What You Need To Know
Dr. Daniel Varga on how Hackensack Meridian Health is reimagining episode-based care to meet new CMS expectations and deliver better outcomes.
With the launch of the Center for Medicare Services’ new Transforming Episode Accountability Model (TEAM), health systems are being called to redesign care delivery to improve coordination, outcomes and accountability across episodes.
This shift from a traditional fee-for-service model represents not just a regulatory requirement change, but an opportunity to rethink how care teams are built and how they work together to deliver better outcomes.
We sat down with Dr. Daniel Varga, President, Physician Services Division and Chief Physician Executive, to discuss what TEAM means for the future of care delivery and how the organization is preparing its physicians and staff for success through the development of Care Pathways.
Building Blueprints for Care Delivery
At its core, TEAM places shared accountability for care episodes squarely on the shoulders of providers and systems — which means traditional care silos need to come down. To respond effectively, HMH is building standardized Care Pathways that reflect both national best practices and the real-world insights of clinicians across the network.
Joining HMH just before the COVID-19 pandemic, Dr. Varga saw firsthand how care teams can pivot under pressure — and how those lessons can shape smarter, more collaborative care moving forward.
“Now, standardization requires a much more socialized, much more accommodating sort of approach,” Dr. Varga said. “The way I look at it, it’s the obligation of the system, with the appropriate inputs of all the appropriate constituents, to determine what we need to do and why we need to do it.” The Care Pathways approach is prescriptive, said Dr. Varga, but it also emphasizes the need to be nimble and agile — understanding that every hospital, clinic and wellness center is a unique clinical care delivery platform. “The more that we have a high degree of standardization around the majority of the care, the more we’re going to be able to effectively manage the unusual elements of care.” Dr. Varga likens the Care Pathways to a blueprint that standardizes the majority of the “standard work” — like taking daily vital signs and implementing a salt-restricted diet for a patient with congestive heart failure. “That doesn’t require a physician’s thinking,” said Dr. Varga. “We know it’s just standard. The Care Pathway should, in and of itself, encompass almost 100% of standard work.” That standardization, he explains, frees clinicians to focus on special cause variation — the complex, unusual elements of a patient’s condition that require unique expertise. “If the clinician can trust that the Pathway is accommodating those elements of care model design, they can stay focused for special cause variation for when things go off the rails.” Centering Clinicians in the Process
For these new care delivery models to succeed, clinicians can’t just be participants — they need to be partners in the design. Dr. Varga emphasized the importance of involving frontline experts at every stage of building Care Pathways, tapping into the real-world insights of the people who know the work best.
Physicians, nurses and other care team members bring unmatched knowledge of what works — and what gets in the way. By involving them directly in pathway design, we ensure that what’s built reflects the real-word experience of delivering care.
The initial development of these Pathways is strategically focused on the areas where CMS mandates change, including surgical episodes handled by orthopedic and cardiac surgeons. This immediate need serves as a proving ground for creating flexible, standardized models. Dr. Varga stresses that the goal is not to create siloed, one-off models, but to identify common specifications — such as how to manage perioperative diabetes — that can be used across multiple procedures like total hip, knee or colon surgeries.
That feedback loop doesn’t end at the planning table. Using an agile transformation model, Dr. Varga said, leaders can translate clinician insight into real-time adjustments. When providers see their contributions reflected in the systems and workflows they use every day, it builds trust — and it makes it easier to deliver care in a way that feels intuitive, rather than prescriptive.
Innovation and Standardization Go Hand-in-Hand
Dr. Varga sees incredible creativity in how nurses and care teams manage their day-to-day work — finding efficient, resourceful solutions to care for patients in complex and dynamic settings.
"When you look at how they get their work done, it’s amazingly creative and innovative,” he said. “They’ve spent years figuring out how to get from 7 a.m. to 7 p.m. and take the best care they can of their patients.”
That’s why conversations about standardization can sometimes feel daunting — but Dr. Varga sees it differently. When clinicians can trust that standard work is handled efficiently, their innovative energy can be directed toward higher-level problem-solving and patient-centered improvements, rather than just getting through the day.
"I think the takeaway message is that innovation is the ability to identify innovative opportunities and actually execute in that domain. It’s made way easier and effective when you introduce standardization."
The shift toward Care Pathways isn’t just an invitation for innovation — it’s also a way to create a foundation for scalable, tech-enabled care delivery.
It’s a vision that aligns closely with the promise of AI: to automate low-complexity tasks and support smarter clinical workflows — once the foundational work is in place. As the TEAM model reshapes expectations, HMH is leaning into collaboration, building Care Pathways that reflect clinical expertise, frontline realities and a shared commitment to better outcomes.
“If you account for common cause variation, engineer the work, and then automate the engineered workflow, then you’re probably at a place where you’re going to get really good results,” Dr. Varga said. “If we could ever get to that, I’d just be doing somersaults.”
At its core, this work is about elevating the expertise of the people who know care best — and turning their insights into action. The Care Pathways initiative reflects a belief that the most effective solutions are the ones built with clinicians, rather than for them.
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