Claims & Episode Data Integration
Preparing claims and related datasets required to construct CMS TEAM episodes accurately.
The CMS Transforming Episode Accountability Model (TEAM) introduces new requirements for episode construction, attribution, and risk analysis.
While the logic is well-defined, operationalizing it consistently is challenging.
Organizations often struggle with:
As a result, CMS TEAM analytics efforts can become fragile, manual, and difficult to scale.
Enabling CMS TEAM risk analytics is a data engineering and analytics enablement challenge, not an actuarial one.
This use case typically involves the ability to:
When done correctly, CMS TEAM analytics become operationally reliable and defensible.
We approach CMS TEAM enablement by focusing on data integrity, deterministic logic, and traceability, while respecting actuarial and regulatory boundaries.
Our typical approach includes:
Preparing claims and related datasets required to construct CMS TEAM episodes accurately.
Operationalizing episode timelines and rules in alignment with CMS TEAM definitions and guidance.
Designing repeatable analytics workflows that support utilization, risk, and cost analysis at the episode level.
Ensuring analytics outputs can be traced back to source data and episode logic for review and validation.
This approach allows CMS TEAM analytics to be consistent, explainable, and scalable.
In the walkthrough, you’ll see a simulated visual demonstration of how CMS TEAM risk analytics enablement typically works. The walkthrough focuses on enablement patterns and data workflows, not actuarial decision-making.
Get a short walkthrough showing how care gap management and care plan workflows can be enabled using interoperable data, analytics, and automation.