Built for Hospitals Navigating TEAM and Beyond

Outperform bundled payment targets, reduce readmissions, and improve post-acute navigation—without new hires or workflow disruptions.

Post-Acute
Care Challenges Rising

Hospitals across the country are facing unprecedented pressure, including:

CMS-mandated participation in TEAM, with strict timelines and complex reporting requirements

Overburdened case managers, often managing 30–40+ patients per nurse

Limited visibility into post-discharge performance, length-of-stay (LOS) variation, and discharge disposition

Manual workflows and underdeveloped analytics infrastructure

Full episode risk, including skilled nursing, inpatient rehab, home health aide (HHA), outpatient care, and readmissions

Misaligned incentives between hospitals, post-acute care (PAC) teams, and surgical teams

Fragmented post-acute networks and wide variation in cost and outcomes

High-stakes financial penalties tied to compliance and performance shortfalls

Siloed communication across inpatient, outpatient, and post-acute teams

TEAM isn’t optional. Hospitals must now oversee the entire 30-day surgical episode, including transitions and coordination.

What Deacon Delivers

Deacon brings the infrastructure, team, and tech hospitals need to succeed under TEAM.

Risk-Ready
Partnership

We share downside risk and offer a predictable per-episode cost structure. Our evidence-based approach supports long-term sustainability and compliance.

Turnkey Care
Navigation

24/7 care navigators guide patients from pre-op through the entire episode of care—no new hires required. We extend your case management team and offload care coordination complexity.

Surgeon and
PAC Alignment

We work alongside your teams and discharge planners to reduce variation, limit out-of-network discharges, and build unified care pathways.

Real-Time Data +
Actionable Insights

We integrate directly with your workflow and give you visibility across the full continuum.

Track every step of the episode:

Readmission risk
PAC utilization and LOS
Follow-up appointments and rehab adherence

Results That Matter

Deacon’s platform and clinical model produces measurable results:

4%

30-day readmission rate (vs. 10–15% national average)

13.5%

average mean-loss-ratio (MLR) reduction

$120M+

in Medicare savings delivered across 50,000+ episodes

85%

of post-surgical patients regain full mobility within 6 months

95%

follow-up visit compliance

91%

patient satisfaction

Our Solution

Deacon’s TEAM Method combines high-touch clinical navigation with real-time analytics to:

Triage high-risk patients
before complications arise

T

Engage patients early with guided support and clear follow-up

E

Align hospital, PCP, and PAC teams with shared insights

A

Manage the entire recovery journey, from inpatient through 90-day follow-up

M

TEAMWell

Transforming Episode Accountability Model

Patient Journey:
James, 65+, retired construction worker

Condition:
Severe knee osteoarthritis requiring total knee replacement.

Challenge:
James suffered from debilitating knee pain, limiting his ability to work and perform daily activities. His biggest concern was post-surgical recovery and its impact on his ability to enjoy retirement.

STEP 1

Referral

James enters the MSK Managed Care program through the acute care hospital system participating in TEAM

STEP 2

Navigator

His nurse navigator helped him prepare for surgery, ensuring he understood the procedure and expectations

STEP 3

Therapy

After surgery, navigators closely monitored his rehabilitation, including physical therapy, medication management, and pain control

STEP 4

Follow-Up

Weekly telephone check-ins ensured he adhered to post-surgical guidelines and addressed any complications early