Supporting value-based care payment models is no longer a question of "when" but "how." By understanding episodes of care, you can treat patients holistically and build value into the care continuum. Tap into claims data to flexibly construct clinical episodes, identify variations and opportunities for improvement, and assess your financial risk in value-based reimbursement agreements.
Start with standard episode definitions.
Construct and analyze claims as clinical episodes of care based on HCI3's standardized definitions, and automatically detect associations between episodes for a holistic patient view.
Manage new payment models (e.g., bundled payments).
Respond to new incentives to provide more efficient and better quality care by reducing care variation.
Identify potentially avoidable complications.
Differentiate between typical, complication and unrelated services to discover ways to reduce complications.
Create physician accountability for patient care.
Attribute individual episodes to multiple, accountable providers and measure adherence to protocols.
Understand accurate costs of episodes.
Quantify variation in utilization, cost, efficiency and quality, and calculate actual vs. patient-severity and risk-adjusted costs.
Compare performance across providers on similar episode types.
Adapt your analysis to how your organization treats different episodes, and even experiment with different attribution models.
- Automatic episode definition. Examine episodes created by condition signals based on standard definitions from HCI3. Capture all services related to an episode to see the entirety of care across the episode.
- Potentially avoidable complications. See which services, procedures and medical events are relevant to a condition, as well as hierarchical relationships as typical or complication, and then allocate claim dollars to the most appropriate episodes.
- Clinical associations between episodes. Find potential clinical interactions of various episodes, and identify if a connection is a typical or complication relationship to understand the true clinical status of a patient.
- Patient-severity/risk-adjusted cost comparisons. Obtain expected, total costs of episodes of care and adjust them to account for heterogeneity and condition risk propensity in patient populations.
- Accurate calculation of true episode costs. Understand how all claim codes are relevant to a specific episode. If related to more than one episode, SAS splits the claim across relevant episodes.
- Provider attribution to measure cost and quality. Attribute a conducting provider, facility or other entity to a specific episode, and assign episodes to understand if cost and quality measures are being met.
SAS Episode Analytics helps us and our provider partners recognize and prevent avoidable complications, reduce variations in cost and quality, and ensure accountability for patient care.