Understanding Shared Savings in TEAM and CJR-X: How to Build a Gainsharing Arrangement That Holds Up
Published by APM Connect 10/1/2026
TEAM hospitals move into downside risk in January, and CJR-X is on the way. The surgeons already know gainsharing is allowed, and many are asking for it. Kevin Lieb of Physician Alignment Solutions and Candice Morton of UNC Health walked APM Connect members through what it takes to put a shared savings arrangement in place: the legal structure, how the money flows, how to pick collaborators, and where programs get stuck.
What we covered:
A shared savings arrangement is a legal agreement between the hospital and its collaborators. Internal counsel, and often outside counsel, need to be at the table, and independent physicians may bring their own lawyers. Multi-group negotiations can take up to nine months.
Every payment has to be tied to quality. Choosing metrics that the data can support at the individual physician level takes longer than most teams expect. UNC agreed on four metrics and still cannot pull two of them consistently.
There is nothing to share without a positive net reconciliation. In TEAM, all five episodes net together, so losses in one episode can wipe out savings from total joints. Kevin recommends taking program costs off the top, then funding specialty pools, then distributing on quality-weighted activity such as Part B work RVUs, not raw volume.
Keep a reserve and put claw back language in every agreement in case CMS recalculates the reconciliation and you end up owing money later.
Internal cost savings programs can run alongside shared savings and cover all payers, but only on hard invoice costs with every case included.
Data analytics was the biggest operational barrier named by both presenters.
The full session, including audience questions on reserve accounts, internal versus vendor analytics, and which TEAM episode is hardest to engage surgeons on, is here: VIDEO & SLIDES
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APM Connect is where hospitals, health systems, physicians and ACOs work through the CMS mandatory models together, across TEAM Connect, ASM Connect, and CJR-X Connect communities.
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