"Watching" your TEAM numbers isn't a strategy — it's waiting for a repayment demand. Mandatory participation means every decision made within an episode, from the first incision to 30 days post-discharge, now carries direct financial risk. And the infrastructure to manage that risk takes at least a year to build.
The hospitals that will earn shared savings in 2027 aren't waiting. They're building.
Managing risk under the new Transforming Episode Accountability Model (TEAM) requires hospitals to look beyond the four walls of the operating room. The hospital is the primary accountable entity and bears 100% of the risk for total cost of care, including post-acute utilization, complications, and readmissions. For most CFOs and COOs, that means owning costs they can't yet see. By the time claims data arrives, the readmission has already happened and the shared savings window has already closed.
As Dr. Michael Meneghini, CEO of Indiana Joint Replacement Institute and 2025 AAHKS President, put it:
"Hospitals have no idea where their costs are going. To really understand your cost to manage risk is very challenging — it takes a lot of time, effort, money, and people."
The tools most programs are relying on can't close that gap. Claims lag 60–90 days. Phone calls are subjective. CMS data can't be translated into operational action fast enough to prevent a readmission. Under TEAM, 2/3 of hospitals are projected to lose an average of $1,350 per episode under current spending patterns. In 2027, 20% of target reimbursement goes at risk.
To manage this risk effectively, health systems need to focus on two key levers:
Control post-acute spend. Most episode cost variance lives in the post-discharge phase. Without objective recovery data, care teams default to caution. Unnecessary inpatient rehabilitation facility (IRF) admissions, avoidable readmissions, and missed intervention windows are where TEAM margins are lost.
Protect patient reported quality scores. Quality outcomes determine whether shared savings are earned or lost. Automated collection of Patient-Reported Outcome Measures (PROMs) at CMS-required intervals is essential — missing data at the threshold is a direct path to reimbursement loss.
What these levers have in common is they require real-time visibility into what's happening after discharge. That visibility is what most programs are currently missing.
Falls are one of the strongest predictors of avoidable readmissions. A single fall-related readmission can eliminate any potential for shared savings in an episode. And the clinical reality is that patients often report feeling "fine" even when their gait metrics show dangerous compensation patterns or instability.
The signal exists. Most hospitals just aren't capturing it.
The 0.1 m/s metric. A drop of just 0.1 m/s in gait speed correlates to a 10% higher readmission risk and a 7% higher fall risk. OneStep surfaces this signal 10–14 days before a clinical event — enough time to reassess therapy, adjust a care plan, or make a proactive call before the complication escalates.
Objective over subjective. Patients who say they feel fine and patients who are recovering well are not always the same patients. OneStep is 4x more accurate than standard fall risk assessment methods at identifying patients at elevated risk because it measures how a patient actually moves at home, not solely how they perform in a controlled clinical setting.
Proactive intervention. When a care coordinator receives a Walk Score alert, the response is likely a telehealth visit or an adjusted therapy protocol, not an ER admission. The cost of a telehealth intervention is a fraction of the cost of a readmission penalty. The cost of a readmission penalty is a fraction of the cost of losing shared savings eligibility entirely.
This is not a new workflow. It improves the timing and targeting of the care coordination that already exists. Care coordinators stop calling every patient and start acting on the ones whose data says they need attention.
The TEAM model cannot be managed with retrospective data. By the time the claims arrive, the costs are already incurred.
To protect margins and achieve shared savings, health systems need a proactive care model built around the primary drivers of cost: post-acute spend, readmissions, and functional decline. OneStep closes the 30-day blind spot with a daily Walk Score for every patient, captured from their own smartphone, delivered to care teams.
2026 is the practice year. The bills will come due in 2027. The hospitals that build the infrastructure now will be the ones with shared savings then.