New AI tools target providers looking to succeed in TEAM demo

November 5, 2025
This article was originally featured in Modern Healthcare. Technology companies and post-acute providers say new artificial intelligence tools could be secret weapons for those in the Transforming Episode Accountability Model to keep patients from bouncing back to the hospital. Some tools flag at-risk patients, while others consolidate and streamline information on patients moving from acute care to post-acute care in TEAM. Software companies and post-acute providers offering the technology say AI could give health systems, nursing homes and home health companies an edge in securing collaborators for TEAM. But the model launches in January and some tools are just hitting the market, making...read more

From Surgery to Recovery: Winning Under TEAM with Real-Time Insights

October 21, 2025
This article was originally featured in Healthcare IT Today. Hospitals are about to take on greater responsibility for patient outcomes—extending well beyond discharge. Beginning January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) will implement the Transforming Episode Accountability Model (TEAM), requiring hospitals to manage care for Medicare patients undergoing the following surgeries: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. Each care episode concludes 30 days after the patient is discharged from the hospital. This shift significantly raises the stakes for acute care providers. Avoidable readmissions...read more

Leading with Impact: The Director of Nursing’s Essential Role in Value-Based Care

September 15, 2025
This article is sponsored by Real Time Medical Systems and was originally featured in Skilled Nursing News. As value-based care (VBC) continues to redefine reimbursement models and quality standards in skilled nursing facilities (SNFs), the Director of Nursing (DON) plays a central role — driving clinical excellence, operational efficiency and financial performance. With hospitals, health plans and VBC programs increasingly viewing SNFs as strategic partners, the DON’s influence is just as vital in broader care discussions as it is within the facility. Lindsey Ford, RN, has seen this leadership first-hand: the SNF DON actively making rounds, engaging with staff and...read more

Why health plans need post-acute directors of nursing as clinical partners in value-based care

August 26, 2025
This article was originally featured in Fierce Healthcare. As the transition to value-based care (VBC) continues to present both opportunities and challenges, post-acute care (PAC) remains a significant cost driver for health plans. Traditionally overseen through administrative channels, it’s increasingly clear that health plans operating in today’s VBC landscape need a more innovative approach to managing post-acute spend – one that leverages a critical, yet often overlooked, clinical partner: the Post-Acute Director of Nursing (DON). DONs represent a largely untapped resource for health plans aiming to improve outcomes and control costs among their most vulnerable member populations. One of the...read more

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