle.
So starting to track how often the rebatewas paid within 10 days by manufacturer,
some type of equivalent metric to days inAR by manufacturer, denial rates.
So think about it by raw claims count,
by raw dollar value, and as a percentageof both by manufacturer.

(07:48):
And then also, I'd track your cost,how much it's costing in terms of
staffing, legal, IT support, other costsnecessary to manage the rebate cycle.
And I'd be certainto share that information
not only with my hospital associationsor my
provider associations and 340B health,
but I'd also want to sharethis information directly with HRSA

(08:08):
and my elected officialsat both the state and federal level,
so they can understand thata) this is not cost-free
to the covered entity,that you are incurring costs,
and b) so that they can understandhow this is skimming resources
that should beotherwise used from the 340B program
for its actual purpose,which is to expand access to care

(08:30):
for socio-economicallychallenged populations.
Moving on to the
second topic, the OBBBA updated CBO score.
So, two weeks ago,the Congressional Budget Office
released its updated estimateof the impact of OBBBA on Medicaid
spending, the number of uninsured,and the deficit.
The CBO now projectsthat the law will leave 10 million people

(08:53):
without insurance by 2034,as well as increase the deficit by $3.4
trillion over the period 2025 to 2034,
relative to the 2025 baseline.
And this is despitethe trillion dollars in federal Medicaid
spending reductionsthat were included in Subtitle B.
What's interesting about this is,while we saw commentary

(09:16):
after the House passed its bill,that OBBBA because it increased
the deficit, would trigger the mandatory4% Medicare S-PAYGO sequester.
We haven't seen similar commentary,but because the deficit
is increased, I would anticipatethat the sequester is triggered.
And if this is allowed to go into effect,that 4% cut to Medicare,

(09:36):
it would be all Medicare paymentsor providers and Medicare Advantage plans
and would now be on top of the standing2% sequester
that Congress tends to re-up annuallyto fund the various extenders.
The S-PAYGO
issue has come up from time to time,and at least over the course of my career,
Congress has always, quoteunquote, “wiped the PAYGO scorecard clean”

(09:58):
and normallyI would bet that will happen in one
or more of the various bills that end upfunding the federal government for 2026,
because my guess is we're going to end upin a mix of, you know, some budget
titles, pass some continuing resolution,some combination of both.
However,I would say that the historical rules
for how Congress behaveshaven't exactly held true for six months.

(10:20):
So I think this is something
that's going to bear watching closely,particularly as we approach
the end of this fed fiscal yearand we get into next fed fiscal year.
In terms of the IPPS final
rule, on July 31st, CMS released the 2026final rule.
CMS estimatesthat inpatient payments to hospitals
will increase by $5 billionas a result of all changes in the rule.

(10:44):
As I mentioned at the top,
this is a significant increaseover the $4 billion in the proposed rule.
In addition to the payment updates, CMSalso finalizes refinements
to the mandatory TransformingEpisode Accountability Model or TEAM
Episode Payment Model,which now will begin on
January 1st, 2026for more than 700 hospitals.

(11:07):
Generally, the IPPS rule was finalized
as proposed, and unlike the OPPS rule,
most of the provisions that were finalizedwere non-controversial.
Just to kind of cover
a couple of things in the rulethat I thought were interesting.
The Market Basket update.
CMS finalizes a net market basketupdate of 2.6%,

(11:28):
and this is increased from 2.4%.
So you can put a pin on that
and that will be your market basketupdate for outpatient as well.
And this is for hospitalsmeeting quality and interoperability
reporting requirements.
CMS also finalizesa capital update of 2.8%.
Again, increased from 2.6%.
Again, the Market Basketupdate is considerably lower

(11:49):
than what Medpac recommendationwould have been, which was 3.6%.
And that's the combinationof current loss.
So the final 2.6 plus 1%.
The nonpartisan advisory bodybelieves that an increase to Medicare PPS
payments for hospitals is merited,given that its group
of relatively efficienthospitals have negative Medicare margins.

(12:11):
It's also worth noting that the proposedMarket Basket update does not account
for anticipated increasesin supply cost as a result of tariffs.
Additionally, given that nursingand other clinical staff
make up a disproportionate percentageof hospital cost structures,
it's difficult,if not impossible for hospitals
to improve productivity at the same ratesas the general economy, right?

(12:35):
You can't offshore nurse,you can't automate a nurse.
So therefore, hospitalswill need to find ways to reduce
non-clinical labor costs and non-laborcosts as a way to offset the compounding
productivity reductionsand costs of tariffs.
In terms of wage index,based on reclassifications submitted
by the deadline for the final rule,CMS estimates that 961 hospitals

(12:59):
will receive their state's rule floorwage index value for 2026,
and this is up considerably from 556in the proposed rule.
In the final rule, CMS notes that in 2026,approximately
70% of geographically urbanhospitals will receive a wage index
equal to their state's rule floor,imputed floor, or frontier floor

(13:21):
prior to any outmigration or 5% decreasecap adjustments.
That's up from 58% in 2025.
Other thing worth noting in the final rule
is the uncompensated care pool for DSHhospitals.
CMS finalizes increasing UCDSH dollarsavailable
for distribution by $2 billion,and that's up from $1.15 in the proposed

(13:43):
and that $2 billion is 2026compared to 2025.
This is the result of a couple of things.
First, Medicare traditional dollars,so factor one, increased and that increase
is a result of the increased market basket
update and a slight upward adjustment
by CMS to its assumptionsabout inpatient utilization.

(14:06):
Second, part of the increase was relatedto factor two or the rate of uninsured.
In the proposed rules, CMS projecteda one percentage point increase in CY 2026
uninsured rate from 7.7% in 2025
to 8.7% for a compositeuninsured rate of 8.5%.
Again, that was proposed.

(14:27):
In the final, CMSadjusts its projection of the 2025
and 2026 uninsured ratesupwards to 7.9 and 9.0%, respectively,
resulting in a composite Fed fiscal 2026
uninsured rate of 8.7%.
You know, despite CMS’ recognitionof the impact of the expiration

(14:48):
of the Inflation Reduction Act's enhancedhealth insurance exchange subsidies,
even this
may be an under-projectionof the uninsured rate.
The Kaiser Family Foundation estimatesthat the number of individuals
receiving advanced premium tax subsidiesgrew from 9.6 million in 2020,
so the year before the enhanced subsidiesbegan, to 19.7 million in 2024.

(15:12):
And so, the loss of these subsidies,assuming they expire on December
31st of 2025,will likely cause greater increases
in the rates of uninsured,particularly in non-expansion states.
Moving on to the OPPSproposed rule, on July 16th, CMS
released its calendar year 2026 OutpatientPerspective Payment System rule.

(15:34):
The rule includespayment updates for hospital
outpatient departments and ASCs.
CMS estimates that beforethe accelerated recoupment related to 340B
separately payable drugs, changesin the rule will increase OPPS payments
by $1.61 billion in 2026 compared to 2025.

(15:55):
CMS proposes a net market basketupdate of 2.4%.
Obviously, that will be increasedin the final rules we just discussed,
and after budget neutralityand other adjustments, the resulting OPPS
conversion factor is $91.75
for hospitalsnot subject to the 340B recoupment.
For hospitals that are,the conversion factor will be $89.96.

(16:20):
The net update is 2.4%
for ASCsmeeting the ASC quality reporting,
resulting in a conversion factorof $56.21.
CMS estimates applying the Market Basketupdate to ASCs
will increase paymentsby approximately $160 million in 2026.
As I mentioned, CMS proposes to accelerate

(16:42):
the recoupment of increased paymentsfor non-drug services
related to 340B payment policythat was overturned by the Supreme Court.
If finalized, CMS will increasethe recoupment for non-drug related
services from 0.5%,which was finalized in this year's OPPS
rule, to 2%starting in calendar year 2026.

(17:03):
That would shortenthe recoupment period by 10 years.
So instead of ending in 2041,it would end in 2031.
And CMS believesthis change is now necessary
to ensure a more equitable impacton all hospitals
by minimizing the potential changes
in non-drug services over time.
It's estimated the recoupment will reducepayments by $1.1 billion in calendar

(17:28):
year 2026 for providers that are subjectto the 340B remedy offset.
And so just to kind of clarifywho that group is,
the recoupment does not apply to providersthat began billing Medicare under
OPPS after January 1st, 2018.
The proposed rulealso includes an expansion or proposal

(17:48):
to expand site neutral paymentfor drug administration services.
So, beginning in calendar year 2026,
CMS proposes to payfor drug administration services provided
and accepted off-campusHOPDs at the physician fee schedule
equivalent rate,which is 40% of the applicable APC.
If finalized,the policy would apply to APCs

(18:11):
5961 through 5964.
The agency estimates in 2026it will save $280 million.
$210 of that will be saved by CMS,$70 million of that will be saved by
beneficiaries in the form of reduced costsharing, or I should say beneficiaries,
state Medicaid programs and beneficiariesMedigap plans.

(18:32):
Like the site neutral clinic visitpolicies, CMS
proposes to exempt rural sole communityhospitals.
And CMS is also proposing to apply thischange in a non-budget-neutral manner.
So, similar to the clinic visit policy
that was finalizedduring the first Trump administration.
It justifies this action as a quoteunquote “volume control method,” incites

(18:54):
the growth in spending and drugadministration services in accepted HOPDs.
It's worth noting that, again,this was telegraphed by the president
in an executive order on drug pricingthat was released earlier this year.
And in terms of the justificationfor doing this non budget-neutral, as
I mentioned, CMS used the same rationalefor the clinic visit policy.

(19:16):
When hospitals challenged
that policy in court,it was upheld by a federal appeals court
and the Supreme Courtdeclined to hear an appeal.
CMS is also requesting feedbackon expanding the site-neutral clinic
visit policy to apply to clinic servicesprovided in on-campus HOPDs.
It also seeks feedbackon developing a systematic process

(19:38):
for identifying ambulatory servicesat risk of being shifted to, quote unquote
“more expensive-hospital basedsettings due to financial incentives.”
In terms of other policies
that are making a comeback in the 2026OPPS proposed rule,
in response to the president's drugpricing executive order, CMS announces

(19:59):
it will field a drug costacquisition survey
for covered hospital outpatientdrug costs.
Based on the proposed rule,CMS anticipates the survey
opening in late 2025and closing in early 2026.
And the rule notes thatthe results of the survey will be used to
inform payment rates for coveredoutpatient drugs in the 2027 OPPS rule.

(20:23):
Reading between the lines,it is very likely that the results of this
survey will be used to reprisea reduction in payment
for separately payable PartB drugs acquired under the 340B program.
Given there were response rate issueswhen the prior Trump administration
attempted to field a similar surveyin the spring of 2020,
the 2026 proposed rule considersapproaches to account for non-responses

(20:46):
to ensure the data set providesa large enough sample size
to be statistically reliableand meets statutory requirements.
Based on this commentary, CMS appearsto assume that if a hospital does
not respond to the survey, its outpatientcovered drug costs are not significant.
As a result,it discusses assigning these hospitals
the lowest reported acquisitioncost for its peer group.

(21:09):
The rule also notes that CMS may considerexpanding packaging in some instances,
as low response rates might indicateinsignificant outpatient drug costs.
Another change within the rulethat is aligned with
where the administration has indicated
that it's going is related to pricetransparency.
CMS proposes changes effective January1st of 2026

(21:31):
to the hospital transparency requirementsrelated to the machine-readable file.
Also addresses penalties for noncomplianceand compliance attestation.
In terms of the changesto the machine-readable file for prices
based on algorithms and percentages,CMS proposes
replacing the estimated allowed amountwhen negotiated charges included in

(21:52):
the file are based on a percentor algorithm,
with requiring hospitals to insteadinclude
the 10th percentile, 90th percentile,and median allowed amounts.
And then to help machine readable filesunderstand the reliability
of these three statistics, CMSalso proposes requiring hospitals
to include the count of allowed amountsused to calculate these values.

(22:16):
And the proposed rule providesa considerable amount of detail
on how these statisticsshould be calculated.
In addition,
with the machine-readable files, CMSis proposing requiring hospitals
to encode the name of the hospitalchief executive officer,
president or senior official designatedto oversee the encoding
of true, accurate and complete datain the machine readable file.

(22:40):
The rule also proposes hospitalsinclude its National Provider Identifier
to, quote unquote, “advancethe comparability of data.”
And then in terms of penaltiesfor noncompliance, CMS actually proposes
decreasing noncompliance penaltiesin certain situations by 35%
when a hospital waives its right to ahearing by an administrative law judge.

(23:04):
Finally, CMS proposesreplacing the existing compliance
statement with a new compliance statementto make clear the agency's expectations
that hospitals will encode all availablenegotiated rate information,
including all information necessaryto derive a dollar value
when the hospital is unable to displaynegotiated rates as a dollar value.

(23:25):
The proposed attestationstatement is more nuanced and specific
than the existing requirementand would encourage hospitals to review
that language carefully and providefeedback to CMS and their associations.
A couple of other things in
the OPPSproposed rule certainly not unexpected.

(23:45):
Beginning in 2026, CMS is proposingto phase out the inpatient-only list
by three years by removing 285 CPT codesthat are mostly musculoskeletal services.
So, again, something
the prior Trump administration proposed,but the Biden administration overturned.
The services CMS proposes removing
are listed in table 69,page 496 of the display

(24:09):
copy so you can get a sense ofwhat would come off.
Correspondingly, CMS proposesto create a seven-level
musculoskeletal procedures APC,to which it will assign procedures
moved from the inpatient-only listbased on applicable estimated cost.
CMS will complete the phaseoutby calendar year 2029.

(24:31):
Correspondingly, CMS is also expanding
the ASC covered procedure list.
The proposed rule expands ASC coveredprocedure lists by 547 services,
276 procedures in general,and then 271 of them are coming over
from the inpatient-only list.
In the list of proceduresthat CMS is proposing adding to the CPL

(24:52):
are in tables 80 and 81, and those beginon page 568 of the display version.
Moving on to the physician fee scheduleproposed rule.
Again, mid-July CMS issued it.
Obviously, there's a lot more herethan we have time to cover
so I just want to hit a couple of thingsthat stuck out.
Starting in ‘26, as CMSit was required by

(25:17):
MACRA.
There will be separate conversion factorsfor physicians who qualify as Advanced
Alternative Payment Model participantsand those who don't.
The proposed CY 2026 qualifying
APM conversion factor is $33.59,
a 3.83% increasefrom the current conversion factor.

(25:37):
The proposed 2026 conversion factorfor non-APM
qualifiers is $33.42,
projected increase of 3.62%.
And also important to remember here,the bump in physician payments
is a resultof the one-year increase in OBBBA.
And so unless Congress steps in for 2027,this is a one-time plus up.

(26:02):
The physician fee
schedule proposed rule also createsa new mandatory alternative payment model,
the Ambulatory Specialty Model,which is focused on specialists who treat
fee-for-service beneficiarieswith lower back pain or heart failure.
The performance years would span 2027through 2031.
Impacting payment years 2029 through 2033.

(26:23):
The model is designed to test how paymentadjustments could incentivize specialists
to focus on chronic disease prevention,early diagnosis and disease management.
Under the ASM, performanceof participating
specialistswould be assessed at the individual level
on four merit-basedincentive payment system MIPS categories:

(26:47):
quality, cost, improvement activities,and promoting interoperability.
Scores from these categorieswill determine the payment adjustment,
which could range from a low of -9%to positive 9% in the first year
and would be applied to future PartB claims for Medicare fee for services.
The model is intended to be budgetneutral,

(27:08):
and the other thing to noteis that, much like SNF VBP,
CMS will take a chunk offthe top of the pool of savings
so it will automatically generate savingsfor the program.
While CMS did not list the physiciansthat are required to participate,
the agency notesthat the model will target specialists

(27:28):
who treat at least 20 fee-for-servicebeneficiaries per year
with heart failure or low backpain over a 12-month period in roughly,
quote unquote, “one quarter of core basedstatistical areas.” Heart failure
participants would include physicianswho specialize in general cardiology.
The low back pain cohort would includephysicians specializing in anesthesiology,

(27:49):
pain management, interventional painmanagement, neurosurgery,
orthopedic surgeryor physical medicine, and rehabilitation.
The other two
things that I'll flag in the ruleare the efficiency adjustment
in the changes to the facilitypractice expense RVUs.
CMS has longstanding concernsabout the reliability of the AMA

(28:09):
Relative Value ScaleUpdate Committee, or RUC survey data
used to update practice expense RVUs.
For 2026, the agency is proposingan efficiency adjustment
to RVUs and related intra-serviceportion of physician time
for non-time-based services,based on the assumption that efficiency

(28:30):
in performing these servicesshould increase with experience.
CMS is proposing to use
the prior five-year MedicareEconomic Index Productivity Adjustment,
which would result in a -2.5%
adjustmentfor the services that it's applied to.
In addition to this, CMSis proposing updates to the methodology

(28:53):
used to calculate practice expenseRVUs for facility-based physicians
given the decline in the numberof physicians working in private practices
and the increase in employmentby hospitals and health systems.
For calendar year 2026,
CMS is proposing to recognize greaterindirect costs for practitioners
in office-basedsettings. The proposed 2026

(29:16):
Medicare payment increase marksthe first for several years.
However, providers will need to reviewthe CPT codes they bill frequently
as both the proposed efficiency adjustmentand change to price expense RVUs will
redistribute payments across both providertypes and settings of practice.
These changes will likely havea disproportionate negative impact

(29:36):
on procedural and hospital-basedphysicians.
This concludes today's Washington Watch.
Up next, I'll be joined by my colleagues,Michael Wolford and Stephen Kitterman,
for a conversation about TEAMand other value-based care priorities
for CMS.

(29:59):
I'd like to welcome our guest
for today's episode,Michael Wolford and Steven Kitterman.
Michael is a principaland Stephen is a managing director
in the healthcareconsulting practice at Forvis Mazars.
They work closely togetheras the firm's go-to resources
on value-based care, alternativepayment models and episodes of care.
Steven, Michael,thank you for joining us today.

(30:21):
I like to start by asking each of youto tell our listeners a little bit
about your background in healthcareand how you came to the field.
So, Michael, let's start with you.
Yeah. Thanks, Chad.
It's really a pleasureto be with you all today and to talk about
some of my favorite topics here.
But about me,I've been with our firm since
2010, and,obviously when I came here in 2010,

(30:46):
bundledpayments were just getting their start.
Alternative payment modelswere more of a concept than reality.
And so one project
in 2012 led to another and to another.
And we've really kind of riddenthe wave of alternative payment model
and value-based care activity

(31:07):
at our firm, now Forvis Mazars,
now for the last 13 years and counting.
Just really, really thrilledto be sharing some insights
with our listeners today.
You know, Michael,I remember when we first
had the opportunity to work togetherwhen I was at HFMA
starting up the Value-BasedHealthcare Innovation Council
and certainly as I was doingpolicy work in this space,

(31:29):
you know, you were incredibly instrumentalin helping me
sort of thinkthrough some of these issues,
have always appreciated the partnershipand certainly your expertise.
Stephen, same question to you.
Yeah.
Thanks, Chad, for having me.
And, I like itwhen Michael goes first in these things
because as you said, we've worked togetheron these initiatives for a long time.
And so I just get to kind of editwhat he says.

(31:51):
I've been with the firm since 2012.
In the industry prior to that,was in the accounting profession.
And as Michael said,this really energizes us.
It's what we get up thinking aboutfrom a professional standpoint.
And, I think this is a great timed conversation

(32:14):
just with everythingthat's going on, both in Washington
and with these new alternative payment models coming out.
Yeah.
No, I
Stephen, couldn't agree with youmore particularly given that we're
five months to the start of the mandatorybundle payment model TEAM.
Can you both tell us a little bitabout how Forvis Mazars helps
organizations succeed in value-basedcare and value-based payment models?

(32:38):
As we've mentioned, we do a lot ofalternative payment model work.
Which, alternativepayment models are essentially
a niche of value-based care.
And so when we say we help folkswith value-based care and payment models
really work, combining three

(32:59):
assets or facets of the types of workwe do.
Everything we do is deep in policy
understanding, policy, interpretingpolicy, helping
clients, which, for TEAMand for many alternative
payment models are hospitals,health systems and physician practice,
helping them understand the policies

(33:21):
and their optionsfor implementing those policies
and complying with these rules,regulations, contracts, etc.
Second is, it's about the money.
We help folks understand
their financial risk and opportunity
where they've got opportunities to improve

(33:45):
their financial situation.
And, the final piece is the actual strategies
to combine the policywith the financial to do different things.
I think there's a little bit of a misnomerout there that alternative payment
models allow organizations to just

(34:05):
do the same thing, but earn a bonus,
and that is false on its face.
There have been prior models like,
other alternative payment models,like model payments,
where organizations have succeeded
without making substantial clinicaland operational changes based on,

(34:30):
you know, some of their past history or,
certain provisions of the payment model.
TEAM won't be that way.
And so, to kind of come back to Chad'soriginal question,
we help people understand policy,
understand where their performance exists
today, and create strategiesto improve performance in the future.

(34:53):
Yeah.
And I'd maybe just add to that, Michael.
I mean, you're exactly right.
Taking a macro-level policyand putting it in a local context
for providers and the industry.
Just from a...it's going to impact.
There is a macro-level impactof each of these implementations,
but at the local context,there's going to be different

(35:17):
levers that providers are going to haveto look at in order to be successful.
Whether it's a mandatoryvalue-based arrangement
or a voluntary model in that sense.
So, I think the other thing that I wouldadd there is when we perform
those services,you talked about the strategy

(35:40):
that comes out of it,but there also is required
a deep understandingof healthcare economics
and what that looks likeand how, those different methodologies
work into a particular provider'sperformance.
And so, we we've been really successful
in kind of evaluating thesemodels before they begin,

(36:03):
doing
the implementationpart from a strategic perspective,
and then kind of monitoring performanceas you go through and making changes
to increase chances of success.
You know, I guess I'll just addone more thing, Steven.
And I think a lot of people can say, yeah,we help with TEAM,
we help with alternative payment models,
and it's importantto say things that we don't do.

(36:26):
And one of the things we don't do is
we don't take over as the managersfor the hospital.
We, to use the old proverb,
the old saying, we teach you to fish,we don't fish for you.
And so,
I think that's an importantdifferentiator, I think.
Secondly, some of the ways that we help are

(36:48):
more than just thisspecific alternative payment model
because some, other folksthat we run into in the marketplace,
are very
focused on one thing,
and we tend to be lessfocused on just one thing and more focused
on being a long-term adviserfor anything related to value-based care.

(37:09):
You know, the way I think about itis, Michael, to your point, it's
we help them with the strategy.
We help them understand the data.
We help them understandhow to use the data to re-engineer
clinical caredelivery and clinical workflows,
and to structure the workand to structure the incentives correctly.
So, to your point about the economicsthat the incentives become a line
to improve outcomes for patientsand help these organizations succeed

(37:33):
in lowering the total cost of care,sharing in the savings and again,
improving outcomes for patients,which is all incredibly rewarding work
to the extent that,
you know, I've had opportunitiesto work with you guys in the past.
Over the past
15 years, we've seen CMMI’s value-based
care priorities shift with each newpresidential administration.

(37:54):
Tell us a little bitabout what you've seen from the Innovation
Centerunder the current Trump administration.
Yeah, Chad,I think that's a good question.
And maybe if I could back upto the first Trump administration
and then get to the present Trump
administration, because I think it wasa little bit different, right?
I think in 2017 to 2020,

(38:16):
there was a bit of a build-outand realignment, if you will.
If you remember, there wasa comprehensive joint replacement model
that was mandatory when the first Trumpadministration came in.
That was kind of,peeled back a little bit.
So, half the marketswere exited from that model.

(38:37):
They also hadsome other mandatory bundles
that were canceledin the way of some cardiac
and some surgicalhip and femur fracture additions.
So I think we saw kindof a rollback of mandatory,
influx of voluntary when they started
the BPCI advanced model in that timeperiod.

(39:01):
And then, you know, they tweaked a couple
of other models in that time period.
Then after that,when you had the Biden administration,
and Adam Boehler came in, you saw CMMI
kind of launch a lot of different models.
They were focused on a bunch of different areas.
We saw some episodic based,some primary care focus, some disease

(39:25):
specific models, basically kind of a
let's just testa lot of different models.
Let's see how they perform.
Let's see if we can find an improvementin quality,
an improvement in expenditures and savingsfor the Medicare trust fund.
And I think you'll see that those models,

(39:48):
as now they've had some evaluation reportsdone, have mixed results.
Some did not save,did not have net savings,
and some did have success,
from an ROI perspective.
I think as we pivot to the current Trump
administration,you're seeing a pivot in strategy.

(40:12):
from CMMI.
We're seeing models getting canceledquicker, we're seeing a shorter
leash, we're seeing ROI take centerstage versus
some of the other initiativesor the other goals that CMMI may have had.
And I think what you're going to seeas we continue in that administration

(40:35):
is very differentthan the first Trump administration,
and that you're going to see moremandatory models, less voluntary.
You're going to see two-sidedrisk happen a lot more.
And I also think you're goingto see this creep into other payers,
meaning how do we test these models thathave been successful that do have an ROI?

(40:56):
How do they impact Medicare Advantageor commercial payers?
And that type of thing.
So, Michael, anyanything to kind of add to that with?
I think I'm just going to
reinforce a point that you made, Stephen,which is you said that
during the Biden administration,a lot of different models were tested.

(41:19):
And even before the Biden administration,
in the first 10 years of CMMI,from 2010 to 2020,
they tested a lot of models to seewhat would work.

The results are (41:32):
CMMI
was supposed to save billions of dollars,
and the headline is they
increased healthcare expenditures
by more than $5 billion, clearlygoing in the wrong direction.
So new administration,new priorities in 2025.

(41:54):
We are done testing.
We are implementing what we know works.
Episodes.
Surgical episodes.
Search.
Things that are mandatory are working,and we need to,
as a government,they say, we need to be pushing forward

(42:14):
with things that are going to save moneyfor the Medicare trust fund and get CMMI
back to its originally stated purpose,
which was to improve the healthof Americans and do so more efficiently.
I think both of those are great insightsand just want to pick up on threads
that both of you pulled.
So, you know, Michael,you talked about the Innovation Center

(42:34):
sort of mission and mandateand the way I've thought about
because the Trump administration came inand canceled a number of models,
or the new Trump administrationcanceled a number of models.
And, you know, as you thinkabout the original sort of thinking
on the Innovation Center, it was to, quoteunquote, “let a thousand flowers bloom.”
Well, to your point,they're now pruning the garden.
And then to Stephen’s point about Trump

(42:57):
one and canceling the mandatory
EPM model
and then also dialing backon the mandatory piece of CJR.
I think a lot of people post-electionin 2024 read that as TEAM was also going
to get canceled because the administrationhad some issue with mandatory.

(43:18):
And I think that fundamentally misreadthe circumstances around
why both of those models were alteredunder the first Trump administration.
And I think that had more to do withthen at the time, CMS
administrator prices,
preferences for how some of those modelswere rolled out
and who should be involved with them,as opposed to any philosophical bent

(43:39):
by President Trumpor his health policy staff
other than former CMS administrator,or former HHS Secretary Price.
When you think about everythingthat we've just talked about,
what are the implicationsfor healthcare organizations?
Well, I think there's a
realigning
in our government around CMMI priorities.

(44:03):
And clearly, one of the few placesCMMI can influence
decisions is in the hospitaland provider settings.
They're trying to create incentives
or mandates, penalties,to change provider behavior.
I mean, if you really boil itdown, that's it.

(44:25):
And so to the extentthe federal government is going to try
to get CMMI back to its original purpose,save money, improve health,
prune back the garden of flowers
to continue your analogy, Chad,
we're going to see more focused

(44:45):
models and less voluntary participation.
Just a little side note on voluntary:
the same organizations, the same roughly
25 to 35% of hospitals participate
in all of the voluntaryalternative payment models,
and very few of the remaining

(45:07):
participate, very little or not at all.
And that's not achieving the
goals that CMMI was set out to accomplish.
And so the only wayto avoid selection bias
and to truly test improvement in health

(45:28):
is to force providers
into participating in these models.
There
have been a lot of forces overtime, right?
Forcing value-based, purchasing,forcing hospital-acquired condition
penalties or readmission penaltiesand forcing MIPS.
A lot of those models are still in place.

(45:50):
All four of those that I just
mentioned are still in placeat the time of this recording,
but they haven't had the same impactas something like a mandatory
CJR or mandatory TEAM, whichwe'll talk about here in a few minutes.
Yeah.
And I may add to that, you know, I think,
as Michael,you said before, you know, there

(46:13):
historically there's been
chancesfor, call it arbitrage or what have you,
where there are tailwinds to
participating in these models.
What you're going to probably see now,
is CMMI go
less in the innovation spaceand more in the ROI, right?

(46:35):
They are looking at they're probably undera little bit of pressure
to make sure that these savingsare going to be achieved.
And so we're going to go from,and Michael, you and I have talked
about this for years, the perfectand popular test of models.
We're probably going to see models go
from that popular scale to more perfect

(46:58):
in terms of achieving savingsversus being popular with providers.
When we say perfect and popular, though,we really mean
that when there is an optionto participate in something.
Organizations are ...
organizations, like providers,are looking for imperfection.

(47:18):
Imperfections in the model, or loopholes,
or unintended policy gaps,
which are totally legal and appropriate,
are imperfect and drive participation.
The flip side of that is,when you get a perfect model

(47:39):
that has no loopholes,that has no arbitrage, where
you really have to change a bunch of stuff
to either not lose or win.
Those models are not super popular,and you can see that
that evolution comes straight forward

(47:59):
with Bundled Payment for Care ImprovementAdvanced Program, where there were
a lot of arbitrageopportunities and loopholes
in 2018, ‘19 and ’20.
The program was very popular.
At one point, there were,I think, 800 IPPS
hospitals enrolled in BPCI Advance.

That’s our acronym for it (48:21):
BPCI.
And then at the end of ‘20,they closed all those loopholes.
CMMI closed all the loopholes,
and participation, by the end of ’21,was down to a shell of its former self.
Today, with all of those loopholes closed,
there are barely a hundred

(48:44):
hospitals leftparticipating in BPCI Advanced.
Listen, I'm not making a judgment
call of whether it's good or badthat there are or aren't loopholes.
We simply need to acknowledgethat in mandatory models
there is no demand curve.
They have established a demand curveand if you're on that list,

(49:04):
you're participating and the response is,
how do we understand what we're doingtoday?
The deep understanding of policyand the strategies
we can undertake to,you know, win, or not lose.
If we shift our focus to TEAM,the mandatory bundled payment model
that begins on January 1st of 2026,can you give us just a one-minute

(49:28):
overview of the model for those listening,who may not be familiar with it?
Well, team stands for TransformingEpisode Accountability Model,
and it is a five-yearmandatory bundled payment model
that starts in ‘26 and ends in ’30.
Hospitals were selected to participatebased on where they're physically

(49:51):
located, and 700 hospitals were selected
in 188 CBSAs nationwide.
These are surgical bundlesfor five inpatient and outpatient
procedures, including joint replacements,hip and femur fracture treatments,
spinal fusion,cabbage, and major bowel procedures.

(50:13):
They’re 30-day episodes,
and the revenue cycle is not
disrupted,except for once a year when Medicare pays
the gains or recoupsthe losses from the hospital.
The first year is upside only.
But after the first year,a majority of hospitals will bear

(50:34):
risk on 20% of the episode costs.
Call that like 5 to $6000, on average,
potential loss over the
total case count.
Organizationsthat are in TEAM can still participate
in other alternative payment modelslike a Medicare ACO.

(50:55):
And there are requirements.
Think of these like enhancedconditions of participation in Medicare
that don't have financial bearing, but
simply must be done for these hospitals,
for all TEAM patients,or risk other types of penalties.
And if I'm a hospital that's been draftedinto it, into TEAM, how do I prepare?

(51:18):
Yeah, it's a
questionthat we're getting a lot right now.
And there probably is a couple of
initial considerations there.
One would be
understand the methodology.
Education to your stakeholders on
what's included, what's not included,

(51:40):
how do expenditures get calculated,how do target prices get set?
And really, what's our exposure?
So, how many of these patients dowe have coming in the door?
What are the market conditionsthat may change as we go into 2026?
And how do we perform from a expenditureversus

(52:00):
benchmark perspectivein these particular episodes.
So that may be at the 10,000-foot level.
If you go down a little bitand you determine that you are
performing poorlyor have opportunities for improvement,
if you project that you may lose money orhave to pay back CMS in a downside year,

(52:26):
figuring out why that is.
So we know that there'sa number of primary key
performance indicators that are goingto drive performance in this model.
If we can get in front of those right nowand start to implement
the correct strategies, then by the timewe're looking at two-sided risk,
we're going to be in a great positionto impact our performance.

(52:50):
Stephen, you just mentionedkey performance indicators.
And you're absolutely right.
Those KPIs are great proxiesfor performance.
I just want to comment that those KPIsare not
traditional hospital KPIs.
They are not hospital contribution margin.
They are not hospital length of stay.

(53:11):
They're not cost of the implant that
you put in a hip or kneereplacement patient.
They are how many patients doyou send to inpatient rehab?
How long do patients stay inskilled nursing?
If they get readmitted, to whom do theyget readmitted and for what reason?

(53:31):
And how long do they stay?
So, these are things that requireadditional data sets,
additional insights that most hospitals
don't have in their traditional
hospital patientfinancial accounting systems.
Yeah. Great point, Michael.
And maybe just to actuallyput a put a figure to that,

(53:54):
you know, these particular surgeries,
you're looking at anywherefrom 25 to 60% of these bundles
or these 30-day expenditures being outside
of the four walls of the hospitalthat does the surgery.
So that is at a premium as well.
And just to pick up on one of the pointsabout the data.

(54:16):
I mean, these are large data sets that
are hard to manipulate.
So, unless you've got expertisein doing it, it's
not something that you do offthe side of your desk on a Tuesday,
because you've got the timeand you need to figure it out.
If you're an organizationthat hasn't started preparing
and you've been drafted,is it too late to get your ducks in a row

(54:36):
for 1/1/26?
It's not too late.
Certainly not too late.
But I think the time to act is now.
And it's because this is not a flipthe switch type of activity.
I use examples all the timewhere it takes 100
things to go right, for TEAM to succeed.

(55:00):
And that's everythingfrom discharge planning and registration
and surgeons and
anesthesiologists and, and, and
the list goes on.
It takes a lot of coordination activity
that isn't part of a hospital'stypical day to day for TEAM to go right.
And so,the more time you give yourself to make

(55:23):
the plans and implementthe strategies, the better.
With that said,
some of the thingsthat are causing organizations
the most headaches are clearly the datawhich we've talked about,
but also these model requirements.
When we say model requirements,
we mean primarily three things.

(55:45):
Every TEAM patient must be screenedfor health-related social needs.
Every TEAM beneficiary must receivenotification that he or she is
in the TEAM model, or may be in the TEAMmodel before they leave the hospital.
And most of all, the third of three, isthat patients must receive a referral

(56:07):
to primary care before discharge,and that one particular
is causing a lot of concernand consternation
among the hospitalswith whom we're working,
because it's simply not built into today'swork processes.
So to come back to your questionis it too late?
Of course not.
But every day that passes is one fewer day

(56:29):
to even meet the most basicelementary requirements,
not even to mention the opportunitiesyou have to improve
the financial performance.
Well,and because of the design of the model
and the benchmarks or target pricesfor each of the episodes,
it's incredibly important to performwell in the early years.

(56:51):
Can you share a little bitabout why that is?
Yeah. Happy to.
So, as you mentioned,
these benchmarks,which is the kind of denominator
that you're going to be compared to, inthese models is based
at your census region level,which is a handful of states.

(57:12):
I believe there's nine of these censusregions and essentially
every patient with the same
diagnosis or same surgery,
in those census regions is going to start
at the same target price.
Of course,they're going to be adjusted for patient
characteristicsand things like that and patient acuity.

(57:35):
But, that being the case,
there is a pace of change element to this.
They're going to continue to rebase thosetarget prices each year of the model.
So if your performance is getting better,but it's getting better at a slower rate
than the other providers in your region,
you're going to face some headwindsif you will, as the model goes on.

(57:59):
So, you're going to see
maybe targets get a little more aggressiveand that type of thing.
The other thing to consider there is,and this is,
I think, a really important pointthat we've come to emphasize a lot is,
when we talk about all the providers
in your region,we're not only talking about the 750

(58:20):
or so that got picked for this model,we're talking about all IPPS hospitals.
So you are actually comparedto all of those hospitals,
even if they're not participating.
So it's bigger in size,it has a more macro-level consideration.
And it's also going to

(58:40):
emphasizeeven more the importance of pace
of change in your expenditure patternsand performance.
Yeah, it's it's a little bitlike the old hiking joke.
You don't have to outrun the bear,
but you do have to outrunat least one of your hiking companions.
You know, you guys have both alluded to itwith 60% of the spend
happening outside of the four wallsof the hospitals.

(59:02):
Clearly, TEAM is going to impactother providers.
Can you talk a little bit
about what that means for post-acutecare providers and TEAM markets?
Well, when we say post-acute careproviders, I just want to be more specific
that we're talking about Part A billing
rehab providers.
So that's home healthcare agencies,skilled nursing facilities,

(59:27):
inpatient rehab and LTAC,
which is a long-term acute care hospital.
So when we talk about those, somemight also throw in outpatient therapy
to that bucket, those post-acute providers
that provide services to TEAM patients.
The expense that Medicare bearson those providers for TEAM patients

(59:52):
are, in effect, being paid by the hospitalall through TEAM right?
We’re not changing revenue cycle,but we're talking about every dollar paid
to any other provider is not a $1
that comes back in gains to the hospital,
or becomes a penalty to the hospital.

(01:00:15):
With that said,if you are representing a post-acute care
provider and listening to this podcast,
my recommendation is to call the hospital
where a lot of your referrals come from
to talk about their preparations for TEAM,
understand where you sit
in their historical performance and volume

(01:00:39):
and costliness and quality resultsthat they're looking at.
All the things that matter to
that TEAMhospital that you can help influence.
And the last point here on post-acutecare providers is
there are many TEAM hospitalsthat also own post-acute assets.

(01:01:01):
And when you discharge to a post-acuteasset that you own,
this is ...
this gets to simple, yetcomplicated financial mathematics.
And so those these have beenpretty sensitive financial and strategic
discussions with the hospitals with whomwe're working, around how do we not

(01:01:23):
cut off our nose to spite our facewith the post-acute assets that we own?
All that said, I can't shy awayfrom the fact that post-acute providers
should prepare for a change
with TEAM patients come ‘26.
Well, and Michael,just to add to that, as you said before,

(01:01:46):
just as hospitals should understandtheir performance,
post-acute care providers,while they don't bear direct risk,
need to understandhow they're contributing
to those mandatedhospitals performance in TEAM.
Also looking
at, hey, how much volumeare we looking at?
How many of these patients arewe caring for in our post-acute setting?

(01:02:09):
And what is our value proposition?
How do we fare in outcomesand those primary key
performance indicatorsthat we talked about before?
So, just as much as the hospitalsare preparing to bear that direct
financial risk, these post-acute providersare going to have some indirect
contribution to that performance.

(01:02:33):
You know,I think those are great insights,
particularly for our post-acute providersthat are listening.
You know, when you think about
there are a lot of hospitalsthat were not selected for TEAM.
How should they be thinking about
TEAM and episodes in general,given that they might be next?
Well, I'll jump in here because,
episodes and hospitals go together.

(01:02:57):
That's been, I don’t want to sayproven over time, but hospitals bearing
direct accountability for episodes,
while some might not like it,there is a recipe there
that seems to be working in CJRand they believe will work in TEAM.
So with that said,I think hospitals that weren't selected,

(01:03:18):
if you represent one of the 23or 2400 IPPS
hospitals out therethat was spared from TEAM,
don't rest
on your laurels for too long,because if this works,
Medicare will expand TEAM
to more surgical types and more hospitals.

(01:03:40):
CJR has already laidthe groundwork for that.
CJR is the Comprehensive Carefor Joint Replacement model,
which was the precursor to TEAM.
CJR started with 300 hospitals
and now TEAM has more than 700.
So it's only a matter of timebefore the right

(01:04:02):
policy gets expanded to more hospitals.
And what can you do about it?
Like, how can you prepare?
A lot of hospitals are participating
in Medicare ACOs,and if you're one of those, you ought
to be looking at the episodic datathat Medicare is giving you.
They call it shadow bundle data.

(01:04:23):
It's really richand really valuable information.
The data doesn't necessarily reflect
all of the hospital’spatients based on the attributed provider.
But, this is a great starting
point to get datato understand your performance,
to make strategies,to be prepared for the future.

(01:04:44):
I think this maybe like leadsto the ultimate question.
Chad, is what do we need to do to prepare?
Whether we're in TEAM,not in TEAM, like bundles,
don't like bundles, have startedpreparing, have it prepared.
Like,it doesn't matter what the scenario is.
What do you need to do today?
And I would simply lead with three simplesteps.

(01:05:08):
Step one, understand your history.
The reality is history can't be found inyour patient financial accounting system.
It needs a different data set and adifferent set of data manipulation talent.
Second, you need to create a planto make the future different than the past
or to lock in that pastso that it doesn't regress in the future.

(01:05:33):
And third, you need to have some wayto continually monitor that performance
so that you'renot taking your eye off the ball.
We know the atrophy that happens
when you don't practicesomething regularly.
When you don't practice episodes, skills

(01:05:54):
all the time, they will
regress in a matter of weeks or months,not years.
Perfect. You know.
We have talked a lotabout the value-based care space,
but what else haven't we covered thatyou think our listeners should know?
Chad, I feel likewe covered a lot of stuff today, but
I guess I would leave the listenerswith this

(01:06:16):
that value-based care is bipartisanand is here to stay.
I cannot imagine a scenario,
barring overhaul
of the Medicare systemand the way healthcare is paid
for in America, where value-based caredoesn't continue to grow.

(01:06:38):
The past has shown that.
The number of two-sided risk arrangements
has doubled in the last seven years.
So I just have to believe value-basedcare is going to continue to grow.
And so, if you're listening to thisand you think
value-based care is not somethingwe're good at today,
it's not a big part of our revenueportfolio today, we can afford to wait.

(01:07:04):
You may be right,but that won't be the answer forever.
Value-based care, alternative paymentmodels, pop health, goes
by lots of different names,but it is here to stay
and it is a capability and competency
that is related to hospital operations.
But it is not hospital operations.

(01:07:24):
It requiresa different set of capabilities.
Michael.
Stephen, thank you again for joining metoday and sharing your insights.
Certainly always learn somethingfrom these conversations with you guys.
I also want to thank our listenersfor tuning in.
If you'd like to learn more about TEAMand other value-based care models,

(01:07:45):
we have links to some of our articlesthat are related in the show notes.
I hope you'll join me in two weeksfor the next episode of Achieving Health.
Till then, hope everybody stays well.
You can follow
Achieving Healthon your favorite podcast platform or visit
forvismazars.us/AchievingHealthPodcastto learn more.

(01:08:05):
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