742 hospitals enter two-sided Medicare financial risk on Jan 1, 2027. The industry built to help them was acquired by UnitedHealth, CVS, and Aetna - and repurposed for Medicare Advantage. The vacancy is real and the deadline is fixed.
Optum projects a majority of mandatory TEAM participants will lose money averaging $1.2M per facility. The reconciliation reports land in early 2028 - after hospitals are already deep into year two of real downside.
The old convener companies (Remedy, naviHealth, Archway) worked. They just got absorbed by payers who needed post-acute utilization management for their own members, not hospital-facing episode operators.
The resulting business: a tech-enabled episode company that manages the 30-day post-discharge window, runs gainsharing, improves target prices through documentation, and sells downside protection backed by its own balance sheet.
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