Dr. Thomas Tsai, Associate Professor of Surgery at Harvard Medical School and Medical Director of Health Policy Research at the American College of Surgeons, joins The Surgical Journey to discuss what it actually takes to redesign surgical care around where patients recover today.

Drawing on his work leading the first randomized controlled trial of home hospital for surgical patients at Brigham and Women's Hospital, and an enhanced recovery initiative that achieved same-day discharge rates above 90 percent for bariatric surgery, Tsai makes the case that better outcomes require more coordination, not less, and that the infrastructure most hospitals rely on was built for the team, not the patient.

He addresses the counterintuitive reality of CMS TEAM: that reducing utilization requires more effort and more investment, not less. And he lays out what it takes to move a protocol from pilot to sustained execution at scale, including a year-long culture and buy-in effort that he describes as the real secret sauce.

Topics covered include pre-habilitation, workflow redesign, gain-sharing under bundled payment, patient-reported outcomes, and the growing gap between where care happens and where the infrastructure to support it currently exists.

EPISODE CONTENTS

00:00 Introduction and guest background

02:22 Redesigning surgical workflow around the patient, not the team

03:35 Why clinical workflows are built for the medical team, not the patient

05:02 Team-based and technology-enabled approaches to home recovery

08:24 How bundled payment models align incentives across the episode

09:55 Pre-habilitation and setting shared expectations before surgery

11:18 The counterintuitive reality: less utilization requires more effort

12:55 Achieving 90 percent same-day discharge for bariatric surgery

14:55 The year-long culture and buy-in effort behind protocol adoption

16:20 What it takes for digital health tools to move beyond a pilot

19:20 Redesigning the full surgical patient journey end to end

21:18 The burden of recovery shifts to patients and caregivers at discharge

23:24 Patient connection to the surgical team does not end at discharge

24:10 Patient-reported outcomes and the future of post-acute measurement

What happens when bundled payments stop being optional?

In this episode of The Surgical Journey, host Lisa Miller sits down with Dr. David Shulkin, the 9th Secretary of the U.S. Department of Veterans Affairs and former health system CEO, to examine the implications of CMS's new mandatory bundled payment program: TEAM (Transforming Episode Accountability Model).

Beginning in 2026, 780 hospitals will be required to participate in TEAM, a Medicare value-based care model that ties hospital reimbursement to outcomes across the full surgical episode — including the 30 days after discharge.

Dr. Shulkin explains why this shift from voluntary to mandatory bundled payments could fundamentally change how hospitals manage surgical care, why many health systems are unprepared for episode-based accountability, and where the greatest clinical and financial risk actually occurs after surgery.

The conversation explores the future of value-based reimbursement, surgical episode management, Medicare payment reform, and the operational challenges hospitals face when managing outcomes beyond their walls.

If you work in hospital leadership, surgical care, bundled payments, value-based care strategy, or healthcare policy, this episode provides a clear view into how mandatory episode accountability may reshape the economics of surgery in the United States.

EPISODE CONTENTS

00:00 — Introduction to The Surgical Journey Overview of the podcast and its focus on improving surgical outcomes through better coordination, communication, and data.

00:51 — Introducing Dr. David Shulkin Background on the former VA Secretary and his leadership experience across health systems and federal healthcare policy.

04:30 — Shulkin's Path from Physician to Health System Leader How clinical training led to executive roles in major health systems and eventually national healthcare leadership.

08:45 — The Evolution of Value-Based Care in the U.S. Why payment reform has progressed slowly and what structural barriers health systems face.

13:50 — Why Bundled Payments Emerged in Surgical Care The rationale behind episode-based payment models and their role in aligning incentives across the surgical journey.

18:35 — CMS TEAM and the Shift to Mandatory Participation 780 hospitals received notice that they will participate beginning in 2026, marking a departure from voluntary bundle programs.

19:30 — Why TEAM Matters Financially Procedures included in TEAM can represent 15–20% of hospital revenue, making performance under the program financially significant.

19:42 — Are Hospitals Ready? Shulkin argues that many hospitals are not operationally prepared to manage surgical episodes under mandatory accountability.

23:10 — Managing Outcomes Beyond the Hospital Walls Why the post-discharge recovery period represents the highest risk for complications, readmissions, and episode costs.

26:00 — What Hospitals Must Do Differently How health systems will need to rethink care coordination and episode management to succeed under TEAM.

In this episode of The Surgical Journey, NovaNav Chief Strategy Officer Lisa Miller sits down with Dr. Albert Hakaim, pioneering vascular and endovascular surgeon and one of the foundational surgical leaders at Mayo Clinic Florida, to discuss what truly drives outcomes after a patient leaves the hospital.

Drawing from decades of surgical leadership, Dr. Hakaim shares practical insights on post-discharge risk, why many recovery issues are invisible in traditional quality metrics, and how health systems can reduce avoidable readmissions through better communication, triage, and standardization across teams.

The conversation explores why aligning surgeons on consistent readmission criteria is harder than most people realize, and why patient experience is often shaped by one simple factor: how quickly questions get answered after discharge.

Key topics include:

• Post-op follow-up calls and why proactive outreach matters

• The hidden drivers of readmissions across surgical specialties

• CABG recovery and why anxiety and uncertainty increase ER utilization

• The tradeoff between length of stay vs readmission costs

• How technology, wearables, and automation can improve triage without adding staff burden

• Lessons from home-based recovery and the patient experience

EPISODE CONTENTS

0:00 NovaNav Introduction

0:54 Guest Introduction: Dr. Albert Hakaim

2:26 Decisions with the biggest positive impact on outcomes

3:28 Automating triage to reduce communication delays and readmissions

4:24 Streamlining post-operative care coordination support amidst workforce challenges

7:25 Patterns in post-discharge struggles that traditional metrics miss

10:21 Cross-team alignment: creating uniform readmission criteria

12:02 CABG readmissions and post-discharge variability in care

16:02 Longer length of stay vs readmission risk: what actually costs more under CMS TEAM

16:59 Managing accountability, data, and outliers across divisions

22:50 Episode wrap-up

In this episode of The Surgical Journey, NovaNav Chief Strategy Officer Lisa Miller interviews Dr. Hans Van Lancker, Chair of Orthopedics (and Bone & Joint services) at Cambridge Health Alliance and an orthopedic trauma surgeon, for a practical conversation on what CMS's TEAM model is changing in orthopedics and post-acute care.

Dr. Van Lancker explains why success under CMS TEAM must be measured across the full episode of care, not just surgical performance, and why the highest-cost and highest-risk portion of the bundle often occurs after discharge. He discusses the challenge of accountability when surgeons and hospitals are financially responsible for outcomes that depend heavily on post-acute settings, care coordination, and patient adherence.

The conversation also explores the future of home recovery, including how health systems can reduce post-operative variability, strengthen patient advocacy, and build workflows that help patients and caregivers succeed at home. Dr. Van Lancker shares why nurse navigation, standardized education, and real-time patient visibility are critical, and how technology can support recovery without increasing clinician cognitive burden.

The episode highlights the role of digital care pathways, patient-reported outcomes, and "top-of-license" work as healthcare organizations adapt to value-based care and new CMS reimbursement models.

EPISODE CONTENTS

0:00 Introduction to NovaNav

1:10 Guest Introduction: Dr. Hans Van Lancker

5:10 Orthopedics under CMS TEAM: defining success across the full episode of care

10:59 CMS TEAM care coordination: aligning the team beyond the surgeon and reducing post-op variability

14:02 Home care and workflows that mimic patient advocacy

17:45 Building a culture around patient advocacy

19:16 Post-op home care: supporting caregivers and increasing patient confidence with technology

23:10 Using technology to free up time for top-of-license work

27:55 Episode wrap-up

In this episode of The Surgical Journey, NovaNav Chief Strategy Officer Lisa Miller speaks with Dr. Robert Hymes, Chairman of Orthopedic Surgery at Inova Fairfax Medical Center and a fellowship-trained orthopedic trauma surgeon, about the impact of CMS's TEAM model on orthopedic departments in 2026.

Dr. Hymes shares how the shift from "excellent surgery" to total episode accountability is reshaping day-to-day leadership, requiring orthopedic teams to own not just the procedure, but 30 days of outcomes and spend. He explains why the biggest risk under TEAM is failing to redesign post-discharge recovery, especially discharge disposition, patient engagement, readmissions, and complications.

The conversation explores the cultural shifts required for success, including aligning surgeons, reducing variation, and rounding as a true multidisciplinary team. Dr. Hymes also introduces a powerful concept for measuring navigation effectiveness: events avoided, not just calls made.

Finally, he discusses the role of technology in the TEAM era and why the best solutions must function as a quiet, scalable early-warning system that supports navigators and care teams without increasing clinician cognitive burden.

EPISODE CONTENTS

0:00 Introduction to Nova Nav

1:06 Guest introduction: Dr. Robert Hymes

2:05 CMS TEAMS overview

7:30 Post-discharge accountability in CMS TEAMS

13:04 Cultural shifts required for CMS TEAMS success

18:21 Reframing outcomes through events avoided

21:44 The importance of care navigation

23:20 How to succeed with CMS in 2026

25:15 The role of technology in CMS TEAMS

28:30 Episode wrap-up

In this episode of The Surgical Journey, NovaNav Chief Strategy Officer Lisa Miller sits down with Dr. Mohammed Quadri, VP of Strategy for Academics, Research, and Innovation at Hackensack Meridian Health, for a practical conversation on where AI is truly delivering value in health systems today.

Dr. Quadri introduces a clear framework for evaluating AI solutions through a continuity of care model, centered on information continuity, workflow continuity, and relational continuity. He shares where AI is already reducing operational burden, including ambient clinical documentation, revenue cycle automation, and the emerging opportunity in perioperative care coordination.

The conversation also explores why many AI initiatives fail to scale, and what conditions must be in place for measurable results, including problem clarity, workflow redesign, data readiness, clinician buy-in, and rapid deployment.

Finally, Dr. Quadri breaks down why CMS's new TEAM model is changing the stakes for perioperative performance, and why AI-enabled coordination across the full 30-day episode is becoming essential for hospitals to reduce cancellations, prevent readmissions, and improve patient experience.

EPISODE CONTENTS

0:00 NovaNav Introduction

1:00 Guest introduction: Dr Mohammed Quadri

2:50 Reducing operational burden with AI via a Transdisciplinary Model of Care: Information, Management and Relationships.

7:02 CMS TEAMS emphasis on technology

8:40 Delivering measurable operational value with AI. Workflow and behavior obstacles can outweigh technology advances. Bridging the gap with outcome-oriented use of AI and data.

14:13 Data quality and readiness. Preparedness is key.

16:50 Innovation pilots and scale deployments: Achieving operational reality via pilot-proven scale.

20:50 Balancing governance and speed of adoption, especially with the speed AI is moving.

22:58 Framing the value of AI in healthcare. "Soft costs" and compounding value.

27:50 Measuring "prevented" metrics such as Avoidable Readmissions

29:09 CMS TEAMS: Opportunities in technology and AI for 30 days post op

30:20 CMS TEAMS overview

32:00 Where AI creates value under CMS TEAMS

37:20 Discussion of AI tools

39:10 Wrap-up

In this episode of The Surgical Journey, host Lisa T. Miller speaks with Dr. Alexander Itskovitch, a hepatobiliary surgeon and Medical Director of the Statesford Cancer Center at Atlantic Health in New Jersey.

Dr. Itskovitch shares a clinician's perspective on why digital health solutions succeed or fail in real-world healthcare settings. The conversation explores the importance of physician involvement in technology design, the challenges of workflow integration, and why clinician buy-in is essential beyond pilot programs.

Together, they discuss workforce shortages, perioperative risk, and how digital platforms and AI can help reduce administrative burden, improve readiness before surgery, and enable earlier recognition of post-operative complications. The episode also looks ahead to the role of virtual hospitals, payer incentives, and how better data and communication can improve outcomes for patients while reducing system-wide costs.

This episode offers a grounded, practical look at how digital health can support safer, more effective surgical care when thoughtfully integrated into clinical workflows.

EPISODE CONTENTS

0:00 NovaNav Introduction

1:02 Guest Introduction: Dr. Alex Itskovitch

2:30 Why clinicians must be engaged in technology conversations

3:54 Technology solutions for workforce challenges

5:44 CMS TEAM: 30-day post-discharge accountability

11:04 Pre-op decision-making that impacts outcomes

15:45 The role of AI in healthcare today

18:08 Surgeon comfort and trust in AI

20:28 The future (and present) of virtual hospitals

23:24 Managed care payer adoption and incentivizing better outcomes

25:37 Episode wrap-up

The Surgical Journey is a podcast about making surgical care work better—for patients and for the teams who care for them.

Hosted by Amit Kirpalani, Founder and CEO of NovaNav, the podcast explores what truly shapes surgical outcomes, from preoperative readiness to recovery at home. Each mini-series focuses on a specific part of the perioperative journey, highlighting the role of clearer communication, better visibility, and smarter use of data in improving surgical care.

Through conversations with clinicians, administrators, and technology leaders, The Surgical Journey examines how surgical care is evolving and what it takes to make it more effective, manageable, and patient-centered.

This trailer offers a preview of the perspectives, themes, and voices you'll hear throughout the series.

Join us on The Surgical Journey.

In this launch episode of The Surgical Journey, host Lisa T. Miller sits down with Amrit Kirpalani, Founder and CEO of NovaNav, to explore what truly shapes the surgical care experience for patients and care teams.

Amrit shares the personal story that led to the creation of NovaNav, inspired by his mother's knee replacement surgery and the fragmented, paper-heavy perioperative process many patients face. The conversation dives into where surgical care commonly breaks down: before surgery, after discharge, and in the critical moments in between.

Together, Lisa and Amrit discuss patient anxiety, variability across health systems, the burden on clinical staff, and why consistency and clear communication are so difficult to achieve in complex surgical environments. They also explore how data, technology, and AI can help reduce administrative workload, support better decision-making, and allow care teams to focus more on patient care.

This episode sets the foundation for our podcast series, offering listeners a thoughtful look at the challenges, opportunities, and future of perioperative care.

Episode Contents

0:00 NovaNav Introduction 1:00 Guest Introduction: Amrit Kirpalani, CEO and Founder 2:30 The catalyst behind creating NovaNav 7:05 Fragmented care and common patient friction points 12:44 Beyond intraoperative excellence: pre-op and post-op opportunities to reduce clinical and financial risk 18:00 Pre-op actions that improve post-discharge outcomes 20:36 Change management: introducing a new model within health systems 25:44 NovaNav Use Case: pre-op interventions to reduce readmissions 29:24 Why patients adopt technology that makes their lives easier 31:24 30-day readmission use cases 33:33 The role of AI in healthcare in 2026 38:35 Wrap-up